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Image: InPen from Companion Medical

Picture an insulin pen that remembers how much insulin you’ve taken and exactly when you took it. A pen that shares data with your smartphone or watch, helps you calculate a meal bolus, keeps tabs on your insulin on board (IOB), can recommend the right amount of insulin to correct a high, and delivers accurate half-unit doses.

That’s not all: Imagine that the pen plays nice with your other diabetes gear, by sharing data. It has a sleek, modern design with mechanical action reminiscent of a fine Swiss watch. It can use different brands of insulin, so it’s no trouble if your health insurance plan changes its “preferred” brand.

We’re talking about the new generation of “smart” insulin pens (S-pens, for short).

The first Federal Drug Administration-approved S-pen came from Companion Medical in 2017, and has been though several major upgrades since. Meanwhile, both Novo Nordisk and Eli Lilly have their own new smart pens in the works.

Smart pens are the next big thing in insulin delivery, with Massachusetts College of Pharmacy and Health Sciences researcher Nikhil A. Sangave and his colleagues estimating the S-pen market will jump from $59 million seen in 2016 to $123 million in the next several years — with a sustained U.S. growth rate of over 25 percent per year.

You may be thinking: That all sounds great, but can an S-pen really solve any real-world diabetes issues for me? Here’s a list of 12 problem-solving fixes that a S-pen can offer.

Want the higher degree of diabetes control possible with a pump, but can’t stand the thought of being literally tethered to a medical device 24/7? I mean, seriously — sleep with the thing?

A S-pen leverages many of the same features and advantages of a traditional insulin pump, without the leash. It’s not connected to your body, but it’s connected to your diabetes world.

Just like a pump, an S-pen can assist in calculating meal and correction bolus doses, and protect you from insulin stacking thanks to pump-like “wizard” features that calculate doses for you. We’ll talk about specifics of those features in more detail shortly, but know that an S-pen can accomplish much of what a pump can, especially around meals, and you don’t have to sleep with it. Unless you want to.

Besides, who can afford an insulin pump? Even if it’s covered by insurance, you have to spend thousands. And for the pump supplies, you’ll pay a high percentage of the cost of durable medical equipment (DME) as defined by health insurance.

The only approved S-pen currently on the U.S. market, the InPen from Companion Medical, is so cheap that it boggles the mind. How do you like the sound of $35 per year for your diabetes gear?

According to Companion Founder Sean Saint, the InPen is currently covered by 81 percent of health insurance plans, many covering it with no copay whatsoever. But if you’re not covered, Companion Medical will provide you with their pen for $35. Such a deal!

Compare that price to pumps that can set people with diabetes (PWDs) back by $6,000 or more and you can see the savings. In fairness, of course, the InPen only lasts a year, whereas an insulin pump lasts for five. Still, at $35 a year for five years, you’re only paying $175. Another plus? Most PWDs are locked into their insulin pump warranty for 5 years. With an S-pen, you’ll have the latest tech every 12 months.

As to the supplies, the only consumables for an S-pen are the pen needles, which are covered as a pharmacy benefit on most health plans, meaning they’re cheaper and easier to purchase in local pharmacies than items in the more specialized DME category.

Compare that to all the stuff you need to use an insulin pump: infusion sets, cartridges, skin prep wipes, and, depending on the brand, a substantial number of batteries over the course of the year. Granted, you still have to pay for your insulin — but that’s true regardless of the delivery method you choose.

Lugging around a spare set of supplies and insulin is a hassle, and it generally involves carrying a lot more insulin than you’d ever need on a daily basis.

All you need to have with you to use an S-pen are some spare pen needles, rather than the miniature version of a diabetes closet that pumpers must carry. As for spare insulin when traveling, insulin pen cartridges are more readily portable than vials, with a form factor similar to a triple-A battery. They hold 300 units, a more appropriate volume for most trips compared to the 1,000-unit standard insulin vial.

I’m not good at math, so figuring out a meal bolus gives me a headache. Can you relate?

Like pumps, S-pens feature powerful bolus calculators. There’s no limit to what’s possible: You can set different insulin-to-carb ratios for different meals, and even fractional ratios. You’ll never need to try to figure out a bolus dose for a 39-carbohydrate-count meal with an I:C ratio of 14.78 in your head!

Did I mention that I’m not good at math? It’s bad enough to figure out a meal bolus, but now you want me to figure an additional correction dose? And add that to the meal?

S-Pen calculators have your back on this front, too, although for now, you need to manually enter your blood sugar, which is also true of some pumps. But there’s evidence that may change, with the S-pens of the future being able to automatically import your blood sugar from a continous glucose monitor (CGM) or Flash Glucose reader. For instance, Novo’s upcoming device will apparently link to both real-time CGMs and flash CGMs.

Like me, are you afraid to take a shot more often than every 4 to 5 hours because you’re worried about “stacking insulin” and the hypoglycemia it may cause?

With S-pens being… you know… smart, they know how much juice they’ve delivered and when, allowing for insulin on board (IOB) tracking. This means the Wizard adjusts subsequent doses based on the amount of insulin still in play in your body, greatly reducing the risk of insulin stacking. As a side benefit, recent research shows that people who take more frequent, smaller shots have better diabetes control than those who just do a few bigger injections per day.

Your doctor wants you to keep a record of all your doses, but who has time for that?

Easy and automatic data tracking really sets S-pens apart from traditional “dumb” pens or the original vial and syringe method of administering insulin. Compared to the traditional method of keeping paper records, electronic logging allows for easier review and more comprehensive understanding of your blood glucose data.

In fact, Erik T. Verhoef, president of Seagrove Partners, a data-driven research company that recently studied S-pens, thinks this could be the real power of these devices. He told DiabetesMine, “The biggest benefit of an S-pen is to replace the manual logbook or lack of data capture that is all too common with MDI (multiple daily injection) patients. This allows the clinician to better follow how the patient’s therapy is going.”

And Verhoef isn’t alone. Maggie Pfeiffer of Eli Lilly, which has a “connected insulin pen platform” in the works, tells us: “We believe the community has only scratched the surface of the potential value that can be unlocked as data from the devices are more widely leveraged.”

She points out that future systems could not only report on what we’re doing, but what we’re not doing. For example, the frequency of missed doses. While that sounds a bit creepy, it can help you and your doctor ferret out problems.

Granted, you can use a standalone app to accomplish all of this, but each and every dose would need to be logged manually into the app, something an S-pen does for you seamlessly, with no effort on your part.

I find I often forget to take my insulin at lunchtime, and then at other times during the day I’m not sure if I took my dose or not.

S-pens feature dose reminders, with no need for you to set an alarm in a third-party app or smartphone. They also allow you to simply look at either the pen or the app and see when and how large the last dose was. Try that with a throwaway pen!

How do I know if my insulin got too hot?

One real challenge for all insulin users is knowing when, or if, the insulin we’re using was exposed to excessive temperature, which would render it useless. The InPen, and surely other pens to follow, has a temperature monitoring system and will alert you if your insulin has been exposed to excessive heat. This feature is doubly important for pens, which are often carried in purses, backpacks, brief cases, or coat pockets.

Carrying spare batteries is a hassle. So is recharging.

The InPen (and likely the other pens coming soon) does not require charging, nor does it need battery changes. Rather, it comes out of the box with enough power to last for a full year.

We all know that insulin is expensive, and hate the idea of having to throw some out every three days, which is often the case when changing a pump site.

Here’s the deal: With a pump, the insulin is held in a plastic container, where it only remains viable for three days. S-pens, on the other hand, use glass cartridges, which allows the insulin to remain viable at room temp for around a month. (The exact number of days varies with the brand and formulation). For most PWDs, this means that you can use pretty much every drop and you only need to be sure to carry a spare pen fill with you when you are starting to run low.

My diabetes supply closet is overflowing. How about yours?

S-pens reduce storage space for D-supplies, because all you need to stock up on is the tiny pen needles.

So there you have it: The medtech industry, health insurance companies, and doctors alike are all in love with the idea of the S-pen. And it’s great to know that there are at least a dozen real-world, in-the-trenches ways that these pens can make our lives as patients easier — by solving existing problems.

That sounds pretty smart to us.


Wil Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, N.M., with his wife, son, and one too many cats.