The advantages of insulin pens
Do you know how to use insulin pens? Test your knowledge with this scenario for dispensary staff
Regular customer Nicola Hunt comes in with her daughter Emma.
"Emma has been diagnosed with diabetes and has to inject herself with insulin using cartridges and a pen," she says.
"The nurse at the surgery showed her what to do, but Emma says that she doesn't feel confident about doing it. I didn't go with her to the appointment, her dad did and he's at work now, so could you show us what to do? And why does she have to do injections at all? Surely in this day and age there's another way?"
1 What are the advantages of insulin pens over syringes? Are there any disadvantages? 2 How should the pen be used? 3 What can you suggest if Emma finds injections difficult? 4 Is there any other way of administering insulin?
1 The main advantage of insulin pen devices over syringes is the fact that the dose can be preset – this is particularly useful for patients with impaired eyesight or who are younger. Many patients also find them more discreet and portable, as well as easier to use.
On the flip side, not all insulins are available in cartridge or prefilled pen formats, and the devices do not lend themselves to mixing different insulin types (as some patients require). They are also more expensive.
2 To use an insulin pen, the cartridge must be loaded (checking the expiry date first) and the device shaken gently. Once a needle has been screwed onto the end and the pen primed to clear any residual air, the required dose should be "dialled in". Emma then needs to pinch a fold of skin on her abdomen, thigh or buttock, then push the needle in at 90° and press the plunger. After a few seconds, the needle should be removed from the skin, taken off the pen and discarded in a sharps bin.
3 Injecting is undoubtedly more painful if the patient is tense, but with practice comes confidence, which will make Emma more relaxed and the process much easier.
It is also less painful if the insulin has been allowed to come to room temperature rather than being used straight from the fridge. If Emma is very anxious, she could try an auto-inject device, which causes the needle to pierce the skin and the dose to be injected with just one press of a button. If she is worried about injections being painful, she could try temporarily numbing the injection site by holding an ice cube against the skin for a few seconds beforehand.
Rotating the injection side is a must as it prevents lumps forming under the skin, which not only make injections more painful but also cause insulin to be absorbed in a less predictable manner, which can cause fluctuations in blood glucose levels. Needles should be changed for every injection.
If this isn't possible (for example, Emma will probably need to carry her pen in her school bag), a fresh needle should be used every day. Injections should not be given through clothes, because of the risk of introducing germs from clothing into the bloodstream and because the fibres can interfere with the needle piercing the skin.
4 Subcutaneous injections (ie just under the skin) remain the administration route of choice for insulin because they are flexible and allow patients to follow routines that mimic the body's natural fluctuations in blood glucose levels.
