3 Thoughts About The V-Go Insulin Delivery Device

 

I had a chance this week to spend some hands-on time learning about the new V-Go insulin delivery device from Valeritas.  Valeritas’ website states that “The V-Go is engineered to simplify basalbolus insulin therapy for the millions of people suffering from Type 2 diabetes.”

      

The facts:

– This is the first disposable insulin-delivery device that will give basal-bolus insulin.

– It is mechanical, containing no electronics.

– It is designed to be worn for 24 hours before it needs to be refilled with insulin.

– The needle is a 30 gauge needle that stays in the user while the V-Go is in use.

– The V-Go comes in 3 “sizes”: one that delivers 20 units of basal insulin over 24 hours, one that delivers 30 units, and one that delivers 40 units.  Each device is also capable of giving bolus insulin in 2 unit increments up to 36 total units of bolus insulin per 24 hour period.

 

Three thoughts about the V-Go:

1) Convenient: This device appears well-built and relatively easy to use.  It is about the size of an Omnipod, and because it is placed on the user for 24 hours straight, allows her to leave insulin at home when going out for the day.  The device needs to be refilled every 24 hours with rapid-acting insulin.  So, the user need only take fingerstick/testing supplies out with her when going to work, running errands, or going out to meals.  It is also somewhat elegant that there are no electronics in the device.

2) Not enough insulin: Though this device promises convenience, unfortunately, the amount of insulin that can be delivered is too little for many type 2 diabetes patients.  The most that can be delivered is 40 units of basal insulin and 12 units of bolus insulin per meal (totaling 36 units of bolus insulin a day).  In my eyes, this is a “type 1 diabetes amount of insulin” in a device intended for people with type 2 diabetes.  The company believes that by improving adherence to insulin regimens and by dosing around the clock with rapid-acting insulin, people will need less insulin than they currently take.  This may be true, but I am still skeptical that this device will deliver enough insulin to meet the needs of many of my patients.

3) Inability to titrate: The device comes in 3 sizes, each delivering a set basal amount of insulin over 24 hours.  These are either 20, 30, or 40 units.  While this may be useful for a patient who has already been on a steady dose of basal insulin, it does not give much flexibility to titrate doses.  Once a patient has paid her co-pay at the pharmacy and picked up a month’s supply, she would have to pay again to switch to a different basal rate.

I think this device represents an interesting start towards a market that will likely increase rapidly in the next few years of devices intended to deliver insulin to people with type 2 diabetes.  Given the above limitations, I think it’s overall usefulness will prove limited, but I look forward to seeing what future iterations and generations of devices will look like.

What do you think?  Would you want to try this (either patients with type 2 diabetes or providers caring for patients with type 2 diabetes)?

 

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About Aaron Neinstein, MD
I'm an Assistant Professor in Endocrinology and Director of Clinical Informatics at the University of California, San Francisco.

20 Responses to 3 Thoughts About The V-Go Insulin Delivery Device

  1. Kathy says:

    The V-Go is very convenient and I thought I had found the greatest thing ever. Freedom at last!! Then my sugar went into the 600’s even after giving more units from the V-GO. Had to stop after less than a week. Back to 4 shots a day. Hope they find someway to increase the dosage.

    Like

    • Harry Hummel says:

      I have been using the V-Go 40 for the past 5 months and am very happy with the results. I am using less Insulin and getting much lower Glucose readings than through injections. My Endocrinologist is very happy with my results.

      Like

  2. john patrick says:

    Hi, entering 2nd month and I like the unit but my numbers are higher. Seeing my sugar MD next
    week. I am 65 and life long diabetic .I am willing to try almost anything to help us all and even if helps next generation.
    Be Well
    John Patrick

    Like

  3. Barbara says:

    As a medical transcriber, I have recently been typing dictation about patients being given V-Go. I am intrigued by it as I currently have an insulin pump for my type 2 diabetes; however, I am a bit skeptical about having enough insulin to last for the 24 hour period. Knowing that 36 units is the maximum for bolus insulin, I very well may pay better attention to what I eat and how much care I take in making food choices, thereby decreasing the amount of bolus insulin I need each day. There is a lot to think about with regard to this latest therapeutic option and I look forward to seeing how things develop in the future.

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  4. Crystal says:

    I have been using V-Go for 4 months. I like the results; however, I am having reactions where the needle is underneath the skin for 24 hours. 😦

    Like

  5. Charles Paul says:

    I am a 32-year veteran of Type 1 diabetes. I just started the V-Go this five days ago so maybe I don’t have enough time in to precisely know what may be coming. I was injecting Lantus twice per day (26u A.M., and up to 20u P.M. – depending on exercise/activity). Novolog came in a 1u per 15 grams of carbohydrates which seems to be the correct ratio for me. My latest A1C was 6.8….which is misleading. My endocrinologist and I discussed this number and how good it appears, but it was just the average of some highs and some very low glucose readings. For example, if I would run or workout the night before…then the following morning my glucose would be in the 40-50 range. I wouldn’t even have taken any Lantus the previous night, and would have eaten something and still the super low glucose.

    So far, I like that the mornings have all been 70-110. I have had only one reading in four days above 200 and all of the rest have been in the 90-140 range. When I workout, run, play tennis, etc. I now have to make sure that I am testing my glucose immediately after – and even during if I can. I am still getting adjusted to the sleeping with this on but it really has not been noticeable whatsoever during the day.

    The 36 additonal units of bolus for me means that I need to keep my daily intake of grams of carbs below 540 (36units X 15 g/C = 540). No problems….I theoretically could have 20 Snickers candy bars and be right at the 540 g/C. In summary, so far I have reduced the amount of basal by 16u per day which represents a 30% reduction in medication (basal). The bolus actually is less as well but somewhat undefined, due to the better and steady flow of basal from the V-Go when compared to my former way of insulin distribution (basal twice-daily injections).

    I am excited for the freedom, and also more aware of what I am doing. Keep in mind that my A1C is a good number but I am working on having that be a more consistent reading with greater health and control to boot!

    Like

  6. Kelli Caraway says:

    I found out two years ago that I am an “Adult onset Type 1” Diabetic. My kind is few and far between. One day my pancreas was working and the next day it had completely shut down for no apparent reason. I was taking 40 units of Lantus before bedtime and taking Humolog before meals at a rate of 1unit per 15 grams of carbs. On average i was taking under 20 units per day.
    A few days ago my endo started me on V-Go 40. I had 3 lows during the night. The next morning she had me come in and exchanged for the V-Go 30. It seems to be my lifesaver so far. Two mornings in a row I have had a fasting level of under 90. Everytime I test my levels are under 100. I haven’t done this well since finding out I am diabetic. I give it an A+ !!!

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  7. Andrew says:

    I am a 20-year Type 1 who is very insulin resistant. In the past, insulin drips have always seemed to work better than the 6-8 shots a day. I have been using levemir at 22u every 12 hours and 4-6, 30-40u of novolog throughout the day. I have never liked the pump due to the amunt of maintenance/calibration they require, I never really saw a benefit. I like this V-Go and once I dial in on the settings, I think it may be an improvement over having to take/remember so many shots. I am only on day 2, so I am still questioning whether or not this really improves anything, treatment wise at least.

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  8. Don says:

    I’ve been using the V-GO for 6 months and blood sugar levels have increased a little during that time. More troubling to me, however, is the irritation caused by the adhesive. Does anyone have a recommendation?

    Like

  9. Mark Green says:

    I am on vego 30 right now. I have a hard time getting my #’s low enough. I have been thinking of trying to find a pump that’s a little more flexible and not to mention less expensive. ( $1500.00 for
    A three month supply, which is my part to pay.)

    Like

  10. Natasha says:

    I don’t understand why the V-Go would be better than an insulin pump for instance an Omnipod. There seems to be so much more flexability in dosage with a pump—is it just that a pump is More expensive?

    Like

  11. Robert Smith says:

    I am only on my 5th day with the V GO and my readings are between 100 and 150, but no matter how good they get, I would have to sell the house and car to be able to afford the system ( 500.00 for 2 vials of nova log and 400.00 for the delivery system) WHO can afford that except a millionaire, which I am not. I am like the rest of the people commenting, I need help with the price!!

    Like

  12. Greg says:

    This is an expensive system because it doesn’t include your insulin. If you use pens, they come pre-filled with insulin. If you use vials, the syringes are usually very cheap. Very misleading. Watch out.

    Like

    • Yes and no to the costs. I used 2 types of insulin and syringes. With amounts I needed daily, it was around $250 a month with copay. With copay now it is around $195 a month. I also have a copay card from Valeritas that brings my cost down to $145 a month. It really depends on your situation. If I didn’t have any sort of prescription coverage, then it would be way too expensive for me.

      Like

  13. Daniel Leatherman says:

    I’m on month two and I love it. I have finally leveled out. I like not having to remember my insulin pen or having to dodge into a restroom to do an injection.

    Like

  14. Sandi Hall says:

    I have been using VGO-40 for 3 years now and my levels have stayed in range. I’m type II and I take 10 units of Levemir at bedtime. I also take 5 mg of Glipizide at breakfast and at dinner. I have an Accu-chec Expert glucometer so I can key in my carbs for each meal and determine the correct amount of Humalog to click out of my VGO. I lead a very busy lifestyle and the VGO device is a very convenient alternative for me. I used to miss injections because it wasn’t convenient for me to leave and inject. I sit in the innermost wall of a booth at a restaurant so I can take my glucose reading in private and away from other diner’s eyes. The VGO allows me to stay in the booth and click the amount of Humalog I need for the meal. I like it because it has allowed me to stay on target with my insulin; it’s convenient; and it has allowed me to bring my high ranges over 200 down between 90 and 130. Of course, counting carbs has helped, too. [I get little exercise (I’m 70 years old) and I volunteer at my church a great deal. I try to walk a little each day, but my real “walk” comes in when I grocery shop once a week. I spend about 3 hours at the store on my feet, reading labels, and walking the aisles. I have to lift the bags from the cart to my car and from my car into my house which involves a lot of back and forth walking.]

    I will fight to keep my VGO! My insurance doesn’t include it in their formulary, and my health care professional has to ask permission of my supplemental Anthem BC/BS Insurance to allow the VGO for a limited year’s time every year. I’m in the donut-hole right now and my co-pay is very expensive; however, when I reach the catastrophic level of my insurance it comes down to $13 for the kit and $38 for the Humalog. I’m usually in the donut-hole for 4 to 5 months. In the donut-hole, I pay $288 for a 90-day supply of Levemir. At my age I can be quite forgetful and using injections at meal time doesn’t work for me. The VGO is always there. I don’t have to leave for the restroom to take a shot. I don’t know if Medicare would help with VGO payments. I need to look into that.

    I recently learned that my endocrinologist’s office is no longer prescribing VGO. They continue to support me with my ongoing prescription. They wouldn’t tell me why they no longer promote it. As I said, I will fight to keep my VGO. It works for me.

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  15. Joe Delmonte says:

    I have been using the vgo 30 since january 2013, for the last year and a half my A1C has been 5.9 to 6.1. My last batch of 90 day pods have had serious issues – the stop working and leak from the bolus button midway threw use . I have contacted company directly and asked for replacements – My 1st months box were defective and my second month worked perfectly and now my 3rd month having same issue- I called the customers service for the 1st box they “just thanked me ” they did not want the defective pumps to research , now the same issue again and they are now going to just send 6 units I wanted to exchange the box for a new one – they said they could not do that…. WOW after 3 years of use they instructed me to contact my doctor – pushing it back to me that i cannot control my high sugars. i just left my Endo’s office last friday and my A1C was 6.1

    For a relatively new product and company – not very supportive and not accountable for a bad batch of production

    Joe Delmonte

    Like

    • Hope Wilkinson says:

      Joe, I was just told about V-Go last week by my D.O. He tries to stay up on new resources for his type 2 diabetic patients. I am actually a type 1 (for 45 years), but he thought that because I am severely visually impaired that the V-Go might work for me when a pump did not because I could not see the device to enter information into it. I was also tried on the Omnipod back in 2008. I had the same issue with it that you are having now – defective units that the company did not want to replace. After reading your experience I am now not so eager to try V-Go because I certainly cannot afford for my BG to go higher.

      Like

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