As every family is acutely aware, managing a child or teen with diabetes requires attention to detail, persistence, and the unfortunate requirement of intermittent pain to care for a child safely. At this stage of diabetes management, some discomfort is still associated with blood glucose monitoring, insulin injections, and even insulin pump therapy. Although continuous blood glucose sensors are widely assumed to decrease the requirement of blood glucose monitoring, sensors still need to be applied and in many situations, based on the sensor, additional blood glucose measurements are necessary.
Families are consistently informing me of various tools and gadgets that attempt to reduce discomfort in performing diabetes self-care skills. Unfortunately, I am aware that the popular Pelikan lancing system has been discontinued. It is ironic that the most likely reason is due to the lack of financial viability of the company because of the small subset of children with diabetes as compared to the 90 percent of the population with type 2 diabetes. However, even people with type 2 diabetes must perform blood glucose monitoring. What about their discomfort with blood glucose sampling?
There are three gadgets that we commonly suggest for use in our patients: the shotblocker, the insuflon, and the iport. There is also a cool "tattoo" in development that could possibly help monitor diabetes in the future. These devices have been very helpful for all ages and not just the toddlers who are afraid of shots. The shotblocker is a device that is applied to the general region of the site in which an insulin injection is to be administered. The small plastic device has pointy plastic prongs under the surface that serve to scramble the pain of the injection (perhaps akin to acupuncture). It works really well and is not expensive. We have them available in our diabetes teaching classrooms.
The other two devices are the insuflon and the iport. The insuflon has been around for some time and the iport is the newest on the block. These devices serve to allow insulin to be delivered subcutaneously into the fat without a needle each time. They serve as conduits for bolus insulin (regular, humalog, novolog, and apidra) to avoid the need for multiple injections. They must be inserted every three to seven days and replaced with a new one to avoid walling off of the surrounding tissue with subsequent decreased and erratic absorption of insulin. For many children and teens, the use of these devices eliminates the barrier of progressing to intensive insulin therapy that requires multiple injections of both basal and bolus insulin. At Children's National Medical Center, we have found that many patients prefer to use these devices and, as a result, have improved glycemic control due to the willingness to administer bolus insulin through the insuflon or iport. In our Childhood and Adolescent Diabetes program, we require a trial of basal bolus therapy with multiple injections via syringe or via the insuflon/iport prior to transitioning to insulin pump therapy. Our rationale is to ensure that the families and children/teens with diabetes learn how to calculate insulin boluses with insulin/carbohydrate ratios, correction factors (insulin sensitivity factors) and most, importantly how to troubleshoot in emergency situations. By learning intensive insulin therapy through the "poor man's pump" (i.e. a car's manual transmission), they will understand the principles involved upon transitioning to the insulin pump (i.e. a car's automatic transmission).
An excellent suggestion during this period of transition is to employ these devices to decrease the need for injections. Keep in mind, it is still recommended by the pharmaceutical companies to avoid giving basal insulin (Lantus or Levemir) through the same site (insuflon or iport) due to the potential mixing of insulins. (Some families have tried this strategy despite the warning with mixed results.) These gadgets mimic the insulin pump catheters by which they are inserted and provide a "dress rehearsal" for future insulin pump therapy. The good news is that generally they do not have to be changed out as often as necessary with insulin pump catheters. Many children love the insuflon and iport and are so happy with basal/bolus therapy that they decide to postpone insulin pump therapy. Keep in mind that both forms of intensive insulin therapy are very effective. The downside to these devices is the expense and difficulty of finding pharmaceutical supply companies that can deliver them. Of course, insurance companies may also be an obstacle; however, Children's National provides its patients with letters of medical necessity that are sometimes effective in changing decisions of insurance companies.
I would like to bring to your attention to the Nano Ink Tatoo that was forwarded to me several days ago by one of my George Washington University second year medical students. According to a release from the Discovery Channel, a special tattoo ink that changes color based on glucose levels inside the skin is under development by Draper Laboratories in Massachusetts. According to Heather Clark and colleagues the tattoo would be a few millimeters in size and would not be as deep as a typical tattoo. My understanding is that these tattoos would function more like the continuous glucose monitors in which the interstitial glucose lags 20 minutes behind blood glucose levels. Testing of the glucose monitoring nanotech ink in mice may begin at the end of February. Human testing will only occur after the animal research is completed.
I would appreciate hearing of any other tools or devices that may improve the quality of life our families and children/teens with diabetes. Please chime in with your comments.
If you're in the DC area, be sure to purchase a ticket to the April 25 game between the Washington Nationals and Los Angeles Dodgers and support children with diabetes!
Published On: March 16, 2010