Thursday, March 15, 2012

Injections of my future

On Wednesday morning, I'll be seeing my endocrinologist. There's bloodwork I need. I may go over some of the blood sugar patterns that are driving me batty- unfortunately I suspect his recommendation will be switching from Lantus to Levemir and I don't really want to. I'll probably get a battery of bloodwork since I haven't been in since November- a CBC, A1c, TSH, a lipid panel. My A1c is probably going to be up a bit, so I'm not looking forward to seeing it. I'm thinking it'll be in the upper 6s. I'm probably due for a microalbumin test too. I was planning on having my nurse practitioner test my testosterone levels next month, but maybe I'll ask the endo to run those tests.

I'm planning to talk to my endo about getting a jet injector. I just got off the phone with a technician at Activa, a Canadian company that makes jet injectors. I forgot to ask if she thought insurance would help with the cost. In any case, there's a start up price of $695, to paid after they build the injector, and an ongoing price for vial adaptors. For each vial used with the jet injector, you use a new vial adaptor (meaning one disposable item per vial instead of per injection) and a pack of four of those is $38. Since I'm figuring on using this just for Regular, that would mean I'd need to buy two packs per year, since I'd use about eight vials of Regular per year. That would make the ongoing cost $78 per year for me if insurance paid nothing, vs $200 per year in copays for syringes. At a savings of $122 per year, it would take five years for the injector to pay for itself, and that's assuming that I stayed insured and my copays didn't increase (it's also assuming I won't need to buy syringes during that time, which may be a false assumption given that I inject testosterone as well). The jet injector comes with a two year warranty but existing customers can buy replacement jet injectors for under $200.

At this point, the only thing making me hesitate is the question in my mind about how long I'll be doing shots for. I see no advantage to me in the current insulin pumps available in the United States, because their pump+CGM combo doesn't change insulin administration based on CGM readings on its own. If and when the US gets a pump+CGM combo that features an automatic basal turn off based on low blood sugars, then I would be interested, although I'd first want to see how well I tolerated the sensors and infusion sets. The sof-sensors are not good enough for my skin. I was very disappointed to see that in Europe, where the Animas Vibe has been released, the Animas does nothing based on Dexcom readings. It just lets you use one receiver/monitor for the Dexcom CGM and Animas pump.
I think the soonest something I'd be willing to use would be available in two years. Realistically, I think it may be even longer, since Dexcom doesn't seem to going in that direction and minimed hasn't gotten FDA approval for the low glucose suspend or for the enlite sensors. And I'd need to try out the enlite sensors before switching to the pump because I'd want to be reasonably certain that the sensors were wearable for me as well as reasonably accurate; otherwise there'd be no point to having a pump that relied on them.
Anyways, if I figure I'd need to be needing injections for five more years before the jet injector paid for itself, then it might or might not end up paying for itself but I'm interested in trying something new anyways. Maybe it will really give me a better injection experience, anyways. That would be nice! And hopefully it will be nicer for the environment. And maybe with there being no needles, it would be sort of more discrete.


Nathan said...

The jet injectors are pretty futuristic, eh? Are they willing to allow you to test one out before you buy one. I'd be curious how it effects the tissue and what the pain is like. I'll be interested to hear how it goes.

Michael Hoskins said...

Good luck at the endo appointment, with everything and the jet injector discussion!