Facilitating intensive conventional insulin management using a manually operated syringe injector

A manually operated 3-ml insulin catheter and syringe injector system was evaluated in 26 insulin-dependent ketosis-prone patients for a mean of 11 months per patient. Eighteen patients had normal kidney function, 5 had renal insufficiency (plasma creatinine 2.0-4.8 mg/dl) and 3 had successful kidney transplants. Regular insulin was infused 15-30 min before each meal. The subcutaneous route of delivery was used in all patients except the 3 renal transplant patients who received regular insulin intraperitoneally through a chronically placed intraperitoneal microbore catheter. Basal insulinization was obtained using subcutaneous long-acting insulin. Blood glucose control improved in all 3 groups of patients. Mean blood glucose decreased from 203 +/- 10-118 +/- 3 SEM; hemoglobin A1 decreased from 12.5 +/- 0.4-9.2 +/- 0.25 SEM (normal range 5-9%). We conclude that a manually operated syringe injector can be used to make multiple dose insulin management less painful and more convenient. The injector can be worn and activated beneath clothing and also worn while showering or swimming. Yet it can be removed while sleeping, when sexually active or when engaged in strenuous athletic activity.