Using injection ports as an alternative injection mechanism on MDI

[tim2000s]

As I've said many times, I eat a low carb, higher protein diet such that I inject far more frequently than the three times daily bolus that MDI is supposed to be.

Having been MDI for many years, and amidst concerns that my injection sites may be starting to get less reliable, I did some research into injection ports following a link on the forum.

These are essentially sets, similar to those that pump users have, that you apply and inject through a septum.

There are two types available. Insuflon, which look a lot like an intravenous set and i-Port, which looks like the Inset (and is know made by medtronic).

The Insuflon sets go in at an angle and the i-Port goes in perpendicular to the skin.

After discussing with my DSN, she agreed to write a letter of approval to AMT who supply the kit and they sent me two 6mm i-Ports, two 9mm i-Ports and two Insuflon sets to trial so that I could decide which I might purchase. The Insuflon sets are a lot cheaper (less than half the price of the i-Ports) for a box of ten and neither are available on prescription.

I started with the 6mm i-Port which I am wearing for three days.

I imagine it feels a lot like a pump set does to wear and use.

The initial application wasn't difficult but I certainly felt it. The applicator makes it easy to use. I suspect that the 6mm is probably long enough for a perpendicular set as I don't have huge amounts of body fat (around 10%).

This one has been in for 24 hours and I don't think it makes any difference to the speed at which insulin is absorbed. It hasn't affected the amount I need. As the insulin passes from the port into my body, I do feel a slight burning sensation, although the site isn't tender.

What I note about the i-Port is that there is no way to see the point where the cannula enters the skin, so if it did look red and angry I wouldn't know.

It is effective at reducing the number of skin penetrations, although I continue to do my levemir into my bum.

I notice the head of the port sticking out on the side of the stomach and I have caught it a couple of times on obstacles. I'll give this three days and then switch to an Insuflon to make a comparison.

 

[xAoifex]

I do feel a slight burning sensation, although the site isn't tender.

The burning sensation is most likely due to the speed of you injecting the insulin, with a pump we have the luxury of programming and letting the pump do the work which you don't get with injections but a big bolus for me can give this sensation.

 

[tim2000s]

The burning sensation is most likely due to the speed of you injecting the insulin, with a pump we have the luxury of programming and letting the pump do the work which you don't get with injections but a big bolus for me can give this sensation.

Interesting. It's not something I ever noticed with a standard injection.

 

[xAoifex]

Interesting. It's not something I ever noticed with a standard injection.

neither did I! Maybe it's something to do with the cannula size. Its def more noticeable with a fresh set too. Not that it's a problem or painful, I'm just aware of it. Maybe its just me! YMMV

 

[tim2000s]

Having got used to this i-Port and there seeming not to be any ill effects thus far, I have decided to extend the life by a further 24 and then 48 hours, if it continues to function appropriately. Insulin is still going in with no issues and I've got used to the injection sensation. I'm looking forward to trying the Insuflon and seeing how effective that is, but I can see the benefits of using these already!

 

[tim2000s]

I removed the i-Port last night after five days use. I'm confident it would have lasted for a good 2-3 more days, but decided to take it out anyway. It has been replaced with an Insuflon device, which is very similar to a pump set and anyone who has been on an intravenous drip will recognise them.

Factors I noted on the removal of the i-Port:

1. The very tip of the cannula was slightly crumpled - it looks as though either it crumpled on the way in or it was being squashed against muscle under the fat. It was only a 6mm perpendicular cannula so I suspect that a 9mm one wouldn't really work. I will try it and see.
2. The area around the site was in good condition on removal.

Applying the Insuflon device, this one goes in at an angle. Again, no drama with application - it's only a needle after all, but the way it is applied requires a little thought to make injecting into it more straightforward.Reading the literature, these have been used for 7 days for insulin infusion, so I expect to get longer out of it that the i-Port.

Noticeable differences between the two systems

The first thing that I've picked up on is that the Insuflon is less easy to inject into, as the port lies along the skin rather than parallel with it. It's not a huge issue, but should be borne in mind.

The second is that the rate of insulin absorption is different. Going into the i-Port device, it was clearly taking about 15 mins for insulin to take effect. Via the Insuflon, it's roughly 35. I assume this is down to the depth under the skin the cannula is placed, and that the 6mm i-port was practically into muscle.

As I have further observations, I'll update this topic!

 

[Heathenlass]

Thanks Tim, I'm watching your experiment with great interest !
It's baffled me that injection ports are not prescribed or used with insulin much, and think that it would provide a solution for people who are now having problems with absorption. Injecting over a long period of time is bound to have some impact , perhaps more so for those of us that have a history of using some pretty brutal needles in the past

I have asked my team about using this but have met a brick wall - partially because my way of MDI ( pumping without a pump ) isn't their recommended method, though they do acknowledge that it works for me. But also there seems to be insufficient knowledge and interest . Possible cost concerns perhaps ?

Signy

 

[tim2000s]

Thanks Tim, I'm watching your experiment with great interest !
It's baffled me that injection ports are not prescribed or used with insulin much, and think that it would provide a solution for people who are now having problems with absorption. Injecting over a long period of time is bound to have some impact , perhaps more so for those of us that have a history of using some pretty brutal needles in the past

I have asked my team about using this but have met a brick wall - partially because my way of MDI ( pumping without a pump ) isn't their recommended method, though they do acknowledge that it works for me. But also there seems to be insufficient knowledge and interest . Possible cost concerns perhaps ?
Signy

Signy, your approach is the same one I espouse. I am essentially pumping without a pump as well. My DSN was very open to the idea of reducing damage to my potential injection sites, but concerned about funding them, so I said I would do it myself. I haven't had any majorly brutal needles, although both my arms and my legs are showing 26 years worth of injecting.

There is certainly a lack of knowledge - the DSN team had little experience with these things so I am also part of an experiment of one for Guys and St Thomas' on using them with proper observation (by me). Hence why I started this topic and am blogging about it.

I can understand the cost concerns, but given the research and my usage experiences so far, where I think that 7 days for a set is not unreasonable, the cost per annum of the Insuflons would be £250. I don't see any issue with re-using needles with these as you aren't doing skin damage, so I imagine the costs would work out relatively flat.

Anyway, this is another area that I am very willing to shout about. The discussions with AMT (the UK supplier) suggest that there are a significant number of people funding these privately as they can see the benefits.

I'll keep you updated!

 

[yingtong]

This is very interesting observations tim2000 after injecting for over 52 years of which36 years of MDI,i have had concerns of absorption,although I have no lipo's, since changing to a pump 18 days ago my insulin requirements has drooped by some 20%, think you have some very good points and look forward to further updates.

 

[Charlie Tudgay]

As I've said many times, I eat a low carb, higher protein diet such that I inject far more frequently than the three times daily bolus that MDI is supposed to be.

Having been MDI for many years, and amidst concerns that my injection sites may be starting to get less reliable, I did some research into injection ports following a link on the forum.

These are essentially sets, similar to those that pump users have, that you apply and inject through a septum.

There are two types available. Insuflon, which look a lot like an intravenous set and i-Port, which looks like the Inset (and is know made by medtronic).

The Insuflon sets go in at an angle and the i-Port goes in perpendicular to the skin.

After discussing with my DSN, she agreed to write a letter of approval to AMT who supply the kit and they sent me two 6mm i-Ports, two 9mm i-Ports and two Insuflon sets to trial so that I could decide which I might purchase. The Insuflon sets are a lot cheaper (less than half the price of the i-Ports) for a box of ten and neither are available on prescription.

I started with the 6mm i-Port which I am wearing for three days.

I imagine it feels a lot like a pump set does to wear and use.

The initial application wasn't difficult but I certainly felt it. The applicator makes it easy to use. I suspect that the 6mm is probably long enough for a perpendicular set as I don't have huge amounts of body fat (around 10%).

This one has been in for 24 hours and I don't think it makes any difference to the speed at which insulin is absorbed. It hasn't affected the amount I need. As the insulin passes from the port into my body, I do feel a slight burning sensation, although the site isn't tender.

What I note about the i-Port is that there is no way to see the point where the cannula enters the skin, so if it did look red and angry I wouldn't know.

It is effective at reducing the number of skin penetrations, although I continue to do my levemir into my bum.

I notice the head of the port sticking out on the side of the stomach and I have caught it a couple of times on obstacles. I'll give this three days and then switch to an Insuflon to make a comparison.

Hi Tim2000, I was wondering were I can purchase some of these to give them a go. I'm currently on MDI but am injecting 8-10 times per day (on a good day!)
Do you have to have permission from your DSN first?
Thank you

 

[tim2000s]

Hi Tim2000, I was wondering were I can purchase some of these to give them a go. I'm currently on MDI but am injecting 8-10 times per day (on a good day!)
Do you have to have permission from your DSN first?
Thank you

The process I went through was that I contacted AMT first. They told me that they needed permission to supply from my diabetic care team. I spoke to my DSN, who agreed to send the required email. I then emailed them copying her in, she responded to the email confirming and the process was done.

 

[tim2000s]

Well, my statement regarding time to effectiveness with the Insuflon was premature. I can only assume that on the day, inflammation was causing a slight delay in absorption. More than 24 hours later and a few libre traces and I see that the time to effectiveness (i.e. When the curve starts to turn) with the Insuflon is less than fifteen mins. My conclusion is that both devices are quicker than a direct injection, except where that is intramuscular.

 

[LucySW]

This is so interesting Tim.

 

[RuthW]

This is very interesting, and I agree that it is likely to spare your insulin sites a lot of damage, especially if you are sugar surfing (which I would also do on MDI). A word of warning, though. With a pump, I do change the site religiously every three days. In my experience the site can start to heal over with the cannula in place if you extend it more than that. In other words, you get a mysterious occlusion and your bloods start to rise, for no apparent reason, until you change the set and they go back to normal instantly. In my case this healing over/occlusion of the cannula can happen especially if I injure myself in some way (once I cut my finger, once had badly blistered heel) or if I do a particularly hard weights session, which kicks off the muscle-repair/healing process. So I would be very careful about extending the life of the port past three days. Keep a good eye on your blood sugars and any unexplained upward trending. Not least because if you get healing around the cannula, that will give more lumpiness and scarring and ultimately do more harm to your sites.

 

[tim2000s]

Thanks @RuthW, I noticed this with one of the i-Ports last week and ended up taking it out on day 5. I've noted that the Insuflons seem to be better over five days than the i-Ports. I've certainly concluded that five days is the safe maximum.

 

[tim2000s]

Having now interspersed two 6mm i-Ports and two Insuflons, I've come to the realisation that the 9mm i-Ports will never go near my body. The 6mm are only just short enough, so I can imagine how using perpendicular sets for people with less body fat than I have could be a struggle. I therefore have two 9mm i-Ports that are sitting there.

But on to feedback on the devices themselves. What do I make of them?

The i-Ports are easy to apply and very easy to use. They were efficient and I didn't have any problems with them. The parallel to your skin placement means that injecting is almost identical to what you do with a needle vertically into skin. Put simply, they work. Well.

The Insuflons are slightly different. These require you to pinch up a layer of fat and then inject at around 30-45 degrees. You then have to stick them down and leave the port free. Whilst this isn't really an issue (and doesn't hurt) it causes some interesting challenges. When injecting you have to run the needle parallel to the skin and into the port. If you think about how you use your hands to do this, it limits somewhat the placement of the device. There is then the issue of actually applying it in the correct position. Whilst this is possible, it helps to be ambidextrous as you find that you have some slightly awkward contortions to get the things in place.

Once in and working properly they are no less efficient than the i-Ports. Of the trial sets I had though, I had a 50% failure rate. One just wouldn't work properly. Once it was in place, I was having to stick the needle into the septum multiple times for it to feed properly through into the chamber. This took 10 attempts on one occasion, and at that point I removed the Insuflon. I'm not sure precisely of the cause, but I get the feeling that it may have been a manufacturing issue on that particular port as I think the chamber wasn't fixed securely within the port and the needle kept catching on something as I entered it.

As a result, when it comes to spending my own money on insulin ports I have opted for the more expensive, but in my eyes, more reliable i-Ports. For me reliability in terms of injecting is ease of application, ease of use and lack of issues, and although half the price, I get the impression that the Insuflons are likely to have more failures than the i-Ports, so I've gone with the i-Ports.

 

[LucySW]

Thank you Tim. Making your findings available is a real service to us all - most of all those of us who are doing a version of sugar surfing. Which is what the Libre allows you to do - bless it.

 

[tim2000s]

And here they are...

 

[tim2000s]

@LucySW, if it helps people get better care and manage their condition more efficiently, I am happy to do it. It's all a bit of a journey and experiment for me too.

 

[RuthW]

I have to say they seem like a very good idea indeed. Good test run, Tim. They are fantastic for people who are on MDI and manage their blood sugar intensively.