INSULIN MEASUREMENT DEVICES
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, non-sighted 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 for non-visual 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 manufactured by Jordan Medical Enterprises, 202 Oaklawn Avenue, South Pasadena, CA 91030; telephone: 1-800-541-1193. Cassette instructions are supplied. Its suggested retail price is $59.95, but the National Federation of the Blind (NFB) sells it for $40, the lowest price on record. Order through: Aids, Appliances, and Materials Center (hours of operation 12:30pm to 5:00pm 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 vial holder 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 non-sighted insulin measurement.
(NOTE: The NFB Materials Center also has a supply of the older, now discontinued, 1cc/100-unit Count-A-Dose. Operation is similar, but this device uses the B-D 100-unit syringe, and each click of the thumb-wheel draws two units. No cassette instructions. Price is $40.)
The Syringe Support: This device is manufactured in Canada, and is available in the U.S. from Cleveland Sight Center's Eye-Dea Shop, 1909 E. 101st Street, Cleveland, OH 44106-8696; telephone: (216) 791-8118, extension 278. U.S. price: $26. Instructions (standard print only) are bilingual (English and French).
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.
The Load-Matic: This device is available for $49.95 from Palco Labs, Inc., 8030 Soquel Ave. #104, Santa Cruz, CA 95062; telephone: 1-800-346-4488.
This device allows two different measurement increments: 10-unit and/or single units of insulin. It uses only 1cc/100-unit B-D syringes. Depressing the lever measures a 10-unit increment, and turning the dial one click measures a single unit. To mix insulins with the Load-Matic, as with the Syringe Support, it is necessary to remove and replace insulin vials from the device.
Although an intriguing design, the Load-Matic features an overly complex operating drill, with many opportunities for user error. Ambiguous and incomplete instructions take a high degree of familiarity for granted, and may confuse the inexperienced. Its 10-unit lever, if incompletely depressed, is capable of dispensing the unwary user an incorrect dose. The Load-Matic's cassette instructions tell the blind user to draw only about 700 units out of an insulin vial with the device, as "this assures that you will never draw air into your syringe instead of insulin." The printed instructions lack this statement. The instructions make no provision for removing air bubbles from the syringe, which can easily be accomplished by drawing four or five units of insulin, reinjecting them into the vial, three times, and drawing the full measured dose the fourth time (insulin mixers need do this only with their Regular insulin, the first they draw).
Homemade Insulin Measurement 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 must use a different gauge. You may need quite a collection! Gauges may be of a number of shapes (flat, corner-molding, tube...), and can be constructed of many different materials (wood, plastic, metal, old credit cards...), but most of them will 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.
Although many people make their own insulin gauges, out of all types of materials, commercial gauges are available. Meditec, Inc., 3322 S. Oneida Way, Denver, CO 80224; telephone: (303) 771-4863, offers Insulgages, flat plastic gauges analogous to the homemade types described above, but labeled in Braille with raised numbers. Priced at $9.75 each, these are cut for either B-D or Monoject syringes, and many sizes are available; one Insulgage per dose. Use of Insulgages in conjunction with the Holdease needle guide and syringe/vial holder, also sold by Meditec (cost: $15.75), enables non-sighted insulin measurement.
The best insulin gauges, homemade or commercial, 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 non-standard or homemade insulin measuring devices should only follow a thorough checkout of such devices.
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 Insulcap, a color-coded, tactile-cue equipped plastic fitting, attaches to an insulin vial and guides insertion of the syringe, holding the needle at the correct depth. The syringe won't shift and bend the needle, as the Insulcap holds the bottle to the syringe, freeing both hands for the filling operation. Offered by Palco (address above), the Insulcap is sold in sets of two: one blue, without tactile cues; and one orange, with tactile cues. Suggested retail price is $7.95. Individuals with low vision, arthritis, or other conditions causing unsteadiness may benefit, though those without sight would be better served by devices such as the Count-A-Dose.
The Ident-A-Cap, similar to the above, offers a selection of color-coded and tactile cues. Each package includes two different vial caps, which also attach to the neck of the vial, providing some nonvisual identification of the contents. (There are six choices--when you order, they will send you the right caps.) Cost: $1.99 for a package of two. Available from Diabetic Promotions; telephone: 1-800-433-1477; or from Terron, Inc., P.O. Box 958, Sanger, TX 76266; telephone: 1-800-862-2348.
The Unit Calibration Aid is similar to the Inject-Aid, but incorporates two adjustable preset stoppers, allowing two different doses or insulin mixing. It accepts all syringe types, but any adjustment of dose requires sighted aid. Made in Canada. Price $26 U.S.; available from Cleveland Sight Center's Eye-Dea Shop, address above. For liability reasons, I suspect, the manufacturer's instructions state the unit "has to be preset by a doctor or nurse."
Pen Injection Devices
NOTE: The FDA requires all insulin pen devices to carry the following warning on their package or instructions: "None of our devices are recommended for use by blind or visually impaired persons without sighted aid."
The Novolin Pens: Novo-Nordisk Pharmaceuticals Inc., 100 Overlook Center, Suite 200, Princeton, NJ 08540; telephone: 1-800-727-6500, produces a number of pen-type devices, and insulin in two different Novolin Penfill cartridge sizes: the familiar 150-unit, and the European 300-unit. The "Novolin System" insulin cartridge types are available in R, N, or 70/30 mix.
The Novo Pen 3 resembles the earlier Novo Pen 1.5, but uses the larger 300-unit cartridge. It measures doses in single-unit increments from one to 70 units. Suggested price $29.
Novo-Nordisk also offers "Novolin Prefilled" disposable syringes. These devices are smaller than a pen injector, hold 150 units of R, N, or 70/30 mix insulin, and are packed five syringes to a package; suggested retail price (package of five syringes): $25.
The Autopen is a British-made insulin pen injector, compatible with the Novolin system cartridges and disposable needles. In the U.S. it is marketed by Owen Mumford, Inc., 849 Pickens Industrial Drive, Suite 12, Marietta, GA 30062; telephone: 1-800-421-6936. It 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 is priced at $33.50.
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. The B-D Pen should be available at most pharmacies.
Eli Lilly and Company offers the Humulin and Humalog Pens. These are disposable, prefilled syringe devices, each holding 300 units of Humulin 70/30, Humulin N, or quick-acting Humalog 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 also have a clear plastic barrel, and a magnifying dose window to help show the exact dose. Contact: Eli Lilly; telephone: 1-888-885-4559; website: http://www.humulinpen.com
Insulin pump manufacturer Disetronic now offers a different kind of pen injection device. The Disetronic Pen (available by prescription only) utilizes an "open system" 315-unit cartridge that the patient fills with any prescribed insulin. The Disetronic Pen does not use specialized needles, but rather any conventional syringe needle (27- through 30-gauge recommended). Although the unit is priced higher than its competitors ($95) for the pen, the company claims the average user will find its you-load the insulin feature makes it cheaper to use in the long run. For information, contact Disetronic Medical Systems: 1-800-280-7801; website: http://www.disetronic.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 Ezy-Dose 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., of Burnsville, Minnesota, the device does not affect needle insertion, which must be done visually. Price: $4.95, available from LS&S Group, Inc., P.O. Box 673, Northbrook, IL 60065; telephone: 1-800-468-4789.
The Cemco Syringe Magnifier, available in three sizes (to fit syringes of 1cc, .5cc, and .33cc), is offered by Cemco-Marx, P.O. Box 275, Scandia, MN 55073; telephone: (651) 433-3374. The magnifier clips to the syringe and aids precise filling, but needle insertion into the vial must be done visually. Price: $5 retail, or $42 per dozen (any combination of sizes).
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 non-sighted techniques of diabetes self-management. If you have any questions about diabetes and blindness, feel free to contact us.