CA1169323A

CA1169323A - Insulin infusion device

Info

Publication number: CA1169323A
Application number: CA000353268A
Authority: CA
Inventors: Anthony M. Albisser; Bernard Zinman
Original assignee: Individual
Current assignee: Individual
Priority date: 1980-06-03
Filing date: 1980-06-03
Publication date: 1984-06-19
Also published as: DE3121888C2; CA1169324A; FR2486403A1; LU83407A1; SE8103469L; US4601707A; GB2077110A; DE3121888A1; SE444509B; BE889071A; CN1169324A; FR2486403B1; NL8102652A; JPS5722761A; GB2077110B

Abstract

ABSTRACT OF THE DISCLOSURE

The invention provides an improved device for the injection of medicament such as insulin subcutaneously. The device provides discrete regular injections from a tube adapted to contain the medicament and having a vented first end. Medicament is squeezed from the tube through its other end in discrete amounts programmed to provide a basal injection rate. Additional discrete injections can be provided at the user's discretion thereby providing the user with sufficient flexibility to control sudden demands for medicament while nevertheless leaving the basal injection schedule essentially uninterrupted.

Description

1 ;1 6~3~3 This invention relates to a device for controlled subcutaneous injection of medicaments such as insulin in discrete ~uantities at selected timed intervals to provide a user's daily requirement at a basal rate, and for permitting additional discrete quantities at time of increased need at the discretion of the user.
Although the present invention will be decribed for use with the treatment of diabetes mellitus, it will be apparent that other treatments requiring similar extended periods of injection of a medicament are possible using the same device.
The current standard therapy of insulin dependent diabetics with depot insulin injections fails to normalize entirely plasma glucose levels as well as the other metabolic abnormalities of the diseaseO The consequences of this imperfect metabolic regulation are believed to significantly contribute to the long term chronic and disabling complications of diabetes mellitus. Recent studies employing crude mechanical devices designed to infuse insulin continuously or by multiple small injections to meet fluctuations in daily requirements have shown a marked improvement in glycemic and other metabolic and hormonal profiles in diabetic subjects.
Although such mechanical devices are an improvement over daily injections, they nevertheless suffer from `:. ~, ' ~ ., ' , 3 ~ ~

disadvantages which -the present invention is intended to overcome.
For a mechanical device to be acceptable for subcutaneous injection of insulin and the like, the device should be compact, and readily located on the pa-tient adjacent sites where a needle can be inserted subcutaneously. Preferably the device should be capable of providing a basal rate of injection while at the same time being capable of use to provide discrete additional doses at the patient's discretion and as directed. The device should also provide a visible and readily recognized indication of whether or not the device is working as well as the amount of medicament injected and the amount remaining in the device. Preferably the user should be able to over-ride the driving mechanism of the device so that in the event of complete failure, the device can be used manually for sufficient time to permit the user to seek help.
In accordance with the present invention there is provided a device for the subcutaneous injection of a predetermined volume of liquid medicament over a predetermined time interval, the device comprising:
a timer for producing a preselected number of individual pulses at regular intervals;
a flexible tube for containing all of the predetermined volume of liquid medicament;
drive ~eans in direct contact with the tube to change the volume of the tube for dispansing medicament from the tube;

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means coupling the timer to the drive means for dispensing the medicament in a series o~ discrete amounts in response to the pulses ~rom the -timer, the number of pulses being preselectable by the user to cause the drive means to dispense the predetermined volume o-f the liquid medicament;
a catheter coupled to the tube for receiving the medicament and in~ection the medicament subcutaneously.
The invention will be better understood with reference to the following description taken in combination with the drawings, in which:
Fig. 1 is a perspective and somewhat diagrammatic view of a preferred embodiment of a dévice in position on the user's wrist;
Fig. 2 is a sectional view o~ the device showing the relationship between a nip and a tube containing medicament such as insulin;
Fig~ 3 is a schematic diagram illustrating the control mechanism used in the device; and ~ ig. 4 is a view similar to Fig. 3 illus-trating an alternative embodiment o~ the control system.
Reference is first made to Fig. 1 which illustrates a preferred embodiment o~ the device designated generally by the numeral 20 and shown positioned on a user's wrist. In this embodiment the device is attached by a band 22 and is feeding insulin tor other medicament) subscutaneously by way o~ a needle 24. The needle is attached in conventional ~ashion by adhesive strapping 26. It will be seen that the device includes a fixed scale 28 cooperating with a moving element 30 .
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~ ~ 6~3~3 having a pointer adjacent the scale. This pointer indicates the number of discrete pulses of insulin available from the device and not yet used.. ~ith each pulse the pointer moves one division of the scale and these pulses are timed as will be described. Also visible in Fig. l is a small handle 32 which can be lifted from the plane of the dial 28 to rotate a spindle 34 for winding a clockwork mechanism thereby storing energy for use in moving insulin to the needle 24. The handle is arranged so that it must be lifted out before it can be turned so that it over-rides an escapement mechanism which is to be described. Such arrangements are conventional in clockwork machinery generally. For instance a similar arrangement is used when setting the time on a mechanical clock.
As also seen in Fig. 1, the housing of the device contains a small flush button 36 which permits the user to ;~
over-ride an electronic timing circuit to provide a desired number of extra pulses of insulin which pulses are readily visible by the movement of the element 30 and associated pointer around the scale 28. This permits the user to receive increased dosage of insulin prior to meals and at other times of increased demand. However such extra dosing will not affect the basal rate indicated by prior programming of the device as will be described.
Tarning now to Flg. 2~ which is a section of the :; :

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3 ~ ~-3 device shown in Fig. 1, there is a housing 38 disposed about a central axis 40 and de~ining a cavity having an outer wall 42 which is disposed about the axis 40. This wall is positioned to restrain a flexible tube 44 of larger inside diameter having a vented or open end 46 and connected to a further tube 48 of substantially smaller inside diameter leading to the needle 24 (Fig. 1). A roller 50 is held in position by a structure not shown in Fig. 2 on a pin 52 and is restrained to move about the axis 40 forming a nip between the roller 50 and the outer wall 42. Consequently as the roller is made to move about axis 40, there is a displacement of liquid contained between the nip and the needle through the needle causing subcutaneous injection. The inside diameter of the tube 44 is chosen so that deLivery from the needle corresponds to the calibration on the fixed scale 28.
A preferred embodiment of a control circuit is shown diagrammatically in Fig. 3. A CMOS (complementary metal oxide semiconductor) variable frequency oscillator is used to create a square waveform which is fed to a CMOS divider. The frequency of the waveform can be varied over a range of 8 to 1 by a control 54 and it is possible to identi~y the frequency from a test point 56. The waveform leaving the oscillator 53 is shown diagrammatically in Fig. 3 and the divider then reduces the frequency resulting in intermittent pulses which are then fed to a stepper motor driver. An associated motor .

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drives a pinion 58 which is in engagement with a gear wheel 60. The gear wheel carries the pin 52 (Fig~ 2) associated with the roller so that each impulse ~rom the CMOS divider causes the stepper motor to advance the pinion 58 a discrete amount which in turn moves the gear wheel 60. As a result the nip moves around the housing 38 sufficient to cause medicament to be injected subcutaneously.
It will be appreciated that the power required to drive the stepper motor may be available from a miniature battery of the type used for the electronics necessary to drive the variable frequency oscillator and the divider.
Although the connections have not been shown, it ls obvious that additional power could be provided to the stepper motor by way of a separate battery or any other convenient means.
If necessary, an additional battery for this purpose could be attached to the strap 22 of the structure shown in Fig. 1 or remotely as preferred.
Although the preEerred embodiment has many advantages, it will be appreciated that it can take difEerent forms. For instance it could be attached to a patient's abdomen which may be advantageous in some instances but of course makes the visual display less convenient than that shown in Fig. 1.
The structure associated with the stepper motor and roller forms in effect an escapement mechanism. An ~;
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~ .5 8~3~3 alternative escapement mechanism is shown in Fig. 4. As with the structure shown in Fig. 1, a variable frequency oscillator and divider are used but the pulse provided by the divider is fed to a solenoid actuator which again may be fed by an independent battery source. This actuator operates a solenoid 62 and a mechanical rocking escapement element 64. This element is associated with a wheel 66 which, with respect to the roller 50 (Fig. 2) corresponds to the gear wheel 60 shown in Fig. 3.
To use the inventive devices, a user would take a new disposable tube and needle assembly from a sterile package and insert the pump tube into the housing to take up the position shown in Fig. 2. The user would then advance the handle 32 (Fig. 1) in a counter-clockwise direction until the pointer on the element 30 indicated the number of units -to be dispensed during the following 24 hours. The protective needle guard would then be removed from the needle and the needLe inserted into a insulin vial before advancing the timing mechanism (and the arrow on element 30 to zero) to e~pel the air in the tube into the insulin vial. After this has been done, the element would be reversed to aspirate the total daily dose of insulin required ending when the pointer had reached a figure on the scale 28 correspondong to the anticipated need for the day.
Following this the user would then insert the needle into the subcutaneous tissues, tape it in place and tie the ., ..

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3 ~ 3 h~nd 22 about the arm in watch-like fashion~ Alternatively it could be attached by adhesive or by a belt to the abdomen.
The advancement of the mechanism would depend on the escapement mechanism so that at nominal settings a 1 unit quantity of insulin would be administered each hour. For patients requiring more insulin, the fundamental frequency of the timer device can be adjusted by the control 54 (Fig. 3) so that it advances at a rate slightly more often than once an hour. Conversely, ~or a patient requiring slightly less insulin, this electronic timer can be adjusted in such a way that intermittent injections in the basal period occur less than once per hour. These adjustments would be made by technical staff at the direction of the user's medical adviser.
The propulsion mechanism of the pump includes a watch ~5 or clock spring which is rewound each day by the patient during the filling cycle. It is biased in such a way that the spring is always under tension. The control o~ the device by the electronic timer is with a safety escapement mechanism which prevents the accidental injection of the entire contents of the pump tube so the device can only fail safe by not injecting insulin. Lifting the handle 32 (Fig. 1) overcomes this safety feature and allows the device to be set manually~
At mealtime the device is actuated by depressing the flush button 36 on the surface of the housing which would in turn activate the el-ctronlc escapement mechanlsm and advance g .,, ~
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the device by 1 calibrated graduation, thereby administering 1 unit of insulin. Patients will be instructed by their physicians initially on the use of the device and will adapt their insulin regimen according to their dietary habits. In this way, meal insulin may involve amounts of insulin ranging between 2 and 15 units, depending on the type of the meal and the patient's requirements.
This is a novel device which is an improvement over existing devices in that it uses an electronically controlled escapement mechanism for the control of the administration of a drug. The device does not include an external reservoir to contain the drug and only contains enough drug for a single day's use. On successive days, the patient replaces the disposable portion, recharges it and resets the mechanism.
The adjustment of the electronic timer mechanism allows the establishment of a suitable basal rate. It will be appreciated that the pump tube is vented and only orms a reservoir in so far that it is contained between the nip and the needle. Furthermore, because of the intermittent application of insulin, the device is not suitable for the treatment of diabetes by intravenous insulin delivery During the long time between pulses, blood would diffuse into the needle and eventually clot in situ preventing the pump from ad~ancing or distributing insulin and there is a risk that the pump will overcome the resistance of the clot and inject this :, , . -- 10 --``; ~

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-. i ~6~3~3 into the circulation with adverse aEfects. It is also foreseen that the use of a needle in the blood vessel would not be an appropriate method for gaining access thereto, but it is foreseen that in some circumstances, a so~t rubber catheter in lieu of the needle could be placed in the subcutaneous tissue for the delivery of insulin for longer periods of time than a day. This particular alternative configuration may be useful in animal studies.

SUPPLEMENTARY DISCLOSURE

Figure 5 is a sectional side view of the end of a tube used in an alternative embodiment of the invention and drawn to a larger scale than Fig. 1.
Alternative pump tube structures could be used within the scope of the invention. The vented end of the tube could include a one-way valve or flap to allow air to be expelled but which limits air flow back into the tube. In this case the tube would simply collapse behind the roller as medicament is dispensed. Another pump tube can be sealed at the end as seen in Fig. 5. In this embodiment the end of the tube is closed by a small stopper or bung 68 having a thin wall or septum 70.
In use the pump tube shown in Fig. 5 is filled using a syringe and needle which pierces the septum. Once full o medicament, the pump tube is placed in the device and after reassembly, the over-ride is used to move the pointer to register with the number if discrete injections required~ The outlet tube 48 is then connected for injecting the remaining :

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3 ~ 3 medicament in the same manner as described previously. BecauSe the tube is not vented it will si.mply collapse behind the roller as the medicament is dispensed in front of the roller.
These and other modifications are within the scope of the invention as described and c]aimed.

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Claims

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:

1. A device for the subcutaneous injection of a predetermined volume of liquid medicament over a predetermined time interval, the device comprising:
a timer for producing a preselected number of individual pulses at regular intervals;
a flexible tube for containing all of the predetermined volume of liquid medicament;
drive means in direct contact with the tube to change the volume of the tube for dispensing medicament from the tube;
means coupling the timer to the drive means for dispensing the medicament in a series of discrete amounts in response to the pulses from the timer, the number of pulses being preselectable by the user to cause the drive means to dispense the predetermined volume of the liquid medicament;
a CATHETER coupled to the tube for receiving the medicament and injecting the medicament subcutaneously.

2. A device as claimed in Claim 1 wherein the drive means is rotatable and all of the predetermined amount of medicament is dispensable within a single revolution of the drive means.

CLAIMS SUPPORTED BY THE SUPPLEMENTARY DISCLOSURE

3. A device as claimed in Claim 1 in which the flexible tube has an end structure adapted to prevent air flowing into the tube as the liquid medicament is expelled from the tube.

4. A device as claimed in Claim 3 and further including a dial coupled to the drive means to indicate the number of energy pulses available, and hence with reference to a starting point, how many have been used.