If you use multiple daily injections (MDI) – this page is for you!
1 – pen needles
2 – technology to record when you last used your insulin pen
3 – technology to reduce the number of skin punctures
4 – needle-free injectors
5 – especially for kids – Buzzy
6 – a book recommendation
1 Pen needles
Having unpredictable highs and hypos? Bruises around your injection site? Insulin leaking out after you take a dose?
Or has your pen needle prescription been changed – and you’re not sure it’s for the better?
Pen needles, like lancets, are easy to take for granted. But a pen needle that’s not up to scratch (so to speak) can be a real pain. INPUT has become aware of people having problems with their pen needles and we hope we can help.
The main topics to consider discussing with your GP and/or diabetes care team are:
- Needle length – pen needles come in different lengths (measured in millimetres or mm)
- Needle tip characteristics – needle points are not all created equal
- Product quality – if you get a dodgy needle, tell someone who can help
It’s easy to assume that people with more body fat need a longer needle to get their insulin in, and many GPs prescribe pen needles according to that assumption. Or, worse, a GP may give all their patients the same needle, even though they may have different needs.
The Forum for Injection Technique (a body of experienced UK diabetes specialist nurses) recommends:
- Children and adolescents should use a 4mm pen needle regardless of age, gender or BMI. There is no medical reason for recommending needles longer than 6 mm
- 4mm pen needles are recommended for all adults regardless of age, gender or Body Mass Index (BMI). If people need to use needle lengths over 4mm or a syringe they must use a correctly-lifted skinfold to avoid intramuscular injections..
- People new to insulin should first try using a shorter needle rather than a longer one.
Rotating your injection sites regularly means you’ll use a range of different body parts. Most of us have more fat on our tummy than on the top of the thigh. If you use a needle type that works fine for your tummy fat, but which hits muscle in your leg, your insulin might not work as expected. Injecting insulin into muscle can cause hypoglycaemia or unpredictable insulin absorption, as well as visible bruising. For these reasons, it’s best to use the shortest needle that does the job.
However, if you find a big drop of insulin on your skin after you pull out the needle, despite waiting several seconds after you deliver the dose, you may need a longer needle.
If your insulin tends to leak out, it may help to deliver half your dose in one site, and then inject the other half at least 2 inches (5 cm) away. Concentrated insulin (U-200 rather than U-100) might be another option.
Have a look at the box your needles come in to check how long they are (look for a number with mm for millimetres after it). If you think your (or your loved one’s) needles might be too long or too short, ask your GP about trying different ones, or speak to your hospital-based diabetes specialist nurse and ask them to write to the GP if the prescription should be changed.
Needle tip characteristics
To make a pen needle, a thin tube of steel is sharpened to a point using a number of cuts to the metal. More cuts mean the tip is thinner and it can go into the skin more easily. The pictures below show the difference between a needle made with 3 cuts and a needle made with 5 cuts.
If your pen needles have been changed and you think the ones you used to use went into the skin more easily, ask your GP about having your previous prescription reinstated. If they say they can’t help without input from your hospital diabetes team or consultant, get in touch with your DSN and ask them to write to your GP.
As medical devices, pen needles must meet international standards. However, from time to time, a needle isn’t up to the job. It’s important to report pen needles that aren’t safe to use, or accidents that happen (like a broken needle), so problems can be addressed.
If you have a needle that’s not safe or that doesn’t work properly:
- Save it in a puncture-proof container so you can send it back to the manufacturer if they request.
- Call the manufacturer’s customer careline (which should be printed on the box) and report it
- When you have been through a whole box of needles and some were bad, contact MHRA [Be sure to state both what was wrong and the number of bad needles out of the number in the box (for example: ‘1 needle bent after I used it and 2 needles would not screw onto the pen so I didn’t use them, out of a box of 200’)
If you regularly have problems with your pen needles and you want to switch to a different brand, talk with your GP or diabetes care team.
For pictures and descriptions of all insulin pens currently available in the UK, and compatible pen needles, see pages 22 & 23 of the Diabetes UK Meds & Kit guide 2015.
2 Technology to record when you last used your insulin pen
Did you take your lunch time injection? These great pen additions will tell you when you last used them:
Timesulin – is compatible with numerous disposable pens only
Insulcheck – is compatible with numerous disposable or re-usable pens, and
Novopen Echo – is compatible with Novo Nordisk insulins in Penfill ® cartidges
3 Technology to reduce the number of skin punctures
Short-term injection port – The i-Port Advance “is a small injection port worn on the body that users inject into instead of directly into the skin. It can be worn for 3 days or 75 injections, whichever comes first. i-Port Advance reduces the number of skin punctures from an average of 4-6 per day to just one every 3 days. i-Port Advance is suitable for adults and children.”
Andrew said “I use (i-Port Advance) because it is a lot better than taking injections every day and I like (it) cos it’s pain free and I would recommend it to any one.”
Tara said “I used to use these before I got the pump, it was amazing as (it) stopped the stinging pain when I injected, and meant I could inject as many times as I liked as I didn’t need to actually inject through my skin. Between this and the Expert meter, it was the closest I could get to a pump while on injections.”
Ask your diabetes care team if this could help you.
4 Needle-free injectors
The InsuJet™ system is available on prescription in the UK or directly through Spirit Healthcare Ltd.
Injex is available in the UK but not on prescription.
5 Buzzy for Shots
Buzzy – Taking the Sting out of Shots – a little device for children or adults, to minimize the pain of injections, infusion set changes, finger stick tests and blood drawing.
6 A book recommendation
We recommend this book to everyone with type 1, whether they are on MDI or a pump
Think Like A Pancreas by Gary Scheiner. Gary Scheiner is the American equivalent of a Diabetes Nurse Consultant and has Type 1 diabetes and uses a pump himself. This book looks at all aspects of good control, including injecting, pumping, continuous glucose monitoring and avoiding burnout.
Available from Amazon and other book sellers.