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Overview |
Insulin
Insulin
Syringes
For now, insulin is injected
subcutaneous (under the skin) to be effective. Injection with a needle and
syringe—which, for years, was the only available option—remains the
predominant choice for most insulin-treated patients in the United States
today. Fortunately, the devices currently available—disposable,
lightweight syringes, with shorter, ultra fine needles—have made daily
injections more convenient and less painful than ever before. With proper
training and practice, most people with diabetes become extremely proficient
at self-injection. One advantage of syringes is the wide variety of sizes
and styles. When deciding what is most appropriate for diabetics needs,
consider the syringe capacity, ease of use, and readability. Syringes may
also be best for those who must mix different types of insulin into one
dose; pen injectors offer less flexibility. Syringes and insulin vials are
bulkier than insulin pens, and may not be convenient for people with active
lives. In addition, manipulating syringes and vials may be too difficult for
people with limited manual dexterity—for example, those with arthritis or
tremors.
Insulin Pens
Insulin pen injectors combine
an insulin container and syringe into one compact device. Two types are
available: reusable and prefilled. With reusable pens, patients load a
cartridge of insulin into the pen, attach a needle, and "dial in"
the dose before pressing a plunger to administer the injection. The
prefilled pens are easier to use—they contain a built-in insulin
cartridge, and are discarded after the insulin is gone—but they may be
more costly than reusable pens. Insulin pens are more convenient and
portable than syringes and bottles of insulin. In addition, patients are
often more accurate at measuring doses with pens than with syringes. Some
patients find using insulin pens more comfortable than using syringes;
because the pen needle does not have to penetrate a rubber stopper first, it
is sharper and the injection may be less painful. However, the pen needle
must be left in the skin slightly longer than with a syringe injection. Pens
may be easier to use than syringes for people with poor physical
coordination. Some pens have large-print numbers and audible clicks to
measure the dose as it is dialed in, which may benefit those with impaired
vision. Pens may not be the best choice for people who must take very large
insulin doses. A major drawback to most pens is that they do not permit you
to mix different types of insulin; thus, two injections are needed. One new
model, however, allows patients to fill the pen from a standard insulin
vial, and thus to personalize mixtures of insulin.
Pens are somewhat more expensive than syringes.
Jet
Injectors
Jet injectors use a
high-pressure jet of air to send a fine stream of insulin through the skin.
While the elimination of needle sticks may sound appealing, these devices
have had only limited use so far. Jet injectors deliver accurate doses that
are more rapidly absorbed than subcutaneous injections. They may be of
particular benefit for patients who have an extreme fear of needles. These
devices are bulkier than syringes, however, and also require the user to
carry vials of insulin. They must be cleaned every two to three weeks
(though newer models have disposable nozzles). Some people find jet
injectors no less painful than needles. They may still cause pain and
bruising at the injection site, and can damage the skin if not used
properly. Jet injectors are expensive.
External
Insulin Pumps
Recent technological advances
have lead to smaller, easier to use, and more comfortable external insulin
pumps—making them an ideal option for carefully selected patients. About
the size of a pager, these computerized devices are usually worn discreetly
on a belt or placed in a pocket. Insulin passes from a reservoir within the
pump, through a thin, flexible tube, to a fine needle inserted beneath the
skin and taped in place. Also known as continuous subcutaneous insulin
infusion, this method delivers a constant, measured amount of insulin
throughout the day; in addition, patients simply press a button on the pump
to release a supplemental dose before each meal. Patients adjust the size
and timing of these bolus doses. The
basal rate of insulin can be adjusted. The pump also makes it easier to
adjust mealtime bolus doses. Often, therefore, better blood glucose control
may be achieved than with standard self-injections. In addition, the pump
offers greater convenience and a more flexible meal schedule, which may
particularly benefit people who are very active or who travel frequently.
Most people find the pump quite comfortable, even during vigorous activity.
The pump unit is waterproof, or has a waterproof pouch, and so can be worn
during bathing. It can also be removed for brief periods, like during
exercise or for special occasions. However, pump therapy is only appropriate
for people who are highly committed and responsible. Since the pump uses
only rapid-acting insulin, any sort of malfunction such as a detached
needle, blocked tubing, or battery failure—causes a rapid drop in blood
insulin levels; dangerously high blood glucose levels can develop within
hours. For this reason, patients must frequently monitor blood glucose
levels throughout the day, and diligently keep their pump in working order.
This includes making sure the basal rate is set correctly, checking the
tubing for blocks or kinks, keeping the insulin reservoir full, and changing
the infusion needle every two to three days to prevent infection. Moreover,
Pump therapy is expensive.
Insulin
Patch
Development of the patch, or U-Strip, began in February 2000, and the group
will soon be sending its data to the Federal Drug Administration to gain
permission to begin human clinical testing. The patch is about to begin its
second round of animal testing, and hopes to be able to begin human clinical
trials of the product by the end of the year. U-Strip works somewhat like a
nicotine patch and is one of the first non-invasive insulin treatment
devices ever. The patch is placed on the arm and activated by an ultrasound
device. "Ultrasound waves cushion the drug through your hair
follicles," Redding said. "Usually the molecule size is too large
to allow [insulin] to pass through, but with our technology it can."
Unlike other non-invasive procedures currently under experimentation, the
patch would not cause damage to the area of the body it is applied to.
"We have already done tests for rashes," he said, "and there
has been no discoloration, no burning, no itching, no reaction. The
ultrasound device used to transport the insulin from the patch into the
pores is low in voltage -- only one-fifth the power of a sonic toothbrush.
"This is generally not enough power to cause damage to skin
tissue," he said. "We have done tests on animals and human skin
samples, but some things you never can tell."
Glucose
Monitor - GlucoWatch Biographer
The GlucoWatch could be the
next step towards an artificial pancreas, releasing both type 1 and type 2
diabetes patients from a lifetime of monitoring blood sugar levels,
adjusting insulin and other medications, and freeing up diabetes patients
from worries about hypoglycemia. Cygnus'
GlucoWatch enables people with diabetes and their physicians to identify
trends and track patterns in fluctuating glucose levels that would be
difficult to detect with current testing techniques alone. The GlucoWatch
Biographer is comprised of two components: a durable component known as the
Biographer, and a consumable component known as the Auto Sensor, which
measures glucose for up to 12 hours. The GlucoWatch Biographer differs from
other glucose measuring systems in several important ways.
Cygnus'
GlucoWatch Biographer: is non-invasive, collecting glucose through the skin,
not from blood, automatically measures and displays glucose levels, detects
trends and tracks patterns in glucose levels as opposed to a single,
discrete reading, alerts a patient when glucose levels are too high, too
low, or declining too rapidly, stores up to 4,000 glucose values in an
electronic diary that can be reviewed at the touch of a button. The
GlucoWatch Biographer is designed to be worn during the day or night for
glucose monitoring and is expected to mitigate the lack of frequent
monitoring due to the pain and disruption of repetitive finger sticking. The
Biographer uses proprietary algorithms and performs multiple data integrity
checks in order to effectively track trends and patterns in glucose levels.
The GlucoWatch Biographer has been designed to recognize fluctuating skin
conditions, such as perspiration, and will automatically exclude a reading
in order to preserve the integrity of the data.
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