Description
An insulin pens are used to inject insulin for the treatment of diabetes. It is of the size and shape of a large marker and carries insulin in a self-contained cartridge that contains 300 units (3 mL). Insulin pens are used with disposable pen needles that are sold separately. A new pen needle should be used each time.
Types of Insulin
- Rapid acting insulin: It begins to act on glucose in the blood stream faster than normal. It is usually taken just before or with a meal e.g., Lispro, aspart.
- Regular-or short-acting insulin: It is also known as neutral insulin and soluble insulin. The onset of action is half to one hour, the peak effect is 2-4 hours and duration of action 6-9 hours, e.g., Human N, Novolin R.
- Intermediate acting insulin or Lente insulin: These start to act within the first hour of injecting, followed by a peak activity lasting up to 7 hours. Intermediate acting insulin is a suspension of crystalline zinc insulin. For example, isophane, NPH insulins (Humulin N, Novolin N).
- Long-acting insulin: This insulin type controls blood sugar consistently for an entire day, e.g., insulin glargine (Lantus), insulin detemir (Lovemir).
- Ultra-long-acting insulin: This has action of a glucose lowering effect beyond 24 hours after a subcutaneous injection. These agents are longer acting with sustained insulin coverage as compared with other basal insulins, while having a low potential for hypoglycaemia. It reaches bloodstream in 6 hours, does not peak and lasts up to 36 hours, e.g., insulin degludec (Tresiba) lasts up to 42 hours.
Types of Insulin Pens
While there are a number of different brands and models, most insulin pens fall into one of two groups.
- Reusable insulin pens (durable pens).
When a cartridge is empty, it is disposed of and a new cartridge is loaded. Each may last for several days.
- Disposable insulin pens (prefilled pens).
These come filled with insulin and are disposed of when they are empty.
As the patient injects insulin self, he needs to learn about loading cartridge in the pen, fixing needle, and priming the pen with the dose of insulin to be injected.
Parts of Insulin Pen and Pen Needle
An insulin pen has a pen body similar to the barrel of a syringe that has a rubber seal at the top for fixing the needle, a reservoir for cartridge that can hold 3 ml of insulin, a dosage window to visualize the dose of insulin dialed for injection, a dosage knob for dialing the dose, an injection button at its bottom and a pen cap. The pen needle has a detachable outer cap and an inner cap. After fixing the needle on pen, the caps are removed for priming the pen and injecting insulin
Articles
- A pen with insulin cartridge loaded in it.
- Pen needle for injection.
- Alcohol swab.
- Receptacles for used swab and needle
Procedure
Insulin pens are used for self-injection and hence patients need to be educated well about the procedure.
| Nursing Actions | Rationale | |
| 1. | Before procedure Wash hands with soap and water and dry thoroughly. | Removes dirt and germs. |
| 2. | During procedure Check the pen to ensure that it contains enough insulin to cover the full dose. | Avoids chances of overdosing. |
| 3. | Remove the pen cap and screw or click on a new pen needle. Insulin pens are either reusable or disposable. For a reusable pen, put the insulin cartridge into the pen. Disposable pens already have an insulin cartridge. | Assembles the unit for injecting. |
| 4. | Gently stir intermediate or premixed insulin by turning the pen on its side and rolling between the palms of your hands. Clear insulin (fast acting or long acting) generally does not need to be mixed. | Obtains insulin suitable for absorption in the body. |
| 5. | Wipe the tip of the pen with an alcohol swab. Hold the pen straight up, remove the cap and needle covers. | Prepares for priming the pen for injection. |
| 6. | Tap on the side of the syringe (cartridge) to get air at the tip. Push the injection button all the way in. Watch for a drop of insulin to come out of the needle. | For easy expulsion of air from the pen. |
| 7. | Remove any air from the needle. | Avoids air from pen entering into patient’s body. |
| 8. | By turning the knob on the end of pen, dial to the number of units of insulin to be injected. | Visualizes the amunt of units of insulin to be delivered. |
| 9. | Choose a spot on the site of injection that you can see and reach (abdomen thigh or upper arm). On the abdomen, the spot may be 2 inches away from the umbilicus. | Selects the site for injection. |
| 10. | Wipe the skin with alcohol swab | Ensures that the skin of injection site is clean for needle entry. |
| 11. | If the part is flabby, pinch a 1–2-inch portion of skin and fat between your thumb and index finger with left (non-dominant) hand. If the skin is flat, no need to pinch and hold the skin. | Promotes easy insertion of needle. |
| 12. | Hold the pen in your right (dominant) hand like a pencil at 90° angle to the skin and insert the needle with one quick motion all the way in to. | For delivering accurate dose of insulin into the body. The needle tip enters the subcutaneous tissue for expulsion of medicine. |
| 13. | Press the button on the end of the pen with your thumb at a moderate, steady pace until the insulin is fully injected. Keep the needle in the skin for 5 to 10 seconds (count of 5 to 10) depending on dose injected. | Completes delivery of the dose of insulin. |
| 14. | Pull out the needle at the same 90° at which it was inserted. Press the injection site with finger for 5-10 seconds. | Prevents insulin from leaking out. |
| 15. | After procedure Replace the needle cover and remove the needle with cover by unscrewing. | Gets the needle out for disposal. |
| 16. | Place the used needle in a thick plastic bottle or sharps container. When nearly full, close the container with screw on cap and tape. Dispose according to standards set forth by local department of sanitation. | Avoids chances of contamination and injury. |
| 17. | Return pen with insulin to refrigerator. | Keeps medicine safe for next use. |
Advantages
- Pens are more convenient and easier to transport than traditional vial and syringe for use away from home.
- Accurate dose can be delivered repeatedly by the simple turn of a dosage dial.
- Use of pen saves time because there is no need to draw up insulin from a bottle. It is already pre-filled in the self-contained cartridge.
Disadvantages
- Unlike the traditional syringe, two different types of insulin cannot be mixed by the user in an insulin pen. Two different injections must be given, one for each type of insulin.
- Using pens and pen needles is usually more expensive than using the traditional vial and syringe method.
- Not all insulin types are available for use in insulin pen cartridges.
- Insulin pens should only be used for self-injection.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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