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December 24, 2000

Blood Tests and Insulin Injections

Question from Knoxville, Tennessee, USA:

My seven year old son has type 1. I have been reading about a new needleless injector called Injex. My doctor is hesitant about using it. I think it is because it is so new. I would like to know if you have any pros or cons.

Answer:

This product appears to be a jet injector system which allows for “needle-free” delivery of insulin into the subcutaneous space. Historically, these devices have not been enthusiastically embraced by patients. They are expensive. Very often, they are not flexible in delivering complicated insulin regimens. Although there have been claims to be pain-free, very often they are associated with some discomfort as the liquid is sent along a narrow jet at high speed into the subcutaneous space.

I would add a further problem. I am concerned about what jet injector insulin delivery does to subcutaneous injection sites over a long time. Our nurse educator has added additional concerns relating to the sterility of the injection (raising the question of how clean they have to be kept in order to prevent the injection of bacteria) and the depth of the subcutaneous injection. In children with a small subcutaneous space, is there a chance this could go into the intramuscular space? In patients with a lot of subcutaneous space, does it get adequate penetration?

I would recommend answers to questions like these from the manufacturer before purchasing and committing to these systems.

JTL
Additional comments from Dr. Donough O’Brien:

I was rather unimpressed with the Equidyne site for the usual reason with these devices. It gave no indication of how the insulin was stored. I presume it takes conventional cartridges, which of course means that you have to give two injections if your going to vary the ratio of short to medium acting insulin. I rather doubt too if it is all that different from an ultra-fine needle.

DOB
Additional comments from Dr. Stuart Brink:

Injectors of this type for insulin have been around for more than 15 years and are not used by many people. When used, they are often abandoned after a short period of time, in my experience. They are also moderately expensive. Some require special cleaning periodically.

Since our own patients did not continue to use them for very long, we gave up on them years ago and generally do not recommend them. In addition, they require some adjustment of pressure settings to figure out how to minimize discomfort. Sometimes they cause some local bruising. With appropriate technique, most short and fine current syringes and needle tips cause minimal discomfort and no added expense, so these are usually are preferred method for giving insulin injections.

SB