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Painful
Bleeding
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inSite Quick Start Guide:


What is inSite?

This web application, inSite, is an insulin injection and infusion site tracker. It is designed to track where insulin was administered along with relevant associated skin site information. 

Information inSite is designed to track:

  • Average Site Blood Glucose (ASBG).
  • Bleeding.
  • Rash formation.
  • Unusual pain.
  • Periods of erratic blood glucose. 

This application also allows quick visual review of site data to help identify trends and problem areas.  

What is Average Site Blood Glucose (ASBG)? 

ASBG is a value created to help characterize injection and infusion skin sites. Several blood glucose meters and continuous blood glucose monitors make this value easy to find; however, some make it a manual calculation. ASBG does not need to be entered for inSite to be valuable. Just type “0” into the ASBG field to use inSite without this data, all other features will remain active. 

What is a "skin site?"

With an insulin pump:
Wherever an infusion set is inserted constitutes a skin site. ASBG is the average blood glucose value between the time an infusion set is placed to when it is removed. Since most infusion sites are changed every three days, the ASBG would be an average of all blood glucose data over that three day period. Skin sites should not overlap within a one month period. 

With injection therapy:
It is recommended to use an area of skin 2x2 inches (5x5 cm) over a three day period for all injections. Each injection should be 1/2 inch (1 cm, a finger width) from the last injection and each area should only be used once per month [1]. ASBG is calculated from all blood sugar data over this three days period.

Why use inSite?

inSite helps ensure proper insulin site rotation which leads to improved outcomes.

The largest survey ever conducted on patients with diabetes recently revealed that almost half do not rotate their injection sites correctly [2]. 

Further analysis of this study showed that individuals who did rotate their skin sites properly tended to have: less hyperglycemia, lower HbA1C, decreased amounts of lipohypertrophy, reduced glucose variability, and required less insulin each day [1]. 

inSite also helps identify skin sites that have recurrent issues.

Diabetes often seems unpredictable; however, patterns emerge when diligent records are kept and reviewed. Skin site issues such as bleeding, skin irritation, pain, and erratic blood sugars often follow this pattern. Using inSite consistently can reveal if areas of your skin are prone to problems. inSite can also help identify areas that consistently demonstrate irregular insulin or poor insulin absorption. These may be the first signs of lipohypertrophy or another skin problem. 

Who is inSite designed for? 

This application is for anyone using injectable medications for the treatment of any form of diabetes mellitus.

Individuals included in the following groups may find inSite particularly useful. 

  • Parents who are caring for young children with diabetes. Children between two and six years old are at the thinnest point in their lives. The reduced amount of subcutaneous fat increases the risk of intramuscular injection and pain [1]. There is also less skin surface area to spread injection sites across. 
  • Individuals using an insulin pump. Lipohypertriphy is the most common infusion site problem associated with continuous subcutaneous insulin infusion (CSII) therapy and the risk of lipohypertrophy increases with duration of CSII use [3].
  • Individuals using a GLP-1 analog such as exenatide (i.e. Byetta and Bydureon). These agents are known to cause skin nodules which may require specialized medical attention [4]. Additionally, since less research has occurred on these newer medications, users should pay particular attention to their injection site skin health.
  • Individuals with gestational diabetes using regular insulin. Regular insulin in know to change its absorption profile based upon injection location [1]. Varying absorption, even in healthier skin, can lead to unpredictable blood sugars. 
  • Individuals with diabetes who are pregnant. Pregnancy reduces the amount of abdominal fat thick enough for safe injection [1]. As the amount of skin appropriate for insulin administration decreases the need to maintain proper site rotation increases. 

How to get started with inSite?

Register

You may register by using you email address, Google account, or Facebook account. If you register by email/password, a verification email will be sent containing a link to complete your registration. You must complete your registration before you will be allowed to log in. 

Log in

Always use the same method to log in that you used to register. Upon logging in you will be ready to add your first skin site. Click anywhere on the image to mark it. The application will not let you place a new site maker directly on top of any displayed marker. This is by design; inSite wants to promote a more even distribution of injection and infusion sites. You may reduce the number of sites displayed; this will allow the placement of new sites in frequently used locations.  

inSite Quick Start Information, click to enlarge.

Enter skin site information

ASBG is the only required field. If you do not wish to use ASBG, enter "0" for this value. Several users have reported that they track both insulin infusion sites and continuous blood glucose sensor sites with this app by differentiating them with two different, arbitrary, ASBG values (inSite color codes sites by ASBG). Data is stored to your secure account.

Review

Selecting "REVIEW" will prompt the user for a date range. The default date range is inclusive of the past 28 days. All sites for the selected date range are displayed. Mean and standard deviation for the date range is calculated, and sites with an ASBG greater than one standard deviation from the mean will be colored appropriately. Green represents lower ASBG values and violet indicates higher values. Users should note that a statistically normal distribution of ASBG values is expected to have 16% green and 16% violet colored coded sites. However, it should raise suspicion if the majority of green or violet markers tend to localized to one region of the body. The table below the image can be used to sort, filter, and highlight site data. 

Sign Out 

Please let us know if you have any questions, comments, or concerns through our "Contact Us" page. 

What is "Pay What You Want?"


Pay Want You Want (PWYW) is a pricing policy that places the consumer in control.

You get to decide not only if inSite provides value to your life, but also how much value. If you find this application and the information on this website valuable we simply ask that you make an appropriate payment. Many people are unaccustomed to this payment model, and request suggested prices. Therefore, the following was added to the checkout process. 

  • $1.00 - One month trial. Help cover the cost of initial development, web hosting, and ongoing security requirements. 
  • $4.00 - Unlimited annual access. Inclusive of the above costs, and adds support for continuous development and our growing database bandwidth needs. 
  • $10.00 - Our "Pay It Foward" tier. Inclusive of all of the above, plus coverage for those who cannot afford to pay and additional funds to accelerate development. 
  • $??.?? - PWYW. You decide. Use any thought process you desire to determine how much to pay, including "$0.00."  Users have reported paying an amount equivalent to the last ebook they bought,  the cost of their prior infusion site tracking system (pen and paper), their office visit insurance co-payment, and the amount inSite has helped them save in insulin cost by identifying skin sites with better absorption.

Whatever you decide, whether a trifling sum or a terrific act of generosity, is perfect.

We are also using inSite to help increase awareness of the skin complications associated with the treatment of diabetes and as a means to raise charitable contributions. During the PWYW checkout process, contributors will be asked to name their favorite charity. We will be donating 10% of all proceeds to our user's favorite charity next January.

References:

  1. Frid AH, Kreugel G, Grassi G, Halimi S, Hicks D, Hirsch LJ, et al. New Insulin Delivery Recommendations. Mayo Clin Proc. 2016;91: 1231–1255.
  2. Frid AH, Hirsch LJ, Menchior AR, Morel DR, Strauss KW. Worldwide Injection Technique Questionnaire Study: Injecting Complications and the Role of the Professional. Mayo Clin Proc. 2016;91: 1224–1230.
  3. Pickup JC, Yemane N, Brackenridge A, Pender S. Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey. Diabetes Technol Ther. 2014;16: 145–149.
  4. Jones SC, Ryan DL, Pratt VSW, Niak A, Brinker AD. Injection-Site Nodules Associated With the Use of Exenatide Extended-Release Reported to the U.S. Food and Drug Administration Adverse Event Reporting System. Diabetes Spectr. 2015;28: 283–288.