BIOEDGE-FIRST COURSE-SEP 2019-TEAM-INSUGEN, BASALOG,INSULINS

Insulin Pen, Vials and Syringes

Insulin is absolutely necessary for people with type 1 diabetes. It’s often needed for people with type 2
diabetes as well. There are several types of devices available to deliver insulin, and each come with their
own set of pros and cons. The best insulin device for you depends on many factors, including how much
your blood sugar fluctuates each day and your lifestyle.

Insulin vials and syringes

Nowadays, cost is becoming an increasingly important factor to consider when deciding on a device. The
most common way to inject insulin is with a vial and syringe (needle). Syringes are considered the
cheapest form of insulin delivery, but they’re certainly not cheap — at least not anymore.

Pros of vials/syringes
 They’re the least expensive option

Cons of vials/syringes
 Patient need to carry around the vials and syringes
 Patient may require assistance during injection
 Less patient friendly
 Difficult to read and measure for people with vision or dexterity problems

Insulin Syringes
Insulin 100 IU Insulin 40 IU

Each mL contains 100 IU of insulin Each mL contains 40 IU of insulin

Only 100 IU syringe (orange cap) must be used Only 40 IU syringe (red cap) must be used with
with Insugen 100 IU vial Insugen 40 IU vial

Using a 40 IU syringe with insulin 100 IU vial will Using a 100 IU syringe with insulin 40 IU vial will
cause severe hypoglycaemia lead to under-dosage

Lesser volume of injection for a given dose of Higher volume of injection for a given dose of
insulin insulin
Insulin Pens
People with diabetes use insulin pens to inject insulin. The pens allow more simple, accurate, and
convenient delivery than using a vial and syringe.

Different types of insulin pens

Different brands and models of insulin pen are available. Most fall into two distinct categories:
disposable and reusable.

 A disposable pen: This contains a prefilled insulin cartridge. Once used, the entire pen unit is
thrown away.
 A reusable pen: This contains a replaceable insulin cartridge. Once empty, a person discards the
cartridge and installs a new one.

A person must replace the disposable needle after each injection of insulin. With proper care, reusable
insulin pens can last for several years.

Desirable characteristics of a good insulin pen

 Easy to set the dose
o Audible clicks when dialing
o Dialing mechanism should not slip
 Large and clear dose window
 The injection button should not stick out too much after dialling a dose
 Simple and easy dose correction if an excessive dose is set accidentally
 Highly accurate and precise
 Effortless and smooth while injecting

Parts of an insulin pen, needle assembly and insulin refil

Reusable and Disposable Insulin Pens
Competitors Reusable Pen Disposable Pen
Biocon INSUPen® Basalog One
Novo Nordisk NovoPen FlexPen
Eli Lilly HumaPen Ergo KwikPen
Sanofi-Aventis AllStar SoloStar
Wockhardt Wosulin Pen Royale Dispopen

Role of insulin pens in management of diabetes

 Children, Adolescents and young adults
o Accurate even at doses ≤5 IU
o Comfortably used in a public place
o Greater flexibility of meal times and eating habits
 Gestational diabetes mellitus
o Ease of use
o Greater convenience
o Flexibility
o More suitability
o Reduced therapy-related stress
 Elderly patients
o Easy dose setting and dose delivery
o Audible clicks
o Large dose display

Benefits of insulin pens over insulin syringes

 Easier and more convenient to use
 More accurate, especially at doses <5 IU
 More economical in the long run
 Equally efficacious in reducing blood glucose levels
 Safe with respect to incidence of hypoglycaemia
 Lesser pain and discomfort
 Socially more acceptable
 Greater flexibility of lifestyle
 Doctors spend lesser time on training patients
 Preferred by patients
 Better patient compliance
 Better perception of disease control
 Better quality of life
Features of an Insulin Pen

Feature Description

Dosing increment The smallest amount by which the dose may be increased. Most pens allow
dosing increment of 1 unit
Minimum dose The smallest possible single dose that can be administered. Most pens can
administer a minimum dose of 1 unit
Maximum dose The largest possible single dose that can be administered. Ranges from 30
units to 80 units
Dose knob Most pens have a single knob to dial as well as inject. Few pens have a
separate dose dialling knob and injection button
Two-way dose Enables dialling in the reverse direction if an excessive dose is dialled,
dialling without wastage of insulin

Audible click The sound heard when dialling a dose. Aids people with visual impairment
to count the dose
Dose window Shows either dark numbers on a light background or light numbers on a
dark background

Automatic return The number in the dose window automatically returns to zero after
to 0 injecting the dose

Insufficient dose Does not allow a patient to dial more units of insulin than that remaining in
indication the insulin Refil

Refil holder Holds 3 mL insulin Refil

Pen colour Pens are available in different colours or with stickers to indicate which
type of insulin they carry

Digital memory Pens with a digital display can remember the last dose and time since the
last dose of insulin

Parts of an Insulin Pen Needle

  Outer needle cap:
o Provides protection from the external environment
 Inner needle cap:
o Provides safety and sterility
 Needle:
o Administers insulin into the subcutaneous tissue
 Protective seal:
o Ensures safety and sterility
 Length:
o The length of the needle determines how deep the needle would penetrate
o Needles vary in length from 12.7 mm to 4 mm
 Gauge:
o The diameter or thickness of a pen needle is measured by its gauge (G)
o The greater the gauge number, the thinner the needle
o Thinner needles are associated with lesser pain
o Needles vary in gauge from 28 G to 33 G

Insulin injection technique using pens

1. Check the expiration date and that the insulin is the correct type and strength.
2. Wash hands thoroughly.
3. Insert a refil into a reusable pen.
4. If cloudy insulin, resuspend the insulin by gently rolling the pen between the palms of the hands.
5. Firmly attach a new needle to the pen.
6. Remove the needle caps while retaining the outer cap.
7. Wipe the front end of the refil with an alcohol swab
8. Priming (removal of air bubbles): tap the refil with the needle pointing upwards. Dial 2 units and
press the injection button until it stops and dose window shows '0'. You should see 2–3 drops of
insulin come out of the needle tip (repeat the process max. 5 times if drops are not seen).
9. Turn the dial to the correct dose.
10. Double-check the dose before injecting.
11. Clean the chosen injection site with alcohol, and allow the area to dry (Do not inject into areas
that have wounds or bruising).
12. Hold the pen to the injection site, being sure to following any instructions on the packaging.
13. Press the injection button.
14. Wait for 10 seconds before removing the needle from the skin.
15. Hold cotton on the injection site for 5 to 10 seconds, but do not rub the skin.
16. Remove and safely dispose of the needle and replace the cap on the pen.

Insulin Pen Do’s and Don’ts

 Do’s:
o Retract the plunger completely before inserting a new Refil
o Perform the priming step before injecting each dose of insulin
o Press the injection button straight down when injecting
 o During injection, when you see a '0' in the dose window: Hold the injection button down
and count to 10 seconds or count from 101 to 110 before removing the needle

 Donts:
o Do not insert used refil in insulin pen
o Do not use the same insulin pen if more than one type of insulin refil is prescribed

Storage and Handling

Remove the needle after every use. Do not store the pen with the needle attached as this will help
ensure sterility. It will also help prevent leakage of insulin, keep out air bubbles and reduce needle clogs

o Do not use water, alcohol, hydrogen peroxide, bleach or any other solvent to clean the pen
o Do not apply lubrication such as oil
o Store insulin pen out of reach and sight of children
o Insulin pen can be used upto 3 years