Resource Guide 2004FOR TYPE 1/TYPE 2 Insulin DeliverySyringes…pumps…jet injectors…pens…infusers…they all do the same basic thing—deliver insulin. These items carry insulin through the outermost layer of skin and into fatty tissue so it can be used by the body. This section will also cover injection aids, products designed to make injecting easier. SyringesToday's syringes are smaller and have finer points and special coatings that work to make injecting as easy and painless as possible. When insulin injections are done properly, most people discover they are relatively painless. Check with your doctor or diabetes educator and test several brands before you buy. Your equipment should suit your needs. Questions to ask:
Cost is another factor because many stores use insulin syringes as key sale items. Shop around for a good price, but ask yourself: Is giving up a good local pharmacist to save $2 at an out-of-the-way store worth the money? You may be interested in reusing your syringes. Most manufacturers do not recommend this, and there may be some increased risk to patients (i.e., needle dullness causing discomfort, possible infection, or tissue damage). While this practice remains controversial, many patients reuse syringes without any problems. Once again, your health care team can advise you on the practice. (Pen needles, however, should always be removed immediately after use; when left in place, they create an open passage to the insulin chamber. The open passage may allow bacteria into the chamber or fluid to leak out, which may alter the strength of the insulin.) And please, always follow appropriate guidelines when disposing of your syringes and lancets. Some states have very specific laws governing disposal of such items, while others lack guidelines. Even if no guidelines exist, you should be considerate of those who could possibly come in contact with used syringes and lancets. Used syringes and lancets can be safely placed in a puncture-proof container that can be sealed shut before it is placed in the trash. (Label the container "USED SHARPS" with a heavy magic marker.)
PumpsThe insulin pump is not an artificial pancreas (because you still have to monitor your blood glucose level), but pumps can help some people achieve better control, and many people prefer this continuous system of insulin delivery over injections. Insulin pumps are computerized devices, about the size of a call-beeper, that you can wear on your belt or in your pocket. They deliver a steady, measured dose of insulin (the "basal" dose) through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the fatty tissue and is taped in place. In the newer products, the needle is removed and only a soft catheter remains in place. If you use Humalog or Novalog, which are rapid-acting insulins, your pump can release, on command, a bolus (surge) dose close to mealtime to blunt the rise in blood glucose after a meal. If you use regular insulin, you would usually take the bolus dose about 30 minutes before you eat. Because the pump also releases incredibly small doses of insulin continuously, this delivery system most closely mimics the body's normal release of insulin. Also, pumps deliver very precise insulin doses for different times of day, which in many instances are necessary to correct for situations like the dawn phenomenon, the rise of blood glucose that occurs in the hours before and after waking. Many people have chosen the insulin pump because it enables them to enjoy a more flexible lifestyle. To use a pump, however, you must be willing to check your blood glucose frequently and learn how to make adjustments in insulin, food, and physical activity in response to those test results. (These things should be done with insulin injections as well.) You'll want to check with your insurance carrier before you buy a pump and all the supplies. Although most carriers do cover these items, some do not. (Please note: Medicare recently began covering pumps and supplies for people with diabetes [both type 1 and type 2] who meet its eligibility requirements, including those regarding fasting C-peptide levels.) If you are interested in using a pump, talk to your health care team.
Injection Aids And AlternativesThis category includes devices that make giving injections easier as well as syringe alternatives. Talk with your doctor or diabetes educator about these kinds of products. Oftentimes, they will make sample products available to you before you make a purchase. You'll want to look for an item that is easy for you to use and is durable. Some items require more skill and dexterity on the part of the user than others, so try several before you buy. Make sure that the injection aid you purchase works with your brand of syringe and needle length. Some injection aids have adapters for short needles. Insertion aids. These devices accelerate needle insertion into the skin. Some even aid in pushing down the plunger. Most are spring-loaded and hide the needle from view. Syringe alternatives. At present, this category includes insulin pens, infusers, and jet injectors. Carrying around an insulin pen is like having an old-fashioned cartridge pen in your pocket—only instead of a writing point, there's a needle, and instead of an ink cartridge, there's an insulin cartridge. (See note above on removing pen needles after use.) There are even disposable insulin pens now available. The devices are convenient, accurate, and often used by people on a multidose regimen. Insulin cartridges may come in limited total capacities of regular, NPH, insulin lispro, or 70/30 or 75/25 premixed insulin. They are particularly useful for people whose coordination or vision is impaired, or for people who are on-the-go. If you are using a pen with NPH, 70/30, or 75/25, it is important to tip the pens back and forth at least 10 times to ensure the insulin is well mixed. Infusers create "portals" into which you inject insulin. With an infuser, a needle or catheter is inserted into subcutaneous tissues and remains taped in place, usually on the abdomen, for 48-72 hours. The insulin is injected into it, rather than directly through the skin into the fatty tissue. Some people are prone to infections with this type of product, so be sure to discuss the necessary cleaning procedures with your health care team. Jet injectors release a tiny jet stream of insulin, which is forced through the skin with pressure, not a puncture. These devices have no needles. However, they can sometimes cause bruising. You will need to work with your health care team to ensure good blood glucose control while you adjust to one of these devices. You'll want to ask manufacturers about training on the use of a jet injector, as well as how to clean it and how to troubleshoot. If jet injectors interest you, discuss their use with your health care team. Before buying, check to be sure your insurance covers jet injectors.
Aids For People With Visual ImpairmentsThere are several products designed to make injections easier for people who are visually impaired. Some products handle more than one task. Non-visual insulin measurement. Helps you measure an accurate dose of insulin. Some "click" at each 1- or 2-unit increment of insulin. Needle guides and vial stabilizers. Help you insert the needle into the correct insulin vial for drawing up an injection. Syringe magnifiers. Enlarge the measure marks on a syringe barrel. It's important to note that some of these aids fit only with specific brands of syringes, so check to be sure the product you want works with your syringe. Information about blood glucose monitoring aids for people who are visually impaired is found on the Aids for Visually or Physically Impaired People chart** (in PDF format; link will open a new window). **Please Note: Due to the size and layout of these charts, they have been saved in PDF format for easier on-line viewing. These documents require the Adobe® Reader® in order to be viewed. If you do not have this application already on your computer, you can download it for free from Adobe's Web site. ---------- Disetronic Pumps No Longer For SaleIn July 2003 Disetronic discontinued the sale of all Disetronic insulin pumps in the United States and Canada after Food and Drug Administration (FDA) inspectors found that Disetronic's manufacturing processes in Switzerland, where the pumps are made, did not comply with FDA regulations. Disetronic was acquired by Roche Diagnostics in May. Disetronic manufactures D-Tronplus, H-Tron, and H-Tronplus insulin pumps. Earlier this year, Disetronic recalled its D-Tron pumps and replaced them with D-Tronplus pumps after electronic malfunctions in some D-Tron pumps resulted in unintended boluses (extra releases of insulin). Several problems were reported with current Disetronic pumps. These issues were outlined in letters Disetronic sent to customers in July. Problems with the D-Tronplus include stuck piston rods, punctured buttons, and holes in the keypad. Stuck piston rods can result in underdelivery of insulin, which can cause high blood glucose. Punctured buttons and holes in the keypad can allow water into the pump, which can affect how much insulin the pump will deliver. Punctured buttons and holes in the D-Tronplus keypad can occur if you use a sharp object or your fingernails when programming your pump. The manufacturer recommends that you only use the pads of your fingertips to program your pump. Problems reported with the H-Tron and H-Tronplus models include water entering the pumps, cracks in the pumps' casing, and short-lived batteries, all of which can affect how the pumps deliver insulin. Water entering the H-Tron or H-Tronplus could cause the pump to deliver unintended boluses or to shut down entirely. Disetronic is not recalling these pumps from customers who already have them. Rather, the company is not selling new pumps in the United States and Canada. According to Vickie Ebertz, spokesperson for Disetronic, the company is working with the FDA to try to bring its manufacturing processes into compliance with the regulations. It's possible that Disetronic will resume selling new pumps in the United States and Canada in the future, according to Ebertz. In the meantime, if you are currently using a Disetronic pump, it will be up to you and your doctor to decide whether you should continue doing so. If you decide to keep using your pump, you will still be able to buy supplies for it, and Disetronic will continue to offer technical support. If you decide not to continue using your pump, you can call Disetronic at 1-800-281-1986 to discuss your options. For more information, visit www.disetronic-usa.com. There you'll find letters that were sent to Disetronic customers in July, instructions on what to do if your pump malfunctions, and a list of frequently asked questions. |
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