Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Pumps, Pens, and New Insulins

Video Transcription

Video Summary

Professor Earl Hirsch (University of Washington) gives a rapid overview of modern insulin therapy, focusing on pumps, smart pens, and newer insulins. He defines basal insulin (background hepatic control), bolus/prandial insulin (meal coverage), correction dosing, insulin-to-carb ratios, sensitivity factors, and the puzzling but practical concept of “active insulin time” used to tune pump algorithms.<br /><br />He traces pump evolution from open-loop therapy to low-glucose suspend, predictive suspend, and today’s automated insulin delivery (AID), which adjusts basal insulin and sometimes delivers micro-boluses based on CGM data. AID is needed because insulin absorption and requirements vary widely due to infusion-set aging, depot surface area, insulin hexamer breakdown, and meal composition (protein significantly raises glucose and may require 20–30% more insulin).<br /><br />Hirsch emphasizes that AID systems differ “under the hood,” advising clinicians to learn one system well and use resources like pantherprogram.org. He highlights smart insulin pens that Bluetooth dose data to apps, improve bolus calculations, and help clinicians detect issues like over-basalization (e.g., using a “BEAM” bedtime-minus-morning glucose metric).<br /><br />He reviews inhaled Technosphere insulin (Afrezza): ultra-fast but requires high engagement and often repeat dosing, especially with high-protein meals. Finally, he discusses emerging once-weekly basal insulins (e.g., insulin icodec for type 2), noting benefits but hypoglycemia concerns in type 1. AID is now standard of care for type 1 diabetes, with growing promise for insulin-deficient type 2.

Asset Subtitle

Irl Hirsch

Meta Tag

Module DKD

Speaker Irl Hirsch

Keywords

modern insulin therapy

automated insulin delivery (AID)

insulin pumps and CGM integration

basal-bolus insulin dosing

smart insulin pens and dose tracking

Afrezza inhaled Technosphere insulin

once-weekly basal insulin (insulin icodec)