Grusha compares injecting herself with the device to "a pinch."
"It stings a little, but it goes right away," she says.
"It's no more than this," adds Loomis, flicking his forefinger against his arm to demonstrate the force of the
insulin stream. "It's nothing, really. It's like a tap. It doesn't hurt at all."
Loomis and Stemp are quick to point out that the AdvantaJet and other needleless devices don't eliminate skin pricks.
People with diabetes still must test their blood sugar before giving themselves insulin, a process that typically
requires drawing blood from a finger stick or a poke on some other part of the body.
But for patients who have a fear of needles or who have damaged their skin from years of needle use or whose skin is
fragile because they are elderly or very young, a needleless device can be helpful, they say.
"If I were a parent of a 2-year-old child who had to have insulin shots several times a day and screamed every time,
this would be a godsend," says Stemp, president of Carousel Medical Systems of Kempton, which distributes the AdvantaJet.
But Lehigh Valley diabetes educators say needleless devices, while on the market in some form for about
a decade, have yet to catch on.
Barbara Carlson, director of the Helwig Diabetes Center of Lehigh Valley
Hospital, says needleless systems may be of most benefit to Type 1 patients who must take insulin several times a day.
Type 1 diabetic patients produce no insulin. The condition, also called juvenile diabetes because it
strikes in childhood or young adulthood, is believed to be caused by a virus that destroys the pancreas's ability to make the hormone.
People with the more common Type 2 form of the disease produce insulin but don't use it effectively. They need a shot
only once or twice a day, so they need to tolerate fewer needles, Carlson says.
But, she says, Type 1 patients more and more are opting for programmable insulin pumps instead of shots. The wearable
pumps deliver a continuous dose of insulin and allow a user to add more based on activity and diet.
"We really think insulin-pump therapy is the way to go for Type 1 because it offers more physiologic delivery, delivery
more like what the human body does," Carlson says.
Eileen Cole, a diabetes educator at Easton Hospital, says she's taught two patients to use a needleless system, the
Injex 30, a competitor of the AdvantaJet. Injex is made by Equidyne Systems of San Diego, Calif.
But when she recently took one to a diabetes support group of about a half-dozen patients, only two were willing
even to test the device. The resistance is not uncommon, she notes.
"Many diabetics are elderly, and have had
diabetes for many years. ... They get so they are used to needles. They want to stay with what has worked," she says.
Cole says patients who tested the Injex, which is advertised as providing "the soft shot," said it wasn't painless.
"Most said it was okay, but the pressure is forceful enough that you do feel the sting. They said, "Rather than go
through this, I'd rather give myself a needle,"' Cole says.
Few diabetic patients are truly needle-phobic, adds
Christine Petrizzi Gilhool, a diabetes educator at St. Luke's Hospital in Fountain Hill. She has never trained a patient to use a needleless
system.
"Some people will refuse [to use a needle]. But that's rare," she says.
Steve Wills, an account manager for Antares Pharmaceuticals in Minneapolis, Minn., which makes another needleless
device, the Medi- ject VISION, believes needleless injectors aren't used by more patients because "their developers tend to be relatively
small companies that don't have the resources" to do widespread promotion.
About 3,000 of his company's injectors are in use, he says. The device has been redesigned several times over more than a decade.
"It's not a new technology, and it's an excellent technology," Wills says, but patients and their doctors tend not to find out about
it unless they search it out themselves.
Brian Anderson, director of operations and business development
for Equidyne, agrees. The company has been marketing the Injex system for about two years to doctors and diabetes educators, but the
response has not been as great as had been hoped, he says. Recently, the company began marketing directly to patients through pharmacy
chains, including Rite-Aid and CVS, and ads in diabetes- oriented magazines.
"I think early on it [needless technology] was oversold," Anderson says, noting that early devices were bulkier, had to be cleaned and didn't eliminate pain. "So there's a little bit of baggage there," he says.
Diabetes educators say another reason more people don't use needleless injectors may be cost. Not all insurers cover needleless systems in every case or all of the cost. Insurers do cover standard needles and syringes.
For example, the Medi-ject device costs about $300, plus about $25 a month for other disposable supplies if a person is taking three shots a day, according to Wills. The Injex costs $260 and $50 per 100 shots for disposable supplies. The AdvantaJet, which does not have disposable parts but must be cleaned, is about $500.
Loomis and Stemp say the cost of needleless systems sometimes can be offset by lower insulin costs because the devices measure and deliver insulin so precisely that users can use less.
When delivered by a needle, they say, insulin pools under the skin. Some research shows that needleless devices, which deliver insulin in a fine stream, allow the hormone to immediately permeate tiny blood vessels called capillaries and be more effectively absorbed into the bloodstream.
Unlike with some devices, the force of the insulin stream in the AdvantaJet is adjustable to an individual's comfort level. The company that makes it, Activa Brand Products, Prince Edward Island, also makes a device for children, the GentleJet, which delivers less force, and the AdvantaJet ES, which is stronger.
With the AdvantaJet, the insulin is delivered through a hole in the device that is only 6/1,000th of an inch wide, not quite half the size of standard needles. The shot takes less than a second.
Loomis and Stemp like to demonstrate the needleless aspect of the AdvantaJet, which is about twice as wide and twice as long as a fountain pen, with an air-filled balloon which doesn't pop when injected.
According to the pair, some diabetic patients prefer needleless systems because they don't like to carry needles and syringes because of their association with illicit drug use or because of disposal problems.
Other patients credit needleless insulin delivery with enabling them to stay with intensive therapy for diabetes. Intensive therapy reduces complications from the disease but requires frequent monitoring of blood sugar and, not uncommonly, a dozen insulin doses a day.
A major reason Grusha, whose parents are Mr. and Mrs. John Grusha of Lower Nazareth Township, chose her needleless injector is that now, no one needs to know that she has diabetes.
Wearing a pump would be a constant reminder to her, and one that everyone else could see, she says.
But the deciding factor was that a pump would have interfered with the sport she loves.
Although pumps that are waterproof to certain depths have recently become available, Grusha notes that many pumps aren't. And, she says, pump wearers must deal with a thin tube in their abdomen to carry insulin from the pump that she thinks would be awkward.
"Usually, now I just check my sugar before I swim or practice or before a race, and if my sugar's high, I take a shot. Then, I wait 20 minutes to make sure it's not too low, and then I can practice or compete," she says.
In March, Grusha won two bronze medals in district competition, in the 100-yard breast stroke and the 50-yard freestyle.
And, at this year's state championship, she placed 12th overall in the 100-yard breast stroke with a time of 1:06:62, her best ever.
"She's a hard worker," says her coach, Gary Trigiani, who says he wholeheartedly supports whatever his team member has to do to fight her disease and is looking forward to her return as a senior.
Grusha says she's not giving up competing any time soon.
"I just want to get a medal next year at states," she says. "And I want to swim in college."
rosa.salter@mcall.com
610-820-6750
