| Survey
of Patient Preference for Insulin Jet Injectors Versus Needle and Syringe |
Denne, J.R.,
Andrews, K.L., Lees, D.V., & Mook, W. (1992) The Diabetes Educator
vol.18, 22~227.
Many studies
have tested the insulin absorption rate and mechanical reliability of jet
injectors. However, no published papers have dealt exclusively with patient
preference for this method of administering insulin over a period of years.
This paper reports the results of a survey done to determine if use of
a jet injector for delivering insulin has an effect on acceptance of and
adherence to a regimen of multiple doses of insulin. Over the past 15 years,
the authors have instructed approximately 70 patients to use various jet
injectors. A questionnaire was developed and sent to 75 patients. Of these,
42 completed and returned the questionnaire. Survey results indicate that
even though some problems with the injectors were identified, 70% of those
responding still preferred to take insulin by jet injector.
| Plasma
Free Insulin Profiles After Administration of Insulin by Jet and Syringe |
Taylor, R.,
Home, P.D., & Alberti, K.G. (1981). Diabetes Care vol.4, 377-379.
Plasma free
insulin profiles in insulin-dependent diabetic subjects were compared after
jet and syringe injection of insulin. Jet injection of insulin resulted
in a shift of the free insulin profile to the left. Thus higher plasma
free insulin levels were found over the first 30-min after injection (P
<0.05), while after 240 min plasma free insulin levels were lower than
those seen following syringe injection (P < 0.05). Significant differences
in the response of blood glucose and 3 - hydroxyburyrate levels reflected
the differences in plasma free insulin levels. Jet administration results
in more rapid absorption of insulin and could be useful in providing a
more physiological postprandial insulin profile than that seen after conventional
injection.
| Comparison
of Insulin Levels after Injection by Jet and Disposable Syringe |
Malone, J.I.,
Lowift, S., Grove, N.P., & Shah, S.C. (1986) Diabetes care vol.9, 637~640.
Intermediate-acting
biosynthetic human (NPH) insulin was administered by disposable insulin
syringe into the right upper thigh of nine insulin-dependent diabetic youths.
Seven days later, the same amount and type of NPH insulin was given in
the same anatomic site with a Medi-Jector II, which delivers insulin as
a jet stream. Blood was collected before insulin injection and at hourly
intervals subsequently for the measurement of glucose and insulin. The
total serum insulin mea-sured before the first morning dose with the needle
and syringe and the Medi-Jector II was 41.2 + 10.7 uU/ml and 46.2 + 10.7
uU/ml, respectively. During the next 9 h, the areas under the respec-tive
total insulin curves were not different, but the area under the free-insulin
curve after jet injec-tion was greater than the free insulin area after
needle injection (P <.01). The ratio of free/total serum insulin was
0.31+0.02 after needle injection and 0.40+0.03 after jet injection (P <.0025).
The peak of total insulin concentration occurred 4.2 h after jet injection
of NPH: I h earlier than the peak after needle injection. The plasma glucose
at time zero was 197 + 15 mg/ dl before needle injection and 242 + 19 mg/
dl before jet injection. Although diet consumed by each subject on the
2nd study day was identical to that of the 1st day, the mean glucose increase
was greater after needle-injected insulin than after jet-spray injection.
This indicates that the greater amount of free insulin observed after jet-injected
insulin had a direct effect in lowering the plasma glucose. Jet injection
may reduce insulin requirements by increasing the availability of free
insulin.
| Human
Insulin-Induced Lipoatrophy - Successful Treatment Using a Jet-Injection |
Logwin, S.,
Conget, I., Jansa, M., Vidal, M., Nicolau, C., & Gomis, R. (1996).
Diabetes Care vol.19, 255-256.
Objective-
To evaluate the efficacy of the administration of insulin by a jet-injector
device in stop-ping and reversing severe human insulin-induced lipoatrophy.
Case-
We report a case of a woman with severe human insulin-induced lipoatrophy
who has been treated exclusively with recombinant DNA human insulin since
the onset of IDDM.
Results-
The loss of subcutaneous tissue in the injection areas was demonstrated
and measured by high-frequency ultrasound. Dermatologic exam demonstrated
a severe reduction of fat tissue. After 8 months of administration of human
insulin by a jet injector, there were no more new lesions of lipoatrophy
and those affected areas were substantially ameliorated.
Conclusions-
Jet-injection devices might constitute a helpful method to treat those
patients affected by severe human insulin-induced lipoatrophy.
| Jet-Injected
Insulin is Associated with Decreased Antibody Production and Postprandial
Glucose Variability Compared with Needle-Injected Insulin in Gestational
Diabetic Women |
Jovanovic-Peterson,
L., Sparks, S., Palmer, J.P., and Peterson, C.M. (1993) Diabetes Care.
Vol.16, 1479-1484.
The study group
consisted of 20 women with gestational diabetes mellitus who required insulin
randomized to receive either jet-injected or needle-injected human NPH
and regular insulin. Variables of interest were evaluated at the start
of therapy, weekly until delivery, and 6-wk postpartum that included: 1)
insulin antibodies in the mother and her infant, 2) HbAlc, 3) insulin dose,
4) fasting and postprandial glucose levels, and 5) subject acceptance and
preference. Results-- Of the 10 women in the needle group, 6 developed
significant insulin antibodies compared with 1 of 10 in the jet group.
HbAlc and insulin doses were the same in both groups. During the test meal,
glucose levels in the jet group were significantly lower, yet none of the
women in the jet group experienced blood glucose below 70 mg/dl at 3-4
hr after the meal, compared with 5 in the needle group. Jet injection was
associated with a diminished antibody response and postprandial variability
compared with needle-injected insulin. Thus, this warrants consideration
as a therapeutic option for women with gestational diabetes mellitus and
may also be applicable to non pregnant, insulin-requiring diabetic patients.
| Twice-Daily
Mixed Regular and NPH Insulin Injections with New Jet Injector Versus Conventional
Syringes: Pharmacokinetics of Insulin Absorption |
Halle,
J.P., Lambert, J., Lindmayer, I., Menassa, K., Coutu, F., Moghrabi, A.,
Legendre, L., Legault, C., & Lalumiere, G. (1986) Diabetes Care. vol.
9, 279-282.
The
purpose of the present study was to evaluate the feasibility of using a
jet injector in a split and mixed regular and NPH insulin regimen and to
compare serum glucose and free-insulin profiles obtained with the injector
and the conventional syringe and needle. Twelve insulin-dependent diabetic
patients were hospitalized for 5 days. After a stabilization day, six patients
received their insulin injection with the injector for 2 days and with
the syringe and needle for the following 2 days; the regimen was reversed
for the other six patients. Diet, exercise, and insulin dosage remained
constant. The serum glucose levels with the injector were consistently
lower than those obtained with the syringe at all times of the day except
at 5:00 a.m. and 7:30 a.m., when mean values were similar for both treatment.
Free-insulin levels were higher with the injector from 10:30 a.m. to 4:30
p.m. These findings suggest that insulin absorption is faster and possibly
greater with the injector than with the syringe. When switching from a
syringe to an injector insulin program, insulin dose adjustment may be
necessary.
| Comparison
of Plasma Insulin Profiles After Subcutaneous Administration of Insulin
by Jet Spray and Conventional Needle Injection in Patients With Insulin
Dependent Diabetes Mellitus |
Pehling, G.B.,
& Gerich, I.E. (1984) Mayo Clin Proc vol. 59, 751-754.
The characteristics
of plasma free insulin profiles after conventional subcutaneous injection
of regular insulin (10 units) and after jet injection of this amount of
insulin were compared in eight subjects with insulin-dependent diabetes
mellitus. Although administration of insulin with the jet injector resulted
in peak plasma free insulin concentrations (45 + 4 uU/ ml) similar to those
achieved after conventional injection (47+5 uU.ml), it produced more rapid
increases in plasma free insulin concentrations (time to peak concentration,
76 + 11 minutes versus 152 + 16 minutes: P <0.01) and less prolonged
hyperinsulinemia. Variability in the peak insulin concentrations and the
time to peak concentration was comparable for both methods of administration
of insulin. Thus, insulin administered by jet injector may improve control
of postprandial hyperglycemia and diminish the risk for late hypoglycemia
in some patients with insulin-requiring diabetes mellitus treated with
conventional injections of insulin.
| Development
of New Jet Injector for Insulin Therapy |
Lindmayer,
I., Menassa, K., Lambert, I., Moghrabi, A., Legendre, L., Legault, C.,
Letendre, M., & Halle, J.P. (1986) Diabetes Care vol.9, 29~297.
To
improve diabetic patients' compliance to multiple injection protocols,
we developed and tested a new insulin jet injector, the Preci-Jet 50.*
The prototype has the following features: small size (14 X 2 cm) and weight
(160g), capability of mixing two types of insulin, accuracy and reliability
of the ejected volume (dose), ease of use and sterilization, simplicity
of design, and capacity of adjusting jet pressure to individual skin resistance.
The ejected volume, evaluated by gravimetry, was more accurate and more
reliable with the injectors (N = 18), than with 0.5 cc disposable plastic
syringes (N = 18). The dead space of injectors (N = 16), as evaluated by
isotopic recuperation of radioactive insulin, was minimal, allowing mixed
insulin injections. The human-device interface evaluation demonstrated
that diabetic patients (N=13) learned easily to manipulate the injector
and that their ability to use it properly improved after 1 mo. of use.
We conclude that this injector may be a practical tool for insulin dependent
diabetic patients.
* Preci-Jet
50 was a forerunner of the AdvantaJet & the GentleJet. |