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Xu NY, Nguyen KT, Krouwer JS, Akturk HK, Shah VN, Klonoff DC. Retained Diabetes Devices-A Literature Review. J Diabetes Sci Technol 2023; 17:1676-1685. [PMID: 35787699 PMCID: PMC10658684 DOI: 10.1177/19322968221105895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes management and treatment requires the use of many devices that frequently must puncture the skin, creating a risk of unintentional retention in the body as a retained diabetes device. In this article, we reviewed case studies about retained diabetes devices and presented analyses of the success rate of current imaging techniques in identifying retained devices and the success rate of device removal. METHODS PubMed and Google Scholar were searched for articles about retained diabetes devices. Relevant articles that included sufficient details about discovery and removal of the device were included. The success rate of identification and the success rate of removal of retained devices were both calculated as percentages. RESULTS Sixteen case studies of retained diabetes devices were identified. These devices included parts of continuous glucose monitors and infusion sets, a lancet, and various types of needles for insulin injection. Each case is presented with details about the year of publication, the retained diabetes device, the company that produced the device, the age and gender of the patient, the type of diabetes that the patient had, the location of the device, the reason for initial discovery of the retained device, the process of locating the device, the success rate for removal of the device, and the removal procedure of the device. Analysis revealed a 100% success rate for the use of imaging technology including X-rays and computed tomography to identify a retained diabetes device. The patients with retained diabetes devices had a 62.5% success rate for eventual removal of the device. CONCLUSIONS With the increasing use of injected, inserted, and implanted diabetes wearables for digital health, it is likely that some of the devices will detach, break apart, or otherwise become retained in the body. It is important to be aware of available technologies to identify retained diabetes devices so that it will be possible in most cases to surgically remove these devices if they detach or become retained.
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Affiliation(s)
- Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | - Halis K. Akturk
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Stys J, Bernis K, Al Nofal A, Ryckman J. Fluoroscopy-assisted laparoscopic retrieval of retained abdominal wall and intraabdominal continuous glucose monitoring sensor wires. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
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3
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Kesserwan S, Lewis BE, Mao L, Sharafieh R, Atwood T, Kreutzer DL, Klueh U. Inflammation at Site of Insulin Infusion Diminishes Glycemic Control. J Pharm Sci 2022; 111:1952-1961. [PMID: 34986358 PMCID: PMC9880961 DOI: 10.1016/j.xphs.2021.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 01/31/2023]
Abstract
The approximation of euglycemia is the most effective means of preventing diabetic complications, which is achieved through effective insulin delivery. Recent reports indicate that insulin phenolic preservatives, which are found in all commercial insulin formulations, are cytotoxic, pro-inflammatory and induce secondary fibrosis. Therefore, we hypothesize that these preservatives induce an inflammatory response at the site of insulin infusion leading to diminished glycemic control and adverse pharmacokinetic outcomes. Insulin degradation by inflammatory cell proteases was quantitated following protease treatment in vitro. A modified murine air pouch model was utilized to evaluate the relative inflammatory responses following infusions of saline, insulin preservatives, and insulin, utilizing the adjuvant irritant thioglycolate. Blood glucose levels were monitored in diabetic mice with and without air pouch irritation. A pharmacokinetic analysis evaluated insulin effectiveness for diabetic mice between these two conditions. Inflammatory cells are significantly present in insulin preservative-induced inflammation, which effects diminished blood glucose control by both insulin uptake and degradation. Insulin containing these preservatives resulted in similar degrees of inflammation as observed with the irritant thioglycolate. These studies imply that the preservative agents found in commercial insulin formulations induce an intense localized inflammatory reaction. This inflammatory reaction may be responsible for the premature failure of insulin infusion devices. Future studies directed at reducing this inflammatory reaction may prove to be an important step in extending the lifespan of insulin infusion devices.
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Affiliation(s)
- Shereen Kesserwan
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Brianne E. Lewis
- Department of Foundational Medical Studies, Oakland University, William Beaumont School of Medicine, Rochester, MI, USA
| | - Li Mao
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Roshanak Sharafieh
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Thomas Atwood
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Donald L. Kreutzer
- Department of Surgery, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Ulrike Klueh
- Department of Biomedical Engineering, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA,Corresponding Author: Ulrike Klueh Ph.D., Department of Biomedical Engineering, Wayne State University, Detroit, MI 48202, , Phone: 313-577-1359
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4
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize the development of the photoactivated depot (PAD) approach for the minimally invasive and continuously variable delivery of insulin. RECENT FINDINGS Using an insulin PAD, we have demonstrated that we can release native, bioactive insulin into diabetic animals in response to light signals from a small external LED light source. We have further shown that this released insulin retains bioactivity and reduces blood glucose. In addition, we have designed and constructed second generation materials that have high insulin densities, with the potential for multiple day delivery. The PAD approach for insulin therapy holds promise for addressing the pressing need for continuously variable delivery methods that do not rely on pumps, and their myriad associated problems.
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Affiliation(s)
- Simon H Friedman
- Division of Pharmacology and Pharmaceutical Sciences, University of Missouri-Kansas City, School of Pharmacy, 2464 Charlotte Street, Kansas City, MO, 64108, USA.
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Sang AX, Lal R, August A, Danzer E, Buckingham B, Mueller CM. Fluoroscopic-assisted laparoscopic retrieval of retained glucose sensor wire from the omentum. Clin Case Rep 2019; 7:1717-1720. [PMID: 31534734 PMCID: PMC6745354 DOI: 10.1002/ccr3.2348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/24/2019] [Indexed: 11/08/2022] Open
Abstract
We describe a case in which retained wires from a continuous glucose monitor were removed from the abdominal wall and peritoneum of a 6-year-old boy. We highlight a concern for continuous glucose monitor use in children and discuss surgical techniques used to retrieve tiny, mobile objects from complex body cavities.
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Affiliation(s)
- Adam X. Sang
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
| | - Rayhan Lal
- Division of Endocrinology, Department of Medicine & Department of PediatricsStanford University School of MedicineStanfordCalifornia
| | - Auriel August
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
| | - Enrico Danzer
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
| | - Bruce Buckingham
- Division of Endocrinology, Department of Medicine & Department of PediatricsStanford University School of MedicineStanfordCalifornia
| | - Claudia M. Mueller
- Division of Pediatric Surgery, Department of SurgeryStanford UniversityStanfordCalifornia
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6
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Nuri T, Ueda K. Minimally invasive technique to remove broken insulin infusion needles: A case report. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.jecr.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
The extremity foreign body in a child has propensity of getting missed or mistaken diagnosis. We report our experience of extremity foreign body trauma in order to increase awareness of this disease entity. The retrospective series of 24 retained foreign bodies was based on a 10-year chart review of emergency data (ICD code Z18). Patients with both upper and lower limb affections were included. Patients with ocular, otolaryngeal, tracheobronchial, gastrointestinal, and axial foreign bodies were excluded from the study. Male predominance (M:F = 20:4), young patient age (mean 6.8 years), variable lag period for consultation (range 3 h-8 years), and majority lower limb affection (58%; foot [7; 29%] and knee [5; 20.8%]) were some characteristics of extremity foreign bodies trauma. The foreign bodies reported were metallic needle (7; 29%), rubber band (3; 12.5%), pellets (3; 12.5%), bangle glass (2; 8%), glass pieces (2; 8%) "dhaga," wooden twig, wooden thorn, ceramic earthen pot pieces, stapler pin, broomstick, and cracker piece in one case each (1; 4%). Postremoval, the wound healing was uneventful in all patients. Foreign body-related extremity trauma in children is a rare event. It has its own set of characteristics and differential diagnosis. Familiarity with the regional practices and customs is must to establish the circumstances/nature of the foreign body injury. The foreign body should preferably be removed in a well-equipped setting.
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Affiliation(s)
- Anil Agarwal
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India,Address for correspondence: Dr. Anil Agarwal, 4/103, East End Apartments, Mayur Vihar Phase 1 Extension, New Delhi - 110 096, India. E-mail:
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8
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Gopinathan NR, John R, Kanwat H, Sudesh P. Surgical Retrieval of an Impaled Tapestry Needle from the True Pelvic Cavity of a Child-An Unusual Case Report. J Orthop Case Rep 2017; 7:24-28. [PMID: 29242790 PMCID: PMC5727993 DOI: 10.13107/jocr.2250-0685.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Impalement injuries of pelvis have been reported in children but are uncommon. Impalement could be associated with injuries to deep organs, wound contamination, crush injuries, and in certain instances, can even be fatal. Case Report: We present a bizarre case of a 2-year-old female child who presented to us with a tapestry needle embedded in the true pelvic cavity after a history of fall on the buttock while playing at home. The impaled needle was eventually successfully extracted surgically using the modified Stoppa’s approach and the post-operative period was uneventful. We also briefly review the literature surrounding such unusual injuries and discuss tips and tricks regarding the surgical technique in such cases. Conclusions: In impalement injuries, adequate analgesia, tetanus prophylaxis, antibiotics, and immobilization must be given initially followed by meticulous pre-operative planning in the form of radiographs and computed tomography(CT) scans. Minimally invasive CT-guided extraction of needle can be attempted by an experienced interventional radiologist when there is no significant risk of damaging neighboring vital organs or neurovascular structures. The surgical approach if an open approachis decided must be chosen wisely; backup may be needed from an abdominal surgeon, urologist, or gynecologist in certain cases.
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Affiliation(s)
- Nirmal Raj Gopinathan
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
| | - Rakesh John
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
| | - Himanshu Kanwat
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
| | - Pebam Sudesh
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
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Sarode BR, Kover K, Tong PY, Zhang C, Friedman SH. Light Control of Insulin Release and Blood Glucose Using an Injectable Photoactivated Depot. Mol Pharm 2016; 13:3835-3841. [PMID: 27653828 PMCID: PMC5101575 DOI: 10.1021/acs.molpharmaceut.6b00633] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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In this work we demonstrate
that blood glucose can be controlled
remotely through light stimulated release of insulin from an injected
cutaneous depot. Human insulin was tethered to an insoluble but injectable
polymer via a linker, which was based on the light cleavable di-methoxy
nitrophenyl ethyl (DMNPE) group. This material was injected
into the skin of streptozotocin-treated diabetic rats. We observed
insulin being released into the bloodstream after a 2 min trans-cutaneous
irradiation of this site by a compact LED light source. Control animals
treated with the same material, but in which light was blocked from
the site, showed no release of insulin into the bloodstream. We also
demonstrate that additional pulses of light from the light source
result in additional pulses of insulin being absorbed into circulation.
A significant reduction in blood glucose was then observed. Together,
these results demonstrate the feasibility of using light to allow
for the continuously variable control of insulin release. This in
turn has the potential to allow for the tight control of blood glucose
without the invasiveness of insulin pumps and cannulas.
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Affiliation(s)
- Bhagyesh R Sarode
- Division of Pharmaceutical Sciences, School of Pharmacy University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
| | - Karen Kover
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States.,Department of Medicine, School of Medicine, University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
| | - Pei Y Tong
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States
| | - Chaoying Zhang
- Department of Endocrinology, Childrens' Mercy Hospital , Kansas City, Missouri 64108, United States
| | - Simon H Friedman
- Division of Pharmaceutical Sciences, School of Pharmacy University of Missouri-Kansas City , Kansas City, Missouri 64108, United States
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Moser C, Maurer K, Binder E, Meraner D, Steichen E, Abt D, Freund-Unsinn K, Hofer SE. Needle detachment in a slim and physically active child with insulin pump treatment. Pediatr Diabetes 2016. [PMID: 26201949 DOI: 10.1111/pedi.12297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Insulin pump therapy (CSII) is well established in pediatric patients with type 1 diabetes. In childhood diabetes, insulin pump treatment shows considerable advantages such as fewer injections, increased flexibility, fewer hypoglycemic events and lower HbA1c levels. Side effects such as catheter obstruction, technical pump failure, and dermatological complications have been observed, but are rarely reported. The reported patient is a physically very active and slim 10-year-old boy with reduced subcutaneous fatty tissue. After strong muscular activity an accidental rupture of the infusion set and needle detachment occurred in October 2013. X-ray and ultrasound imaging localized the needle in the musculus rectus femoris dexter. The needle was kept in situ and oral antibiotic treatment to prevent inflammatory reaction was prescribed. Repeated ultrasound measurements documented that the needles position had remained unchanged. Steel needle catheters (Sure-T infusion set, 6 mm) positioned in a thin layer of subcutaneous fat tissue of the thigh, combined with intense sports activity can result in a needle rupture and penetration into the muscle. Careful monitoring provides an alternative to surgery and lowers the risk of muscular necrosis. Because of differences in the distribution of subcutaneous fat tissue, an individualized catheter selection is necessary in pump treatment for children and adolescents, requiring a variety of different catheter sets.
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Affiliation(s)
- Christine Moser
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Maurer
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Binder
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dagmar Meraner
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Steichen
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Abt
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Karin Freund-Unsinn
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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11
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Abstract
An insulin infusion set (IIS) is a key component of insulin pumps. In daily practice issues with the IIS appear to be as relevant for a successful insulin therapy as the pumps themselves. The insulin is applied to the subcutaneous tissue via a Teflon(®) (Dupont, Wilmington, DE) or steel cannula. There are intensive discussions about the impact the choice of material for insulin application has on insulin pharmacokinetics. In this review, this factor and others that are known to have an impact on the successful usage of IIS are discussed.
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