1999 did not produce any dramatic breakthroughs where syringes, insulin pens and injection aids were concerned. New products were minor variations or improvements on the same themes. As always, the focus of new injection devices is on less pain and more comfort. The cost-conscious consumer, however, wants durable products that deliver the least pain at the lowest cost. Often, it is hard for manufacturers to meet all these conditions.

This article is not intended to be a comprehensive review of all new injection devices - it is only a sampling of new products that have come to our attention.

On the whole, the 57 respondents who replied to our survey on injection devices preferred to stick with products which they were most familiar with. Most used syringes, either alone (19) or with one or more insulin pens (18). A few had tried injection aids such as Autoject 2 and Inject-Ease when they were first learning to self-inject but had abandoned these products once they became more familiar with the procedure of self-injection. Out of the 7 respondents who still use an injection aid, 4 are children and one adult is a self-confessed "wimpy" shooter. The few who tried the needle-less jet injectors were not impressed.

Syringes

In the category of syringes, Becton Dickinson (B-D) continues to dominate the U.S. market. Barry Ginsberg, MD, medical director for B-D, claims that nine out of every 10 insulin injectors in the United States use B-D syringes. This figure, however, is disputed by several competitors, who say more competitive pricing by other brands, such as Wal-Mart's ReliOn line of Ultra-Comfort syringes, have taken a bite out of B-D's market position. As syringes become ever thinner (and less painful), they also become less durable and more liable to damage. For many people who are uninsured or are living on a fixed income, cost and durability may be more important than comfort. Cost is one of the major reasons why many insulin-dependent people re-use their syringes. Perhaps to buck this entrenched consumer trend, B-D recently featured ads that emphasized the importance of using syringes only once.

Although some of our readers took strong exception to this particular B-D ad (see accompanying box), 17 out of a total 57 readers polled say they use some kind of B-D syringe. Of this group, satisfied B-D customers far outnumbered unhappy ones.

B-D claims that their Ultra-Fine III Short 31-gauge needles are the thinnest in the world. These have received favorable reviews from two parents on our survey who have insulin-dependent children. They said the short needles are not as menacing as the loner ones and injections can be done more discreetly in public. Becton Dickinson can be reached at 1-800-237-4554.

Since B-D still dominates the US syringe market, competitors have focused on making their products come up to par with B-D products. An example is Lite Touch-sterile syringes made by Miami-based Medicore. They come in four common sizes: 1/2 cc and 1 cc for both 28-gauge and 29-gauge syringes.

Perhaps in reference to B-D, Medicore's promotional material claims the Lite Touch syringes were "rated equivalent to the leading national brand by an independent testing laboratory." The syringes are marked with large numbers. Medicore can be reached at 1-800-327-8894.

Other newer syringes include:

• Delta Hi-Tech's Aimsco Ultra-Thin II short needles. These are 30-gauge needles, 5/16" in size, and are available in 1/2 cc or 1 cc models. For more information, call 1-800-378-0909.
• Abbott Laboratories MediSense Precision Sure Dose. These are available in 28 and 29 gauges, and can hold 3/10 cc to 1 cc of insulin. The newest addition is a 30-gauge short syringe which was launched last winter. Dosages are delivered in 1/2-unit increments. The company says the Precision Sure Dose's beveled plunger makes it easier to draw and minimizes air bubbles in the insulin. Also, the barrel is easy to slide. For more information, call 1-800-527-3339.
• Can-Am Care's Monoject 30-gauge short needles. These are 5/16" in size and are available in 3/10 cc, 1/2 cc and 1 cc models. For more information, call 1-800-461-7448.
• Wal-Mart's ReliOn Ultra-Comfort 29- and 30-gauge short syringes are available in 3/10 cc, 1/2 cc and 1 cc sizes. Wal-Mart claims that their syringes, at $12.58 for a box of 100 individually-wrapped syringes, are probably the least expensive nationally, especially for people without medical insurance. In a press release accompanying the launch of the 29-gauge syringe last May, Frank Segrave, divisional manager for Wal-Mart Pharmacy, says their syringes can save uninsured and insured customers up to 40% annually. Consumer feedback to Wal-Mart shows that 9 out of every 10 customer who tried the ReliOn brand of syringes would repurchase. "Half the price of B-D and just as good," was a typical consumer feedback. Call Wal-Mart at 1-800-925-6278.

Other national chains have also jumped on the private-brand syringe band wagon, including Drug Emporium, the Medicine Shoppe, Kroger, Valu Rite, K-Mart and Good Neighbor. More competition is always good news for the consumer, who can expect lower prices and better quality.

Insulin Pens

Insulin pens have been slow to catch on in the United States, in spite of the best marketing efforts by manufacturers and numerous surveys comparing pens favorably to syringes. According to Eli Lilly, only 4.5 percent of insulin-dependent Americans use insulin pens, compared to a 90 percent usage rate in Europe. The results of our electronic poll suggested otherwise: as many as 18 out of 57 respondents use a combination of syringe and insulin pen(s), and 6 used pen(s) only. Two pumpers who responded also use insulin pens.

Of the Diabetes Health readers we polled, the insulin pen users are quite happy with their pens. Many said insulin pens are great for dining out, convenient to transport, discreet and quick. A reader said his pen allowed him to measure his dosage without having to look at it. A few readers who were given free pens, either by their doctors or when they bought insulin cartridges, have stayed loyal to the same brands.

Cost was a deterrent for some, who said the pens (especially disposable ones) were too expensive. Lack of availability was another minus. One reader who uses only syringes says insulin pens do not offer the precise control that she needs. Another reader said one of the disposable pens (he did not specify the brand) was too bulky and noticeable because it had writing all over it and looked like a medical device. This same person said that the pens are often so quick and painless that he is not sure if he has had the injection.

Some readers were also confused about which insulin pens are disposable and which are non-disposable, and whether insulin cartridges made by one company can be used with the non-disposable pen made by another company. One reader from St Louis spent considerable time looking at her local pharmacies for an insulin pen that can deliver Humulin R, but found only Humulin N and Humalog disposable pens. When she called the Eli Lilly customer service number, she was told that Humulin R disposable pens are not available. In desperation, she turned to Diabetes Health. "Have you or your readers any information or suggestions on a pen to use with Humulin R?" she asked us. Hopefully, the following product profiles and our chart will help answer her question.

Newer pens include:

• The Disetronic Insulin Pen, made by Disetronic Medical Systems, Inc, was released last summer. Disetronic says the non-disposable pen is a good backup for pump users. Furthermore, the pen's flexible "open system" allows users to fill their cartridges with any type of insulin, and has the widest dosage range, allowing 1 to 80 units per injection. The Disetronic Insulin Pen is used with a 3.15 ml insulin cartridge and a 30-gauge needle. It has an easy-to-read LCD display, and audible and tactile clicks when dosing. For more information, call Disetronic at 1-800-280-7801 or visit their Web site at www.disetronic-usa.com.
• In addition to its Humulin 70/30, Humalog and Humulin N disposable insulin pens, Eli Lilly's latest pen is the Humalog Mix 25 Pen. Like the other three pens, the Humalog Mix 25 is a pre-filled, disposable pen. Its pre-mixed insulin contains 25% insulin lispro and 75% lispro protamine suspension (NPL). NPL is similar to NPH. The insulin is measured in single-unit increments and can inject a maximum dose of 60 units. For more information on these Eli Lilly products, call 1-800-545-5979.

Injection Aids

In general, people who benefit the most from injection aids are those with poor vision and tremors, needle-phobic adults and children, and people who are just learning to self-inject.

1999 saw the launch of two new products which cater to people with poor vision and or shaky hands.

• The Home Diabetes Aide, by Utah company KenTak, was rated the leader in insulin dosing accuracy by doctors and pharmacists in 1999. Like the Needle Aid, the Home Diabetes Aide would be of the most help to people with poor vision or shaky hands, or children afraid of needles. The device helps to guide the needle into the bottle, protects against accidental finger pricks, stabilizes the bottle to ensure the most accuracy, and helps to remove air bubbles. It fits either hand and can hold any brand of insulin bottle and any size of insulin syringe. The Home Diabetes Aide also has a magnifier which makes numbers look twice their size. It is dishwasher-safe and can also be refrigerated. The Home Diabetes Aide is sold as part of a Go Pack by The Home Diabetes Store. For more information, visit their Web site at
• The Needle Aid, launched in October 1999, targets people with vision problems or tremors, or children who are afraid of needles. The needle is hidden by the Needle Aid, thus making self-injection less threatening to children and needle-phobic adults. The device also ensures that the needle is positioned at the required angle and depth to avoid needle bending or breaking, or other potentially serious and painful complications. Needle Aid can be used with both insulin pens and syringes. It will be sold through major drug store chains throughout Canada, the US and the European Union. The company can be contacted at 902-895-8015.

Of the tried-and-true injection aids, Palco's Inject-Ease in particular received favorable reviews from two parents of insulin-dependent children: one child was a toddler, the other was 16. These parents liked the Inject-Ease because the child does not see the needle, the pressure of the device masks some of the pain of the shot, and both the speed and angle of the injection are "uniform." A mother of two type 1 boys, aged 9 and 11, is considering getting the Inject-Ease for them when they are older. An adult user of the Inject-Ease likes it because it is easy to use but faults it for being made from plastic that breaks too easily. Palco can be reached at 1-800-346-4488.

A 12-year-old likes the Monoject Injectomatic's aluminum spring-loaded injector and prefers it to the Palco device. On the other hand, an adult who had tried the Monoject did not like it because it was metallic and cold to the touch, and was not easy to use.

Two other respondents said they liked Can-Am Care's Monoject Injectomatic because the needle is hidden, there is no pinching or pain, and the device can be used anywhere on the body.

An adult reader likes Owen Mumford's Autoject 2 because it is easy and quick to use, and renders shots relatively painless. Owen Mumford can be reached at 1-800-421-6936. Another person liked the Medi-Jector EZ but regretted that it was not covered by her insurance company.