Insulin Measurement Devices
(This article appeared in Voice of the Diabetic, Volume 11, Number 4, Fall 1996 Edition, published by the Diabetes Action Network of the National Federation of the Blind. Updated July 2004.)
Most diabetics, blind or sighted, want and need to achieve control, independent self-management, of their diabetes. But if a diabetic cannot rely on vision to accurately measure insulin, then, to maintain independence, he or she MUST have effective alternative techniques, specifically designed for individuals with partial or complete vision loss. Many manufacturers have risen to the occasion, and, with the appropriate adaptive equipment, nonsighted self-management is a reality. People's abilities (and ramifications) vary, and it is important to remember that different devices best meet different needs.
Some diabetics, with fluctuating vision, will find that at certain times of the day they can rely on their vision to accurately measure insulin. At other times their visual acuity may diminish, leaving them guessing at their dose of insulin or relying on sighted aid. A diabetic's eye condition can change daily, making reliance on visual techniques unsafe.
The following is a catalog of alternative devices for insulin measurement. Some are designed for those with partial sight. Others are intended from the start for nonvisual operation. A few are the simplest of home-made aids, some designed by resourceful blind diabetics. Note: Prices quoted do not include shipping charges.
Insulin Measurement Systems
The Count-A-Dose: This insulin measuring device is now manufactured by MediCool, of Torrance, CA., and is available from the National Federation of the Blind (NFB). Cost: $40. Cassette instructions are available. Order from: Aids, Appliances, and Materials Center (hours of operation are 8:00 a.m. to 5:00 p.m. EST, weekdays), National Federation of the Blind, 1800 Johnson St., Baltimore, MD 21230; telephone: (410) 659-9314.
Designed for the Becton Dickinson (B-D) .5cc LoDose (50-unit) syringe, the Count-A-Dose holds two insulin vials and directs the syringe needle into the vials' rubber stoppers. The user can easily mix two different insulins, and the "T-bar" that holds the vials has clear and obvious tactile marks to aid insulin differentiation. Dose size is adjusted with the thumb-wheel, which clicks for each unit measured (clicks can be both heard and felt) up to 50 units. The device provides easy, reliable, and accurate nonsighted insulin measurement. At one time, a larger, 100 unit/1cc Count-A-Dose was available, but is no longer manufactured.
The Syringe Support: This device is manufactured in Canada, and its instructions (standard print only) are bilingual (English and French). In the U.S., the Syringe Support may be purchased (Cost: $26) through: The Eye-Dea Shop, Cleveland Sight Center, 1909 E. 101st Street, Cleveland, OH 44106-8696; telephone: (216) 791-8118, ext. 278.
The Syringe Support uses only the B-D 1cc/100-unit disposable syringe, and measures insulin in 1- or 2-unit increments, in doses of one to 100 units. To mix insulins with the device, it is necessary to remove vials from the apparatus. To draw a measured dose, the Syringe Support depends on a set screw with a raised flange, its only landmark, at 12 o'clock. One full turn draws two units. One half-turn draws a single unit. Although the dial lacks definite tactile or audio indicators, in most cases any error would be fractional. Still, the Syringe Support performs best for those who must draw doses of greater than 10 units.
Homemade Insulin Measurement Gauges
Insulin gauges are a relic, an artifact from the bad old days when there was simply no other way to replicate a predetermined dose without sight. Such gauges can be cut for any syringe, and used to administer any injectable medication. But sight is required to cut and calibrate them, and there are better, easier ways now to be independent. Still, some may need these gauges...
The simplest insulin gauges are devices which allow the plunger on an insulin syringe to descend a set distance and no more. The distance corresponds to a measured dose of insulin, and the gauge enables that dose to be reliably duplicated without sight. To draw a different dose, you'd use a different gauge. You'd need quite a collection! Gauges may be of a number of shapes (flat, corner-molding, tube...), and could be constructed of many different materials (wood, plastic, metal, old credit cards...), but most of them would be rigid, flat, several inches square, and on one end of the gauge there will be an L-shaped notch. This L-notch will fit on the plastic collar located between the flanges and the plunger of the insulin syringe.
Further down the insulin gauge will be the small slot where the plunger seats, once you have reached the correct dose for that particular gauge. When making an insulin gauge, keep the slot very narrow, to insure that when the plunger is seated in the slot there is no play (which would allow a variation in the dose). The L-notch and the slot must both be on the same side of the insulin gauge.
The best insulin gauges are those most durable. Insulin gauges constructed from cardboard or staples, however inexpensive, are NOT RECOMMENDED. They distort and break too easily. The use of nonstandard or homemade insulin measuring devices should only follow a thorough checkout of such devices, looking for accuracy and reliability.
It is important to understand that insulin gauges are "cut" for a specific brand and size of syringe. Therefore, an insulin gauge that has been cut for a Monoject, Terumo, or other type syringe cannot be used, will not produce an accurate reading, on a B-D syringe and vice versa. An insulin gauge cut for a 1cc B-D syringe cannot be successfully used on the 1/2cc (Lo-Dose) or 30-unit B-D syringe, for the same reason.
Appliances and Holders
The Uni-Cal-Aid allows tactile draw-up of preset insulin doses, incorporates two adjustable preset stoppers, allowing two different doses or insulin mixing (Resetting the doses requires sighted aid). It accepts all syringe types, but any adjustment of dose requires sighted aid. Cost: $26, available from: The Eye-Dea Shop, Cleveland Sight Center, 1909 E. 101st Street, Cleveland, OH 44106-8696; telephone: (216) 791-8118, ext. 278.
Pen Injection Devices
Novo Nordisk Pharmaceuticals Inc., 100 Overlook Center, Suite 200, Princeton, NJ 08540; telephone: 1-800-727-6500, currently produces an extensive catalog of pen-type devices, reloadable and prefilled. Their "Novo Pen 3," and "NovoPen Junior" are reloadable, and use 300-unit "Novolin System" insulin cartridges (R, N, or 70/30 mix) and "Novofine 30" disposable replacement needles. Novo-Nordisk also offers "FlexPen" disposable syringes. These devices are smaller than a pen injector, hold 300 units of R, N, or 70/30 mix insulin, and are packed five syringes to a package. Costs are comparable to the cost of cartridge replacements for the Novolin Pen.
Novo Nordisk also offers the Innovo "memory doser," that displays the time and amount of the last dose (but is of little use to the visually impaired and none to the blind), and the unique InDuo, a large, very tactile doser. The InDuo uses conventional 300 unit cartridges and pen needles, but its huge "egg timer" dial and oversized "trigger" make it perhaps the most tactile pen of all.
Novo Nordisk pens now use the 300 unit cartridges, but the company also offers insulin cartridges for the older "Novo Pen 1.5" insulin pens, and for other pens licensed to use their system.
The Government requires the following statement on all insulin pen devices: "None of our devices are recommended for use by blind or visually impaired persons without sighted aid." Note: lots of blind and visually-impaired diabetics successfully use insulin pens. The secret is proper training.
The Autopen is a British-made insulin pen injector, designed to use either the Novolin system cartridges and disposable needles or those made by Eli Lilly and Company. In the U.S., marketer is Owen Mumford, Inc., 849 Pickens Industrial Drive, Suite 12, Marietta, GA 30062; telephone: 1-800-421-6936. The Autopen is available in two versions: a one-unit increment (administers up to 16 units) and two-unit increment (up to 32 units) pen, differentiated only by color. Each pen features audible clicks for each increment drawn. Cost: $40 each.
Becton Dickinson Corporation (in partnership with Eli Lilly and Company) offers the B-D Pen. Similar to the Novo Nordisk and Mumford pens, the system dispenses 150 units of R, N, Humalog, or 70/30 insulin, in one-unit increments, from one to 30 units. Although B-D does not specify a "suggested list price," the pen should cost about $40. B-D also offers a "pen magnifier" (similar to the syringe magnifiers described below) that clips to the pen to aid low-vision operation. This magnifier is available free of charge, by calling Becton-Dickinson at: 1-800-237-4554. Available at most pharmacies.
Eli Lilly and Company (Lilly Corporate Center, Indianapolis, IN 46285; telephone: 1-888-885-4559 (Web site: http://www.humulinpen.com) Offers the pre-filled Humulin and Humalog pens, and the new Humalog 75/25 pen. These are disposable prefilled syringe devices, holding 300 units of Lilly's Humulin 70/30. Humulin N, Humalog, or Humalog 75/25 insulin. These pens (which require detachable pen needles such as the Becton Dickinson Insulin Pen Needles, sold separately) adjust in single-unit increments, with an audible click for each unit. They have a clear plastic barrel, and a magnifying dose window to help show the correct dose. Suggested retail price: $40 (package of five pens).
The Disetronic Pen is a very different device, with an "open system" 315-unit cartridge that the user fills with any prescribed insulin. This pen does not use specialized needles, but rather any conventional syringe needle (27- through 30 gauge recommended). The company claims the load-it-yourself feature makes it cheaper to use in the long run. Cost: $95. Available from: Disetronic Medical Systems, 5201 E. River Road, Suite 312, Minneapolis, MN 55421-1014; telephone: 1-800-280-7801; Web site: http://www.disetronic-usa.com
The Insul-Eze 6000, manufactured by Palco Labs (listed above) is a syringe-and-vial holder incorporating a full-length 2x lens, allowing the insulin-drawing operation to be closely monitored. Insulin vials can be changed for mixing without disturbing the syringe. Adaptable, the Insul-Eze works with most types of syringes in the 30-, 50-, and 100-unit size. Cost: $11.
The Truhand, a device similar to the Insul-Eze, is offered by Whittier Medical, Inc., 865 Turnpike Street, North Andover, MA 01845; telephone: 1-800-645-1115. It allows use of different syringe types and sizes, and firmly holds the vial, while providing a 3x magnified view of the scale. Vials can be changed for mixing without disturbing the syringe. Cost: $29.95.
The Magniguide, offered by Becton Dickinson Consumer Products, One Becton Drive, Franklin Lakes, NJ 07417-1883; telephone: 1-800-237-4554, is another syringe magnifier. It attaches to the insulin vial, and provides 2.5x magnification, to aid needle insertion, precise dose measurement, and location of bubbles in the syringe. The Magniguide is available (Cost: $3.95) from Independent Living Aids, Inc., 27 East Mall, Plainview, NJ 11803-4404; telephone: 1-800-537-2118.
The Syringe Magnifier fits all 1/2cc and 1cc syringes, and clips to the syringe barrel, magnifying the scale 2x to aid precise dose measurement. Manufactured by: Apothecary Products, Inc., 11750 12th Ave. South, Burnsville, MN 55337; telephone: 1-800-328-2742; http://www.apothecaryproducts.com/. The device does not affect needle insertion, which must be done visually. Cost: $4.49.
The Diabetes Action Network of the National Federation of the Blind is a support and information network for all diabetics. We have many members willing to share their expertise in nonsighted techniques of diabetes self-management. If you have any questions about diabetes and/or blindness, feel free to contact us.