Research & Studies: Pertinent Abstracts

Precision of Low-Dose Insulin Administration Using the Jet Injector Neufeld, N. (1997). Unpublished clinical study.  Precision and repeatability of insulin dosages using a jet-injector versus conventional syringe was compared. Twenty-eight participants including parents of diabetic children, children with diabetes older than 10 yr. and medical office staff took part in this study. They were asked to draw up 1u, 2u, and 3.5u with each device; the contents were then weighed with a Mettler Analytic Balance. At 1u the sample variance for the syringe was 71.7%, variance for the jet was 7.9%. At 2u, syringe variance was 67.7% and 6.7% for the jet. At 3.5u, syringe variance was 52.1% and 18.1% for the jet. These findings suggest that the jet injector is a useful tool for ensuring accuracy of small dosages of insulin, particularly when considering multiple caregivers may be preparing injections for a given individual. 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.  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.  MORE >>>