title: Self-injection of insulin using appropriate supportive devices in handicapped subjects with diabetes.
abstract: BACKGROUND
  To self-inject insulin, individuals with diabetes must be able to attach the needle to the injector, recognize the appropriate insulin dosage, detach the needle from the injector, and perform a series of operations necessary for the actual injection. These tasks require a grip strength that is strong enough to hold the necessary devices, eyesight, the use of both hands, and at least a minimum intellectual capacity. Subjects who are unable to grasp or handle the devices required for insulin injection often have difficulties with the self-injection of insulin.
  
  
  METHODS
  We treated four diabetes patients who had trouble grasping objects and using both hands. One patient had lost five fingers in an accident, two patients had suffered from ischemic cerebral infarction resulting in complete one-sided hemiplegia with no movement in one arm, and one patient had limited muscular power in an arm as a result of spinal cord disease. The plasma glucose control was poor, and the initiation of insulin therapy was necessary in each of these patients. In three cases, we used a commercially available self-injection device (HumaHelper; Eli Lilly Japan K.K., Kobe, Japan) to enable self-injection; in the fourth case, we used a newly manufactured device similar to HumaHelper.
  
  
  RESULTS
  All the patients were able to inject insulin by themselves using the appropriate supplementary devices. The blood glucose control of all the patients subsequently improved.
  
  
  CONCLUSIONS
  Existing or newly manufactured supportive devices can enable handicapped subjects to self-inject insulin.
authors.affiliation: Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Masuda
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aoki
authors.forename: Kaori
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Uru
authors.initials: U
authors.lastname: Nezu
authors.forename: Tomonori
authors.initials: T
authors.lastname: Muraoka
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shinoda
authors.forename: Akinobu
authors.initials: A
authors.lastname: Nakamura
authors.forename: Makoto
authors.initials: M
authors.lastname: Shibuya
authors.forename: Mayumi
authors.initials: M
authors.lastname: Takahashi
authors.forename: Mari
authors.initials: M
authors.lastname: Kimura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Terauchi
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D006233:Persons with Disabilities; D005260:Female; D006429:Hemiplegia / Q000150:complications; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007267:Injections / Q000295:instrumentation*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D012646:Self Administration / Q000295:instrumentation*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin