Nowadays, insulin is often prescribed in a “pen” form. The name is a little misleading. You cannot write a poem or a long distance love letter with this style of pen…bummer. In fact, most insulin pens are loaded with 3 milliliters of insulin. That’s right. They contain no ink at all!
Insulin pens were named because of the way you are supposed to hold them. To best deliver the shot, you grab the pen device with your dominant hand (for most people that’s the right hand). Then place your thumb over the button end. In this way, the insulin pen is handled in the same manner you would click a retractable pen to expose the writing tip. Despite the misleading name, insulin pens are useful because they dispense insulin in a way that is easy to learn and perform.
We will review how to use an insulin pen and try to make it fun! Let’s get ready to party, insulin pen style!
Part I : “Party Prep” Undressing And Preparing The Pen
First off, wash your dirty hands! Didn’t your momma teach you any manners? Once you are fresh and clean, we will undress the pen by removing the pen cap. The cap should be pulled straight off, no twisting necessary.
Now that the insulin pen is naked, check out the goods! All that clear liquid you see through the plastic window with graded numbers? That is insulin. Most pens hold about 300 units of insulin, but this varies due to the newer forms of concentrated insulin now available. Even though the pen is undressed, it is not quite ready for action. UNLIKE a real pen, clicking the button on the end does not expose the tip. That would be too easy! You have to attach what is called an insulin pen needle.
Remove the paper sticker label from your pen needle. The pen needle tip is then attached by screwing it on clockwise (or to the right) for 3 or 4 full turns. Tighten until it is snug, but be careful not to tighten it too much because this same needle tip gets removed after the injection.
We can now remove the shields over the needle tip. There are actually two shields – an outer shield and an inner one. Remove the large outer shield first and place it to the side. You will need this once again after the injection is complete. You have now exposed the smaller shield. The smaller shield is there to protect you while you remove the bigger one. Remove the smaller shield and chuck it into the garbage. For your safety, you should never attempt to place this smaller shield back onto the needle!
Part 2 : “Pre game” Priming The Pen
If you are right handed, hold the pen in front of you with your left hand. The attached needle should be pointing to the left (reverse this if you are left handed). Let’s move our focus to the side opposite the needle – where the clicker button would be on a ballpoint pen. There is a small window next to the dial – this is appropriately called the dose window. The small arrow next to the window (dose indicator) will be pointing to “0.” By turning the knob next to the window clockwise you can select your dose. We will first be testing the pen with a “test shot” of “2.” This is also called priming the pen. This process will remove any air bubbles that would block the full injection dose.
Let’s dial the knob until the dose indicator says “2”.
Now we are ready for the test shot. Turn the pen upright with the needle facing up. Tap on the clear plastic to bring any air bubbles to the top. Watch the needle tip as you press ALL THE WAY down on the button until the number in the dose window says “0”. A small drop of insulin should be visible on the needle tip after pressing all the way down. If no insulin appears, redial “2” on the dial and try again. After a small bit of insulin is visible, the pen is ready to use.
Part 3 : “The Guest List” Dose selection
The dial should read “0” after the test shot. We dial the dose prescribed, by your physician, in the same way we dialed the test shot. Turn the knob clockwise until the pointer lines up with your prescribed number of units. Before injecting, the dose can always be corrected (by dialing up or down), if you happen to dial the incorrect amount. Keep in mind, if the amount of insulin in the pen is running low, it will only allow you to dial up to the amount that remains.
Part 4: The Injection Party
Party time! Let’s celebrate all that preparation with an injection!
Once you have dialed your dose, hold the pen like you would a retractable pen with your thumb over the button. After cleaning the skin with an alcohol pad, insert the needle directly into the skin at a 90-degree angle. Some people may feel more comfortable pinching the skin around the injection site, but this is not necessary for a successful shot.
Press down with your thumb on the button. The motion should be controlled and slow. You should press down until the number in the dose window goes all the way back to “0.” Once the button is pressed down and the indicator reads “0,” count to 5 slowly. When 5 seconds is up, then you can pull out the needle. Once removed from the skin, it is normal to see a small drop of insulin still on the tip of the needle.
Part 5: “The After Party” Clean Up
Time to clean up from the party!
Find the BIG needle shield. Some sources tell you to never recap the needle, but we disagree because we have seen patients get stuck both ways. If you carefully place the big needle cap back onto the pen needle, it will make it easier to grasp and remove it.
Once the big shield is back on, grab the base of it and turn counterclockwise for 3 to 4 turns. The needle and cap should then easily lift off as one unit. The needle goes into a sharps container. If you do not have a sharps container, an appropriately labeled old laundry detergent bottle will do. A sharps container should be made of hard plastic and have a screw on cap.
Put the pen cap back on the insulin pen (NOTE: The needle should not be attached when you do this!) and store for the next party.
Share this with a patient or friend.