My two year old daughter really hates the injections — she fights them, and at a gathering for kids with diabetes, someone gave me an Inject-Ease and told me this might help. She briefed me on how to use it, but I would like to know if you can give me some more specific instructions. I am dying to try it out, but we don’t have an appointment with the endocrinologist for a long while.

The Inject-Ease� is a simple device. It looks somewhat like a hollow but large pen. The shape is somewhat spaceship-looking, and so some people refer to it as “The Rocket.”

In essence, it works on the same principal as your spring-loaded lancet device. You draw up the insulin dose into the syringe as you normally do. The syringe with needle is placed and secured into the Inject-Ease. Depending on the insulin syringe size (1/3 cc vs. 1/2 cc vs. 1 cc syringe), there is a designated ‘guard’ you place on the Inject-Ease. This guard “hides” the needle. You place the Inject- Ease with the needle hidden by the guard onto the skin with a mild amount of pressure. There is little need to “pinch” the skin because some of skin is now ‘molded’ into the guard (try this for yourself by placing a small hollow cylinder {like a pen top}. You twist the Inject-Ease about 1/4 turn into the skin to secure it onto the skin surface, and then you press the spring-release button which then springs the syringe into the skin. You must then manually push the plunger of the syringe to formally inject the insulin. It takes only a minimum amount of dexterity. The Inject-Ease gives the injection with essentially the same degree of pressure each time. It is rather inexpensive device (about $20) and your diabetes team may have them to give away. Ask them.

There is also another approach that may hold some promise. There is a hollow plastic catheter called the Insuflon which is inserted under the skin over a needle. The needle is removed leaving the plastic catheter which is about 3/4 of an inch long and which is touted to be able to be kept in the skin for about five days at a time when it is secured in place. You then give the injections of insulin with your usual syringe and needle into this plastic catheter. This is supposed to be less painful. There was a recent article by Dr. Hanas in the Journal of Pediatrics, March 2002 that addresses this topic. His data suggest that there was less perceived pain and good tolerance of these temporary catheters. If you use very small amounts of insulin, the catheter may not work as well because the insulin has to “clear out” of the catheter. Small amounts of insulin may stay in the catheter and not be absorbed into the tissue.

DS
Additional comments from Dr. Stuart Brink:

The Inject Ease is very easy to use. Syringe goes inside the plastic gizmo and spring “pops” the needle through the skin quickly, and so less painfully. Then you have to still push the plunger and administer the insulin, of course.

You should really be talking with your daughter’s diabetes team about this situation since they can offer more specific advice.

SB
Additional comments from Dr. Donough O’Brien:

The Inject-Ease is really no more complex than a standard syringe and needle. Its great advantage is that children can’t see the needle. Those who use it like it very much.

DOB
Additional comments from Dr. Matthew Brown:

You can request information about the Inject-Ease directly from Palco Laboratories, the company that manufactures it.

MSB

[Editor’s comment: The problem you describe is very common in children of this age. The Inject-Ease works very well for small children. You might also ask your daughter’s doctor to prescribe EMLA Cream that will numb the injection site, so that perhaps he won’t struggle too much.

I would also recommend using a reward system for not fighting the shot. Try not to focus (although, I know it is difficult) on his “bad” behavior as this reinforces it, and often children this age will seek attention of any kind. You might also try play therapy using a large syringe for painting, giving a stuffed animal a shot, etc. If you are uncertain as to how to do this, you might ask your diabetes team for a referral to a play therapist. Play therapy can be of great help.

We find that much of this is behavioral. It will go away in time.

SS]

[Editor’s comment: Even though your daughter does not have an appointment for a while, call the doctor’s office and speak to one of the nurses. As mentioned, they may have freebies, and they may be willing to schedule a short appointment to see only the nurse to learn to use the device.

WWQ]