Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-83

Refillable/disposable pens The portability, ease of use and precision in dosing of pens has made them popular with people with diabetes and healthcare professionals. Pen selection should be based on the antihyperglycemic agent (injectable therapy or insulin type/dose), personal preference and abilities. Each insulin pen manufacturer provides consumers with different pen options ranging from refillable and/or pre-filled pens in 0.5 unit, 1 and/or 2 unit dose increments for most insulins. Pen needles Research has shown the average skin thickness (epidermis/dermis) for most individuals regardless of BMI, age, gender or race ranges from 1.9 to 2.4 mm; therefore, the majority of people can use a 4 mm, 5 mm or 6 mm pen needle for subcutaneous administration of injectable antihyperglycemic therapies and/or insulin (150). A skin pinch is not required when giving an injection with a 4 mm to 6 mm needle length (150). Some individuals may prefer to inject with an 8 mm pen needle with a skin lift. The use of 12.7 mm needles are no longer recommended due to the elevated risk of an intramuscular injection (150). It is recommended individuals prime the pen needle (with 2-4 units) prior to administration to ensure adequate functioning of the pen delivery device, check for insulin flow and expel air from the needle. During insulin administration, people with diabetes should be instructed to inject at a 90 degree angle and leave the pen needle in the skin for 10 seconds to ensure that the full dose of insulin has been delivered and insulin absorption is adequate (150). Syringes Syringes should be used with U-100 Insulin ONLY (149). Syringes may still be the preferred means of insulin administration for some individuals with diabetes. The safe administration of insulin by syringe requires good eyesight and accurate technique in the mixing and drawing up of insulin doses (151). Although insulin is less expensive in vials than in cartridges, the added safety of insulin dosing with insulin pens may offset the cost of the insulin. Syringes come in different volumes and gradations. Syringe selection should be chosen according to individual needs and preferences, insulin dosage (volume: U-30, U-50 or U-100) and needle length. The FIT guidelines recommend the use of a 8 mm needle and a skin lift prior to injecting (150). During insulin administration, people with diabetes should be instructed to leave the syringe needle in the skin for five seconds to ensure adequate insulin absorption (150).