Has anybody used one? What was your experience if you did?
I am on a waiting list to get a jet injector from Activa. They said they wouldn't have one available for me until August/September, so I got a prescription and I am talking to insurance about getting it covered.
I've not used one, and although jet injectors have been around for a long time, they never really caught on. David Mendosa reviewed the jet injector seen in in 1999 and updated his review in 2009. There have been some minor changes in the last 15 years, they still are not used much and it appears that the annual cost is greater than syringes or pens, so insurance coverage may not be preferred (but almost everyone should cover them in some form) and costs will be higher.
Costs are higher? My syringe copay has shot way up is part of why I'm considering it.
When I spoke to somebody from Activa on the phone, she said annual costs are mostly determined by how many vials of insulin you use, because you need to buy vial adapters- one per vial. 4 vial adapters are $38.
I use 8 vials of Regular per year. I figure if I stop using syringes to inject Regular (at 3 shots of Regular per day, $0.20 per syringe, and 365 days per year, that's $219 dollars per year- insurance has me pay $50 quarterly if I use 3 or more syringes per day, so $200 per year), and my only ongoing cost is vial adapters (at $78 per year) then I have an annual savings of over a hundred dollars.
For me to use Lantus in a jet injector would cost money because I currently use only 8-10 units of Lantus per day and I live in the US, where Lantus is only available in 1000 unit vials and 300 unit pens, making pens a significantly better investment, and the jet injector doesn't work with pen vials.
So if you're in the situation of using 3 shots per day of short acting insulin, at an annual cost of syringes of $219 (whoever pays) or more if you use pens, then the jet injector has a lower annual cost if the only cost is vial adapters and you use no more than 23 vials per year (which is to say, about 63 units per day- I don't come close to that).
If you use 2 shots per day of short acting, the needles are costing $146 per year, so you'd need to use 15 or fewer vials per year (that's 41 units per day) to be saving money.
If you've been taking 4 shots per day of short acting, the needles are costing $292 per year, and you'd have to take more than 30 vials per year (82 units per day) to not be saving money.
It's true that if you use the jet to replace only one shot per day, then for it to save you money you'd have to use very few vials and they'd probably expire in that time anyways.
I have not included shipping and handling in my analysis; this cost obviously is at least partially dependent on where you live and how many sets you order at a time.
So annual cost is less than syringes or pen needles as long as the jet injector is replacing at least at least two shots per day and the person does not use a very large quantity of vials. I think a lot of type 1 diabetics fall into that category in terms of number of shots per day of short acting insulin and volume of insulin used.
And activa really seems to be aiming for the market of people using smaller amounts of insulin anyways; it allows dosing quarter units.
Activa is the only one of the companies in Mendosa's article that is still selling jet injectors to private individuals (I wrote to the companies whose websites didn't make that clear). The price is up at $695 and there is a waiting list to get one. It seems to me that the initial price is fairly large and insurance companies may figure that you have to use one for years- without breaking it- for them to see that investment pay off.
One endocrinologist, M. Arthur Charles, the director of the Diabetes Research Center in Tustin, California, is quite familiar with the J-Tip injector. He studied groups of seven and 10 patients using the J-Tip for 60 and 33 weeks respectively.
"It is very clear that excellent glucose control by each patient was maintained," he says, and "thus I have no hesitation to conclude that the jet injector delivers insulin appropriately. We really like this thing, and our patients really like it too."
Dr Charles was my endo for over 20 years until he retired. I remember when he got the study mentioned here. He was pretty excited about the jet injectors and I wish I could have gotten the chance to participate. From my conversations with Dr Charles, Mendosa pretty much summarizes why the things haven't caught on. I would like to have seen more discussion about the relative effectiveness of the jet injectors though.
Here's an abstract from a study that supports some of the findings that Dr Charles used to talk about:
So, it looks like there's improved absorbance of fast acting insulin using this method, which isn't suprising since the same dose is being delivered over a larger surface area instead of pooling in one location.
Jonah - are you saying your decision to use jet injector is on cost alone ?
And that you are calculating cost of syringes based on single use ? I'm using pump now, but when on MDI, I had used syringes for multiple injections before discarding them.
Bernstein actually admits he is a miser and has a terrible co-pay for syringes, so he reuses them until they are "dull." Whatever that means.
Not cost alone, but cost is definitely one factor.
I do use my syringes only once, although sometimes reuse pen needles. Maybe it's in my technique, but my syringe needles frequently come out bent. I'm also very concerned about scarring; I'm not six years into injections and I'm having significant absorption and scarring issues. I don't have much fat and know that de facto I'm doing muscle shots although that's not the intention.
Right now, pretty much every shot I do in my legs leaves a red dot and many leave lumps that stay lumped for a few days despite adequate absorption. My abdomen has significant scar tissue from surgery and doesn't get consistent absorption. My breasts were my main injection site for years but had been absorbing poorly lately so I'm back to thighs. My butt I use exclusively for Lantus but it is always bruised with lots of red dots. My arms look awful and have significant scarring.
My BMI has been the 19-20 range for the last three years, and I have exceedingly little tissue into which to inject.
The Activa person said that you can change the settings on the jet injector so that it's appropriate for any size person. I'm guessing that's one of the problems with using jet injectors with immunizations; you aren't setting the pressure settings to each individual each time- you can't even if you had time, because they're each getting one shot.
I used one for a couple years when I was diagnosed in 1994. Phew that was a long time ago . . .
Anyway, my take was that it was OK. Sometimes you would get some insulin on your skin, which obviously meant I didn't get the whole dose. Plus, I would get bruising - the more insulin you would dose, the more pressure it would exert. Also, you need a special cap to put on the bottle of insulin to extract it into the injector.
Good luck with it.
The more insulin you would dose, the more pressure it would exert? Interesting. I guess the special cap is the vial adapter.
Do you still have your old one? What type and brand of jet injector was it?
Did you use needles at any point and can you compare the experience? Was it a lot more bruising, a little more, about the same?
I get insulin on my skin after injections with the pens and the pen manufacturers say I still got my dose that way and it seems to be that I do, although I definitely wonder about that.
Keep in mind the last time I used one was in the 1999-2000 time frame (went on a pump at that point), not sure how much the technology has changed etc. I've used needles but not for an extended period of time. Based off my experience, I would go with needles now, but that is just me.
Don't have my old one anymore but it was a Medi-Ject.
Yes the more insulin, the more pressure . Special cap was the vial adapter.
If you don't want to do needles or a pump, it's nice to have another option out there.
I've never used one. I remember my dad's story about being inducted into the USAF in a line of guys waiting for shots w/ those and he explained that "you couldn't move. The guys who moved had blood running down their arms..." which was certainly freaky but it may also have been that I was like 8 or so? When I was in 2nd grade the doctor gave me a shot and I punched him.
Ohmy! Did he keep on being your doctor after that?
I think so but I didn't go that often back in the dark ages (c. 1974...)