Insulin pen injector

The nurse is teaching the client with Type 1 diabetes how to use an insulin pen injector. Which information should the nurse discuss with the client ... 

Discuss that the insulin pen injector must be used in the abdominal area only. 

The insulin pen injector does not require drawing up insulin in a syringe. 

The insulin pen injector can be used in any subcutaneous site that traditional insulin can be injected. 

Lteif AN, Schwenk WF. Accuracy of pen injectors versus insulin syringes in children with type 1 diabetes. Diabetes Care 1999 22(l) 137-40. 

To facilitate multiple subcutaneous injections of insulin, particularly during intensive insulin therapy, portable pen-sized injectors have been developed. These contain cartridges of insulin and replaceable needles. Disposable insulin pens are also available for selected formulations. These include regular insulin, insulin lispro, insulin aspart, NPH insulin, and premixed 70%/30% and 50%/50% NPH/regular, 75% NPL/25% lispro, 50% NPL/50% lispro, and 70% NPA/30% aspart insulin. They have been well accepted by patients because they eliminate the need to carry syringes and bottles of insulin to the workplace and while traveling. 

Figure 8-1 Dial and pen injectors for insulin (on the same scale)...

GaU, M.-A., Mathiesen, E. R., Skott, P., Musaeus, L., Damm, S., Beck-Nielsen, H., and Parving, H.-H., 1989, Effect of multiple insulin injections with a pen injector on metabolic control and general well-being in insulin-dependent diabetes mellitus. Diabetes Res. 11 97-101. 

II.f.1.3. Insulin delivery. Traditionally insulin was given intramuscularly and later subcutaneously. New technology has provided devices for insulin administrations including pen-devices, air powered injectors, external insulin infusion pumps (or continuous subcutaneous insulin infusion, CSII), and implantable insulin infusion pumps. Some novel forms of insulin delivery have been introduced, for example intranasal insulin gives peak insulin concentrations at 10-20 minutes after administration, but most insulin is still administered subcutaneously. 

To facilitate multiple subcutaneous injections of insulin, particularly during intensive insulin therapy, portable pen-sized injectors have been developed. These contain cartridges of insulin and replaceable needles. 

The example we will use in this lesson is the selection of alternatives for treating the illness known as diabetes. This will lead to the most common method of this moment, where the patient treats himself with insulin injections. Figure 8-1 shows two current injector designs dial and pen . 

Injection technique has pharmacokinetic consequences according to whether the insulin is delivered into the subcutaneous tissue or (inadvertently) into muscle. The introduction of a range of appropriate length needles and pen-shaped injectors has enabled patients to inject perpendicularly to the skin without risk of intramuscular injection. The absorption of insulin is as much as 50% more rapid from shallow i.m. injection. Clearly factors such as heat or exercise which alter skin or muscle blood flow can markedly alter the rate of insulin absorption. 

Diabetics have traditionally been forced to perform self-injection, so auto-injectors have been developed for use in this area and look like a modem felt-tip pen. Quantities of insulin can be pre-set by turning a knob on the pen which has features including an audible click, clear resistance prior to each dose and a visual indication on the scale thus helping to eliminate dosing errors. Quick and easy dosing is possible with such systems. Auto-injectors are marketed by a number of companies under the following tradenames Novopen , Novepen II, NovoLet , Optipen II and D-Pen . Pressurised needleless systems are also now available. 

Explain that the traditional insulin syringe is less painful than the injector pen. 

---