SPECIAL INSULIN SYRINGES
INSULIN PEN
This pen like device is loaded with insulin filled cartridge. The injection is virtually painless due to very fine silicone coated needle. The dose of insulin can be measured accurately with the help of the dial. Many models of 'pen', disposable or otherwise are available. For adults, a pen dispensing insulin in U-l steps, is suitable. Children should use a pen dispensing insulin in U- 0.5 steps. In order to push out air bubbles from the insulin reservoir, the pen should be tested by holding it upward vertically and expelling 2 Units. Before injecting insulin suspensions, like isophane, lente, the pen should be tipped 15-20 times, to ensure uniform insulin suspensions. The needles should be changed, as with a syringe.
Compact, battery operated 'pen' device, with a display of dose of insulin and time since last injection, timer display to ensure complete insulin delivery and facility to view residual insulin have been introduced. Only one type of insulin can be injected with this pen, at a time.
SPECIAL INSULIN SYRINGES
Special syringes like 'palmar gun', hypoguard semiautomatic injector, jet injector, pen pump infusor, button infusor, pre-set syringe, click and count syringe, syringe with a magnifier are available abroad.
JET INJECTOR
With this expensive gadget, a spray of insulin droplets is driven through the skin with great force. Although an actual needle prick is avoided, some bruising and discomfort at the site of injection occur. Besides, the absorption of insulin is erratic. The use of jet injector, therefore, is not recommended.
Continuous subcutaneous insulin infusion (CSII)
Normally, there is a continuous insulin production at a basal level with an increase in its production after meals. Even multiple daily insulin injections cannot imitate this normal pattern of insulin production. An external insulin pump consists of an electronically operated syringe, connected to a needle by means of a fine tubing. The needle is inserted under the skin and the pump is worn on the belt. The site of injection is changed once in 48 hours. Rapid-acting insulin is delivered continuously at a low steady level. The rate of insulin delivery is increased during meals. The person monitors his/her blood glucose level daily and adjusts the rate of insulin delivery accordingly. He/she should possess two batteries with an additional spare one.
CSII is indicated in persons with type 1 diabetes, when good control of diabetes is essential e.g. pregnancy, children; but cannot be achieved with multiple daily insulin injections, education, about diabetes etc. It is also now being used in selected persons with type 2 diabetes. CSII does not disturb life-style of the patient.
Self blood glucose monitoring and close contact with a hospital or diabetic clinic are essential. The person should be intelligent, highly motivated and psychologically stable. The initial expense of the pump and the cost of home blood glucose monitoring should be taken into account. The pump does not eliminate other aspects of the care of diabetes.
Infection and small lumps at the sites of insertion of the needle, stoppage of the insulin delivery or too fast a delivery in spite of alarm systems may occur. Persons who get hypoglycaemia without warning should not use an insulin pump.
Many diabetics object to use of pump as it is a constant reminder to them and others of diabetes. At present, insulin pumps are used in very few centers in India, in selected cases.
Implantable Insulin pump
Insulin pumps, which are implanted in the body and which deliver insulin into a large vein or peritoneum (fine membrane which lines he abdominal cavity) have been introduced. Because of its expense and possibility of many complications, this type of insulin pump is less often used than CSII.