When it comes to insulin, a medication that diabetics can hardly bypass, the first reaction of many patients is: “Can I get it without injections?” “Is there oral insulin?” …… Such questions often discourage patients who should be using insulin to control their blood glucose, and indeed the use of insulin has plagued clinicians and patients for years. To clarify the question of whether there is insulin without needles, we must first clarify why the use of insulin must currently be by injection. Insulin, as the only hormone that can lower blood sugar in the body, is a protein in nature, just like the beef and eggs we usually eat, and is synthesized and secreted by the pancreatic beta cells in the body into the bloodstream to lower blood sugar. 30 amino acids, insulin to play a physiological role in lowering blood glucose premise is to ensure the integrity of these two peptide chains. As we know, protein-rich food like beef and eggs will be broken down and absorbed by various digestive enzymes in our digestive tract after entering the digestive tract, so will insulin. The peptide chain of insulin cannot be recombined in the blood to the original insulin peptide chain, so it loses its ability to lower blood sugar, so the simple oral administration of insulin is not effective. If we choose to apply insulin to the skin, it cannot enter the bloodstream through the skin because of its large molecular structure, so it cannot control blood sugar either. For these reasons, insulin can only be injected into the bloodstream to lower blood sugar. It has been nearly a hundred years since 1921 when Canadian scientist F.G. Banting formally discovered and used insulin, and scientists from various countries have been exploring ways to administer insulin to patients without using injections, and there have been some breakthroughs and progress so far. The first thing scientists thought of is that since insulin cannot be taken orally, can it be absorbed through the nasal cavity, oral mucosa or lungs? After human trials, it was found that such an inhalation drug delivery scheme could indeed realize the idea of non-injectable insulin into the bloodstream, but it was also observed in the trials that the lung function of patients who used such drug delivery decreased and there were some signs of fibrosis in the lungs, so this research direction came to a halt. Later on, scientists were inspired by the slow-release and entero-soluble form of many oral drugs and used an envelope that could resist the breakdown of digestive enzymes to make insulin capsules, so that insulin could be delivered smoothly into the small intestine and then released for rapid absorption into the blood by the intestine. At present, such a coating technology has been developed in Israel and started the human trial stage, from some preliminary research results, this technology can indeed replace part of the role played by injectable insulin, but there are still some issues such as the dose, how to simulate the basic long-acting insulin problems have not been solved, but it is foreseeable that in the near future there should be a corresponding insulin preparations marketed for clinical use. However, it is foreseeable that the corresponding insulin formulations will be available for clinical use in the near future. At the present stage, a more practical and simple non-needle insulin injection solution is that scientists have received inspiration from industrial cold-rolled steel technology, using high-pressure driven liquid flow into the rapid subcutaneous way to deliver insulin into the subcutaneous tissue gap, which on the one hand eliminates the needles that have been criticized and feared by patients, and on the other hand allows insulin to better diffuse among subcutaneous tissues, thus improving the absorption of insulin into the blood. efficiency. Since the needle is eliminated, it can help avoid secondary injuries caused by the needle, such as needle breakage, tissue damage, and infection; in addition, since the subcutaneous dispersion of insulin is more adequate, it can also reduce common clinical problems such as tissue clumping and large variability in absorption and utilization caused by insulin injection. Such an insulin dosing regimen is not a bad alternative to needle injected insulin when oral insulin is not yet available. Finally, let’s answer the question of the title of this article, that is, who said that insulin use must be injected? There are already some alternatives, and in the future there will be various insulin dosing options that will benefit the majority of diabetic patients.