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    Insulin Pens - Types, Advantages & How To Use

    Most of the people with type 2 diabetes eventually require insulin. The transition from diet control, lifestyle changes and oral medicines to injecting insulin are not as tough as you might think. One of the most important parts of type 2 diabetes management is controlling one's blood sugar. According to doctors, there could be various scenarios which might require insulin treatment to begin for the patient (especially in cases where the patient has significant hyperglycemia). The need for insulin might be short-term or for a longer duration in case of uncontrolled diabetes where the patient is on multiple diabetic medications [1] .

    The most ideal and convenient way of administering insulin is with the help of insulin pens. Insulin pens are a great hit among the working class due to their ease of carrying and administering. Insulin pens are preloaded and relieve you of the tension to draw up insulin into a syringe every time [2] . Read on to know more about insulin pens, its types, benefits and how to use them.

    Insulin Pens

    What Are Insulin Pens?

    Insulin pens are rapidly growing in popularity. These are used by people to inject insulin in the simplest, safest and painless way. The pens include insulin cartridge, a disposable needle and a dial to measure dosage [3] . Insulin pens are by far the best discovery made in terms of insulin administration when compared to the hassles associated with the vial and syringe method.

    Managing diabetes might require you to have insulin shots multiple times a day. Insulin pens do not eliminate the need to poke yourself with a needle, instead, it makes the measuring and delivering of the insulin much easier.

    The insulin pens can deliver insulin within the range of 0.5 to 80 units each time. The insulin delivered can be done in increments - one-half unit, one unit or two units. However, the type of pen used might determine the maximum dose possible and the incremental amount [4] . The amount of insulin units in the cartridges also varies.

    Disposable insulin pens contain a prefilled cartridge and one would need to throw away the entire pen when the cartridge is empty. On the other hand, reusable pens are the ones where you can replace the cartridge when it is empty [5] .

    The needles on insulin pens come in different thicknesses and lengths. However, most fit on all of the available insulin pens. Your doctor would be the best person to guide you as to which pen would suit you the best.

    Types Of Insulin Pens

    The two categories of insulin pens are [6] as follows:

    • Disposable: Contains a prefilled insulin cartridge. The entire pen will need to be thrown away once used completely.
    • Reusable: Contains a replaceable insulin cartridge. When the cartridge has been used up, it is discarded and a new one is put in place of the empty one.

    It is a good practice to use a disposable needle each time insulin is injected. If taken care of properly, reusable pens can last for several years.

    How To Choose An Insulin Pen

    It is important to have a discussion with your doctor prior to purchasing the insulin pen. There are several factors, as listed below, which play a role in the brand, model and category of insulin pen that you choose to use.

    Some of the general factors to consider are [7] as follows:

    • Size of the insulin dose that the pen can hold
    • The brand and type of insulin available
    • If reusable, then the material and durability of the pen should be considered
    • Incremental adjustments that can be made for the dose of the insulin
    • Size of the numbers on the dial indicating the dose
    • Indication of remaining insulin levels
    • Ability to correct dose levels
    • Level of dexterity required to use the pen

    How To Store Insulin Pens

    Unlike believed and followed by many, insulin pens do not require refrigeration once they have been opened (quite like vials of insulin). However, insulin pens should be refrigerated before their first usage. Once it has been initially used, it is sufficient to store your insulin pen in the room-temperature setting, away from direct sunlight [8] .

    Depending on the type of insulin that the pen contains, insulin pens stay in a good condition for a period of about 7 to 28 days (after the initial use) [9] . Nevertheless, keep a check on the expiry date printed on the pen or the cartridge. If it is way past the expiry date, then please do not use the insulin and discard it right away.

    Insulin pens should not be stored with the needle attached (even if the needle is new). Doing this could affect the sterility of the needle and also interfere with the insulin dose given.

    How To Use An Insulin Pen

    Each time you take out the insulin pen, do the following prior to using it [10] :

    • Check to ensure that the insulin is not clumpy. The insulin should look colourless and clear.
    • Check the expiry date (also check the type of insulin you are using - especially if you use more than one type of pen).
    • First, roll the pen between your palms and then gently tilt the pen.
    • Remove the cap of the pen.
    • Use sterile alcohol to clean the top of the pen.
    • Place the needle onto the pen (use a new needle each time).
    • Dial up the correct dose (always double-check the dose before injecting).
    • Choose a clean site to inject.
    • Unless instructed to do otherwise by your doctor, always hold the needle at a 90-degree angle when injecting.
    • Push the button to inject the insulin.
    • Wait for about 5 to 10 seconds after injecting just to ensure that all of the insulin has been properly absorbed.
    • Remove the needle from the pen and dispose it.

    Note: In case you have accidentally dialled in a too high dose of the insulin, then in most of the cases, the insulin pens have the ability to fix the mistake quite easily. Most of the branded insulin pens are designed to expel the excess insulin through the needle without it entering the skin. Few other pens give you the option to reset your pen to zero and then start over again.

    Insulin Pens

    Advantages Of Using Insulin Pens

    Research has proved that prefilled disposable pens are highly beneficial. People with diabetes find the use of insulin pens much more convenient than the conventional vial and syringe technique [11] .

    The primary reason being that insulin pens have been designed with such features (for instance dose accuracy and auto-shield needles) that insulin administration has turned convenient and safe.

    Research also proves that people who use insulin pens are more likely to read the dosing scale twice, which ensures that accidental wrong dosing does not happen. Insulin pens also facilitate people to stick to their insulin therapy routine better.

    Other advantages of using insulin pens are [12]

    • Ease of use, especially for children and the elderly
    • Delivery of accurate doses along with the ability to fine-tune
    • Portable and convenient nature of pens
    • Accurately pre-set doses using the dial
    • Small and thin needle that is almost painless
    • Prefilled and pre-set insulin levels serve as a time saver
    • Memory-enabled devices that display the last dosage time and amount
    • Easier storage and overall use

    Disadvantages Of Using Insulin Pens

    Some of the drawbacks of using insulin pens are [13]

    • All types of insulin cannot be used (insulin type dependent on the type of pen)
    • Expensive than the vial and syringe method
    • Two different types of insulin cannot be mixed
    • Can only be used for self-injection
    • Some part of the insulin might go wasted with each use (although this is highly dependent on the kind of pen used)
    • Usually not covered by health insurance carriers

    Cost Of Insulin Pens

    Insulin pens are cheaper compared to insulin therapy. Pens usually come in packs and you can just buy one at a time. Pens typically cost more than syringes/vials. In India, a single pen can cost you around Rs. 1650 (this might vary depending on the brand of the insulin pen being purchased). Many insulin pens do not come with the insulin cartridge and you might have to buy it separately, which might cost you about Rs. 450.

    Potential Risks

    Keeping a note of the expiry date of the insulin is essential. In case you use insulin that has expired or is not in a usable condition, then the insulin might not work correctly, or could have adverse effects as well. Always ensure that you check the condition of the insulin prior to usage and discard the insulin in case you see any form of tiny particles in it. These particles can plug the needle and prevent the delivery of the full dose of insulin [14] .

    Delivery of too much or too little insulin might occur in case you fail to double-check the dose that you have dialled prior to injecting. In case this kind of situation occurs, then monitor your glucose levels closely for sometime after injecting. Too much insulin can make your blood sugar levels drop down too low, whereas too little insulin can make your blood sugar increase to very high levels, which could be life-threatening [15] . Having a glucometer always comes handy in such scenarios.

    View Article References
    1. [1] Swinnen, S. G., Hoekstra, J. B., & DeVries, J. H. (2009). Insulin therapy for type 2 diabetes.Diabetes care,32 Suppl 2(Suppl 2), S253-259.
    2. [2] Ginsberg B. H. (2015). Clinical Use and Evaluation of Insulin Pens.Journal of diabetes science and technology,10(1), 162-163.
    3. [3] Thurman J. E. (2008). Analysis of insulin pen devices for the treatment of diabetes mellitus.Journal of diabetes science and technology,2(3), 482-483.
    4. [4] Hänel, H., Weise, A., Sun, W., Pfützner, J. W., Thomé, N., & Pfützner, A. (2008). Differences in the dose accuracy of insulin pens.Journal of diabetes science and technology,2(3), 478-481.
    5. [5] Thurman J. E. (2008). Analysis of insulin pen devices for the treatment of diabetes mellitus.Journal of diabetes science and technology,2(3), 482-483.
    6. [6] Juang PS, Henry RR. Treatment for Type 2 Diabetes. [Updated 2013 Sep 4]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Table 7, Different Types of Insulin Pens.Available from: https://www.ncbi.nlm.nih.gov/books/NBK278942/table/treatment-t2-diab.pentypecom/
    7. [7] Asamoah E. (2008). Insulin pen-the "iPod" for insulin delivery (why pen wins over syringe).Journal of diabetes science and technology,2(2), 292-296.
    8. [8] Gibbs, H. G., McLernon, T., Call, R., Outten, K., Efird, L., Doyle, P. A., Stuart, E. A., Mathioudakis, N., Glasgow, N., Joshi, A., George, P., Feroli, B., … Zink, E. K. (2017). Randomized controlled evaluation of an insulin pen storage policy.American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists,74(24), 2054-2059.
    9. [9] Poudel, R. S., Shrestha, S., Piryani, R. M., Basyal, B., Kaucha, K., & Adhikari, S. (2017). Assessment of Insulin Injection Practice among Diabetes Patients in a Tertiary Healthcare Centre in Nepal: A Preliminary Study.Journal of diabetes research,2017, 8648316.
    10. [10] Dang, D. K., & Lee, J. (2010). Analysis of symposium articles on insulin pen devices and alternative insulin delivery methods.Journal of diabetes science and technology,4(3), 558-561.
    11. [11] Shah, R. B., Patel, M., Maahs, D. M., & Shah, V. N. (2016). Insulin delivery methods: Past, present and future.International journal of pharmaceutical investigation,6(1), 1-9.
    12. [12] Pearson T. L. (2010). Practical aspects of insulin pen devices.Journal of diabetes science and technology,4(3), 522-531.
    13. [13] Thurman J. E. (2008). Analysis of insulin pen devices for the treatment of diabetes mellitus.Journal of diabetes science and technology,2(3), 482-483.
    14. [14] Gudiksen, N., Hofstätter, T., Rønn, B. B., & Sparre, T. (2017). FlexTouch: An Insulin Pen-Injector with a Low Activation Force Across Different Insulin Formulations, Needle Technologies, and Temperature Conditions.Diabetes technology & therapeutics,19(10), 603-607.
    15. [15] Davis, E. M., Foral, P. A., Dull, R. B., & Smith, A. N. (2013). Review of insulin therapy and pen use in hospitalized patients.Hospital pharmacy,48(5), 396-405.

    Story first published: Tuesday, March 12, 2019, 14:58 [IST]
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