Insulin Pens

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Insulin pens are multidose devices in which a small disposable needle is twisted on and the dosage dialed in (Figure 1). Pens have been widely used in Europe

Insulin Therapy

Table 1 Insulin Pen Manufacturers and Products

Manufacturer

Product

Comments

Becton, Dickinson B-D Pen

800-237-4554

Disetronic

800-280-7801 Eli Lilly 800-545-5979

Novo Nordisk 800-727-6500

Owen Mumford 800-421-6936

B-D Pen mini

Disetronic Pen

Humalog NPH

Humalog Cartridges

In novo

Novopen 3 Novopen 1.5 Novopen prefilled

Cartridges Autopen

Uses any 1.5-cc cartridge—up to 30 units in 1-unit increments Uses any 1.5-cc cartridge—up to 15 units in '/2-unit increments Adaptor allows filling the reusable 3.15-cc cartridge with any manufacturer's insulin Disposable pens filled with 3 cc delivered in 1-unit increments

1.5-cc cartridges of Humalog, Regular, NPH, 70/30 for nondisposable pens from other companies Uses 3-cc cartridges; built-in memory with last dosage and elapsed time since last injection

Uses 3-cc cartridges—up to 70 units in 1-

unit increments Uses 1.5-cc cartridges—up to 40 units in 1-

unit increments Disposable pens of Regular, NPH, 70/30 filled with 1.5 cc delivered in 2-unit increments

1.5-cc and 3-cc Regular, NPH, 70/30 cartridges for nondisposable pens Uses any 1.5- and 3-cc cartridge; four models with different dosing range

Pen products available in the U.S. at the time this table was produced. Refer to manufacturers for current products and specifications. Insulin aspartis not shown but should soon be available from Novo Nordisk. Also, glargine from Aventis is available only in vials but reportedly pen-based delivery is under development. Pen and cartridge volumes are based on U100 insulin (100 units per cc).

Lantus Vial Volumes

creased dexterity or vision. Most pens have 1 -unit increments, but 1/2-unit increments (BD Pen Mini) and 2-unit increments also exist (Novo prcfills). Discreet, so injections can be given in public unnoticed. Multiuse, with less waste.

Reduced chance of dosage errors related to air bubbles. Often cheaper for patients who take small doses of insulin because the smaller volume of pen cartridges or prefilled pens (150-300 units versus bottles that contain 1000 units) means less wastage due to expiration of the opened insulin before being used up.

Smaller (31 gauge) and shorter (1/3") needles are available than can be found in syringes.

Disadvantages

Insulin cannot be mixed in pens. However, many patients prefer to take multiple pen shots at one time rather than mixing in a syringe. Some pens have a shorter recommended lifespan (Table 2) once they are opened compared with vials of the same insulin, potentially resulting in increased wastage and cost.

Some insulins are not available in pen form. However, this can be circum-

Table 2 Manufacturer's Recommended Expiration Times for Insulin Pen Products

Pen product

Days at room temperature

Novolin Prefilled Pen 1.5 ml Regular Novolin Prefilled Pen 1,5 ml NPH Novolin Prefilled Pen 1.5 ml 70/30 Novo 3 cartridge—Regular Novo 3 cartridge—NPH Novo 3 cartridge—70/30 Novolog

Lilly Humulin cartridge 1.5 ml—Humalog Lilly Humulin Prefilled Pen 3 ml—Humalog Lilly Humulin Prefilled Pen 3 ml—NPH Lilly Humulin Prefilled Pen 3 ml—75/25

Unused products that are refrigerated can be jtilized to the expiration dele on the pen/ packaging. Once opened or removed from refrigeration, the times listed above apply. Room temperature is 59° to 86°F.

Opened

Unopened

28

28

7

7

7

7

28

28

14

14

10

10

28

28

28

28

28

28

14

14

10

10

Unused products that are refrigerated can be jtilized to the expiration dele on the pen/ packaging. Once opened or removed from refrigeration, the times listed above apply. Room temperature is 59° to 86°F.

Insulin Vial Expiration Once Opened

vented with the Disetronic pen, which can draw up any type of insulin into its reservoir.

• Some insurance companies won't reimburse pen costs.

• Patients on large insulin doses may exceed the maximal insulin delivery of the pen, or they may find them technically hard to use for large doses.

• On average, insulin cartridges and disposable pens are approximately 25% more expensive per unit than vials so they may be cost-prohibitive for patients on large doses.

General Considerations for All Pens

• Use a fresh needle each time since there is no way to cover the needle once opened.

• At each usage, the pen must be primed by expelling 2 units to purge the needle of air. Then dial in the dosage to be injected.

• Always remove the needle between injections, as air can be drawn in and distort the chamber pressures.

• Never use a syringe to draw insulin out of a pen.

• Keep a record of the expiration date when a cartridge or disposable pen is opened, and follow the manufacturer's recommendations on when to discard it.

• Most pen needles are interchangeable, but the pen manufacturer may not honor the pen warranty unless its needles are used.

• Follow the manufacturer's directions on how to prepare the pen and administer the injection. Note especially how to determine when the full dose has been delivered. After injecting the insulin, be sure to leave the needle in for at least 5 seconds. Premature needle removal may result in leakage from the skin (a common complaint of patients when first starting pen use), resulting in a decreased dosage.

• The FDA has not approved pens for the visually impaired, and pen clicks should not be used to count the dose. However, pens are frequently very useful for low-vision patients after their ability to prepare the pen and inject accurately has been confirmed.

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