Jet Injectors

[eshobabu]

I have a 6 yr old child diagnosed T1D, and very sensitive to needles. I have been able to alleviate the finger prick pain altogether with this device called Genteel - its literally painless. However, the insulin is still a challenge. I ordered this thing called comfort-in, but I dont think it will work for us because we need very small amounts 0.5 units, 1 unit, 2 units. This seemed to be geared towards 5, 10,15 units etc. I have ordered tickleflex, and BD autoshield duo needles, hoping that might help. I read an article about jet injectors all going out of business because no one is buying them. Is there anything I can buy that can help with the discomfort of the needle for my daughter?

Is there anything else I can try? Especially for children? We are trying to delay the pump because she seems to be entering honeymoon and we really dont know how long that will last (hoping for a long long one).

 

[MarkMunday]

Reminds me of all the injections I had to have at that age. Didn't like it, but got used to the idea. Needles pretty much come with the T1 territory. They take some getting-used-to, but modern disposable needles are really not that bad. IMHO, there is better payback from getting used to needles now than from shielding the patient from their use. Especially as pump infusion set and CGM sensor insertions are likely in the future.

 

[eshobabu]

I figured, but you have to believe me when I say this - the genteel device - although such a small minor incremental change in the way pricking works - its literally night and day - and its the lowest possible tech- simple vacuum-based pump. And I happened to stumble upon it. Even with the CGM, when we need accurate reading, we don't hesitate, and neither does my daughter because it's literally painless. The finger prick before genteel was way worse! We even make it a game where she does my reading and I do hers - because its literally that much more fun to do!

I know CGMS and pumps eventually will phase all of this out, but something small incremental like the genteel that I have found - and maybe the tickleflex (i am getting it next week and hope that is as helpful as the genteel has been) - very low tech inexpensive devices that help my kid - I'd love to try.

 

[eshobabu]

My daughter just said this:

“I don’t know why you cannot just prick me, I want to get up and be surprised that I have no dexcom on my tummy, I don’t want to think about it , don’t want to itch it and don’t want to have it. Just prick me, I just hope that happens “

She prefers genteel over the dexcom. :-(

 

[Jollymon]

Well, I don’t like things on my body either. But I have to have them there the help manage what I have to deal with.

Diabetes isn’t by our choice. But we have to manage it.

 

[eshobabu]

Well, I don’t like things on my body either. But I have to have them there the help manage what I have to deal with.

Diabetes isn’t by our choice. But we have to manage it.

The thing about being a 6yr old - not very practical. We are trying our very best to help her adjust. Not easy. She's handling it a lot better now. Things she used to say broke my heart (I have another thread about that) but she is adapting better each day. I know she has to get used to it. The things I have found - genteel, tickleflex, different needles, etc that have helped a lot. And I found them by accident - chance - Just wanted to see if people have found things like these that I may have missed that have helped their kids, that's all.

 

[MarkMunday]

I looked up Genteel and it looks like a good idea. After 43 years my finger and thumb tips have had enough, so I may get one too. For insulin, there is nasal insulin (if it is still available) and the jet injector pens. Dosing accuracy could be an issue with both of them, though. Because of the lack of a compelling value proposition, neither product has done well.

 

[eshobabu]

I looked up Genteel and it looks like a good idea. After 43 years my finger and thumb tips have had enough, so I may get one too. For insulin, there is nasal insulin (if it is still available) and the jet injector pens. Dosing accuracy could be an issue with both of them, though. Because of the lack of a compelling value proposition, neither product has done well.

This thing has been a life-saver. It boggles my mind how it's able to get a perfect drop of blood without me even feeling it! I actually have to check and see if the needle even hit my skin . And it is such a simple device!! It's basically spring and a vacuum chamber on top of an existing lancing device. Such a small minor incremental step up, but a huge improvement in QOL for someone who has to do this multiple times a day. Given the fact that genteel figured out a way to do this with lancing devices, I was really confused why there wasn't such a thing for insulin... And then I learnt about jet injectors and how they have all failed. I think given the number of kids being diagnosed is growing significantly, there is a market for child-friendly insulin administration. Hope some of the majors pay attention to this.

 

[Rokaab]

I think given the number of kids being diagnosed is growing significantly, there is a market for child-friendly insulin administration

All I can say is, its a lot better than it was when some of us were diagnosed , the thing my parents had to use on me (I was diagnosed when I was 2) was a big metal and glass contraption and I think the needle was pretty humungous too

 

[eshobabu]

All I can say is, its a lot better than it was when some of us were diagnosed , the thing my parents had to use on me (I was diagnosed when I was 2) was a big metal and glass contraption and I think the needle was pretty humungous too

I cannot imagine having to do this!! But you are right, we are getting so much better at handling this disease. A few decades prior to your diagnosis this thing was a death sentence - I read about the starvation diet - people literally starved to death fighting this disease. I am certain a few decades from now, people will look back at this as a minor flu. Resilience of mankind. You were relatively fortunate as compared to the 1920's, my daughter is relatively fortunate compared to you, and her kids will be even more so. Assuming we have not nuked, polluted, or otherwise ourselves into extinction.

 

[JMK1954]

Anything that makes life easier for a newly-dignosed child with type 1 has to be a good idea. Has your consultant or DSN not been of any use with other suggestions ? Make sure you tell them abiut the GenteeI device. The information might help other people they are treating. I admire your determination to find answers.

 

[eshobabu]

Anything that makes life easier for a newly-dignosed child with type 1 has to be a good idea. Has your consultant or DSN not been of any use with other suggestions ? Make sure you tell them abiut the GenteeI device. The information might help other people they are treating. I admire your determination to find answers.

Every time I go there, they learn new things from me. They had never heard of genteel. Or TickleFlex. Or Comfort Inject OR BD auto shield duo. I learnt all these things on google or boards like this.

 

[TypeZero.]

I would be careful over getting a pump. If your daughter doesn’t like the feeling of a Dexcom then a pump will be a lot worse.

When I was first diagnosed I was so enthusiastic about a pump and CGMs but over the months I discovered they are not that glorious. CGMs are very unreliable like you can’t ever relax with them because you’re worried if it’s telling the true BG value but I used a Libre which is cheaper and less accurate. A pump involves carrying an electronic medical device with a needle inside you all the time and a tube connecting it.

In terms of injections, I find the abdomen very sensitive to needles and very painful, you can try injecting to buttocks or fatty back part of arm as these areas would be less sensitive.

I don’t have any information on your insulins but if you’re using Levemir you could switch to Lantus or you may want to try mixed insulins that you inject like twice a day but they have peaks so your daughter has to eat at certain times.

For the time being there doesn’t appear to be a cure coming anytime soon so it’s best to just get used to the needles

 

[eshobabu]

I would be careful over getting a pump. If your daughter doesn’t like the feeling of a Dexcom then a pump will be a lot worse.

When I was first diagnosed I was so enthusiastic about a pump and CGMs but over the months I discovered they are not that glorious. CGMs are very unreliable like you can’t ever relax with them because you’re worried if it’s telling the true BG value but I used a Libre which is cheaper and less accurate. A pump involves carrying an electronic medical device with a needle inside you all the time and a tube connecting it.

In terms of injections, I find the abdomen very sensitive to needles and very painful, you can try injecting to buttocks or fatty back part of arm as these areas would be less sensitive.

I don’t have any information on your insulins but if you’re using Levemir you could switch to Lantus or you may want to try mixed insulins that you inject like twice a day but they have peaks so your daughter has to eat at certain times.

For the time being there doesn’t appear to be a cure coming anytime soon so it’s best to just get used to the needles

You are certainly correct about the CGMs. I have found them to increase our stress levels because we are constantly watching it. Before the CGM, we would check 4-6 times a day, but the CGM has now become an obsession. As much as it has helped analyzing trends, the false alarms it has raised makes it not a very reliable tool. I have now learnt to take every reading from it with a grain of salt. I have also found that each meter reading, with same meter or different meters can be as much as 50 apart. We have the dexcom g6 and it is supposed to be better. It trails the blood glucose by a good 20 minutes, which makes sense because its reading the interstitial fluid and not blood. But when its stable, it matches the meter quite well. I have learnt to read its mind better, and what I now do is look at the past 3 or 4 readings from the CGM, figure out the trend differential and then apply that to the current one to arrive at the actual point in time number. Most times the result is close.

We have not gotten the pump yet. She is honeymooning so we will defer that to the eventual end of her honeymoon which I am praying is a long long time away.

I am not very hopeful that a cure is within reach, but there are signs of hope. But that was probably true 20 years ago as well. Viacyte has some good stuff in the pipeline. Eversense already has a CGM implant. The G7 is smaller than a coin. We are probably a decade or two away from these things perfecting themselves into artificial pancreas. I am hopeful within the decade we are looking at T1D management being like a hearing aid.

 

[MarkMunday]

... I am hopeful within the decade we are looking at T1D management being like a hearing aid.

That would be a mixed blessing IMO. Having lived with T1 for 42 years, I want to retain control f it. I can do a better job than a machine, especially when the system fails. As you mentioned, CGMs can result in becoming obsessed. They also switch the mind into reactive micro management mode, which is not IMO helpful. Doing it all manually is more resilient and reliable. I recently stopped using a pump because it was too unforgiving and too much of an intrusion. If an artificial pancreas becomes like a hearing aid, how is the user going to know what to do when it doesn't work?

 

[eshobabu]

That would be a mixed blessing IMO. Having lived with T1 for 42 years, I want to retain control f it. I can do a better job than a machine, especially when the system fails. As you mentioned, CGMs can result in becoming obsessed. They also switch the mind into reactive micro management mode, which is not IMO helpful. Doing it all manually is more resilient and reliable. I recently stopped using a pump because it was too unforgiving and too much of an intrusion. If an artificial pancreas becomes like a hearing aid, how is the user going to know what to do when it doesn't work?

Its a hypothetical. Your method does work, and I can see that myself. I can almost predict her number down to the single digits on basis of what she is eating and what she is doing. A machine will never be able to do that. But I do think that if there was a middleground where I had something implanted in the body that gave accurate blood based reading with an insulin synthesizer or even preloaded, that I could use with a phone and say Siri pump me 0.761 units of humalog, and it pumps it directly into the blood stream in micro bursts like the betas do, who knows? So its not on complete autopilot, but a bit of both. Its a pipe dream, I get it, but we're getting there - If you see - there is the eversense CGM FDA approved already - what if they could extend it for years and marry it with insulin delivery?

As much as I find the dexcom annoying and she hates it as well, I insist she wear it, and so do most other parents. I do it because I could use all the help i can get. I can see when she has a lollipop it goes up by amount X and comes back down in time X. I can see it on the chart. And i can see the pattern. And every time what I see does not jibe with the pattern, I know there is something wrong, and she needs more/less/spaced out insulin. I can experiment. I can try increasing/reducing basal, fast acting, and this is what our endo is recommending - try and find a balance that sticks. Is it perfect? Absolutely not. Am I glad we are facing this in 2020 and not in 2010? Certainly. I hope another parent gets to say the same in 2030.

 

[MarkMunday]

The technology has already come a long way. The Tandem basal IQ and the new Medtronic 780G do variable basal insulin infusion, based on CGM input. The biggest limitation is insulin being delivered under the skin. In a non-diabetic insulin is secreted into the portal vein and the liver sees it before it goes anywhere else. So insulin signalling will continue to be a hurdle. Even with the DIY closed-loop systems, the user still has to 'announce' carb consumption to the system, and probably won't stop.

Maybe artificial pancreases become hands-off, resilient and reliable systems. For those who need it, I hope it happens, and that the overhead isn't too high. To me, a more convenient and sustainable system is eating ketogenically, so the body uses fat for energy, and simply injecting required amounts of basal insulin.