What to Know About V-Go for Treating Type 2 Diabetes

V-Go is a prescription-only insulin delivery system for people with type 2 diabetes who require insulin in order to control their blood glucose (sugar).

Like a traditional insulin pump, V-Go is a convenient alternative to needles and syringes for injecting insulin multiple times throughout the day—with one big difference: Whereas traditional pumps consist of an insulin reservoir (a device about the size of a small cellphone) that connects to the body with tubing, the V-Go is a credit-card size patch that adheres to the skin.

This means V-Go doesn't require batteries, infusion sets, or programming by a healthcare provider. Designed to be used with fast-acting insulin, the patch can be worn on the stomach or the back of the arm, so it's easily hidden by clothing. After 24 hours, it is easily removed, discarded, and replaced with a new patch.

V-Go has been on the market since 2012. In research, V-Go was found to be as effective as multiple daily injections of insulin in controlling blood sugar and lowering the amount of total amount of insulin needed per day.

Your health insurance company may cover the cost of V-Go; be sure to check if you and your healthcare provider decide it's right for you. Note that according to studies of the efficacy of V-Go, the device was found to be less costly than multiple daily injections of insulin.

Who Can Use V-Go

The patch is appropriate for adults 21 years and older with type 2 diabetes. It is not prescribed for people with type 1 diabetes.

It should only be used by people who require 20, 30, or 40 units of basal insulin per day. Basal insulin is produced continuously by the pancreas to keep blood sugar levels steady throughout the day and night.

Dosage

V-Go comes in three versions: V-Go 20, V-Go 30, and V-Go 40. The numbers refer to the amount of basal insulin that each delivers continuously during the 24 hours the patch is worn:

• V-Go 20 delivers 20 units of insulin over 24 hours
• V-Go 30 delivers 30 units of insulin over 24 hours
• V-G0 40 delivers 40 units of insulin over 24 hours

All V-Go devices deliver bolus insulin when needed in increments of two units at a time, up to 36 units per 24-hour time period. Bolus insulin is insulin put out by the pancreas in response to eating.

Using V-Go

The patch is easy to learn to use. Your medical professional or healthcare provider can show you how, and the V-Go website has detailed instructions and videos detailing how to apply the patch, activate the flow of insulin, give yourself bolus injections, and store and dispose of the individual parts of the system.

Applying the Patch

To use V-Go, simply fill it with insulin and attach it to your body. This process should take only a few minutes once you've mastered it.

Here are the steps:

1. Fill V-Go with insulin. This is done using a special device called EZ Fill that comes with V-Go. It's a small plastic case the patch slides into and into which the vial of insulin is attached. It takes about 30 seconds to completely fill the reservoir of the patch.
2. Choose where to apply the patch. This can be anywhere you'd normally inject insulin, but the ideal sites are either on your stomach or on the back of your arm. Select a spot that is at least an inch away from where you previously applied a patch and make sure the skin there is healthy and clear of signs of irritation, infection, or excess hair. Think about your activity plans for the day: Don't place V-Go anywhere the device might interfere with your clothing or a seatbelt, or be dislodged by rigorous physical activity.
3. Prep your skin. Swab the area with alcohol and allow it to dry.
4. Apply the patch. This is simply a matter of peeling away an adhesive liner (as you would a bandage) and pressing the device onto your skin.
5. Inject the needle. V-Go contains a pre-loaded needle. To inject it, you'll press a button on the patch. Your basal insulin will begin to flow freely into your body as soon as the needle is inserted.

Activating Pre-Meal Insulin

A button on the patch will administer the bolus insulin you need before meals to cover the spike in glucose that occurs when food is eaten. You can press it discreetly through your clothing.

Bolus insulin is released in two-unit doses. V-Go will not allow you to click the bolus delivery button more than 18 times in a 24-hour period. Follow your healthcare provider's directions for when to inject bolus insulin.

While Wearing the Patch

V-Go is designed to be worn day and night under nearly any condition. You can shower and even swim with it on, although after it's exposed to water or you go into water that's 3 feet, 3 inches deep or more, check that the patch is still securely in place.

There are a couple of specific situations in which you'll need to remove the patch:

1. During imaging tests, including X-rays, magnetic resonance imaging (MRI), and computerized tomography (CT) scans
2. While in a jetted tub, hot tub, or sauna: Before entering any of these, remove the V-Go you're wearing and replace it with a new V-Go afterward.

V-Go should not be exposed to direct sunlight; dress to cover it when you're out on a sunny day.

Removing V-Go

Before taking off the patch, you will need to retract the needle from your skin—again, a simple matter of pressing a button.

Once the needle is out, you can safely and painlessly peel off the patch. It might leave a sticky residue behind on your skin that you can remove with warm soapy water and your fingertip.

Note that the EZ Fill should not be used for more than 30 fills. It, too, will need to be disposed of according to local regulations, with the last insulin vial used attached.

You'll get a new EZ Fill every 30 days with your prescription.

Storage

Every time you fill a new patch, leave the insulin vial attached to the EZ Fill and place it in a clean, dry area of the refrigerator. Find a dry place to store your unused V-Go patches that's out of reach of children and pets.

Side Effects

There are two potential adverse reactions from using V-Go.

• Skin irritation: This may be caused by either the adhesive or the positioning of the patch on your skin. It may be uncomfortable, but is not a serious complication. Tell your healthcare provider the patch is bothering your skin; you may be able to use a product that will create a barrier between your skin and the patch.
• Infection or abscess: If the area around where a V-Go you're wearing becomes red, swollen, or sore, you could have an infeciton. Remove the device and apply a new patch to a site that's away from the affected one. Do not stop your insulin; call your healthcare provider for guidance.

Warnings

As with any supplemental insulin, there is a risk of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) associated with using V-Go.

As such, the manufacturer notes the product is not appropriate for patients who must make regular adjustments or modifications to their basal rate during a 24-hour period, or whose insulin at mealtimes requires adjustments of less than 2-unit increments.

The rate at which V-Go delivers insulin can vary by up to plus or minus 10% from device to device, according to the manufacturer. This happens rarely, but it's advisable to monitor your blood sugar at least three times a day (or as often as your healthcare provider tells you to), as well as before you drive or operate heavy machinery. A drop in glucose levels can interfere with alertness.

Hyperglycemia can progress to a potentially fatal condition called diabetic ketoacidosis (DKA), in which the blood becomes acidic and damage to cells can occur. Again, this is very unlikely to happen, but it's important to stay well hydrated and to know the signs of hyperglycemia so you can call your healthcare provider if you think you may being developing it.