Insulin and medication pens are very common in the world of diabetes. Pens provide a simple, quick, safe, and discrete way of administering insulin and injectable medication and avoid the multiple and delicate tasks involved in using a standard vial and syringe. Many pens come in a disposable format which simplifies the process by removing additional steps of refilling the pen. Currently almost all insulins and all injectable diabetes medications come in pens. This article will provide information on the pros and cons of insulin pens, common characteristics of the pens currently available on the market, how the medication (non-insulin) pens work, and finally considerations regarding the glucagon pen.
Benefits of Using an Insulin Pen:
Ease of use by older adults and children as well as those with disabilities, less fine manipulation and complex maneuvering required (good for those with dexterity issues) or vision loss.
Can provide accurate, finely tuned dosing, using relatively large numbers featured in the dosing window, rather than counting markings on an opaque syringe.
Portable, convenient, and discreet (can even be given through clothing while seated at a restaurant prior to eating).
Accurate doses using a dial, especially superior accuracy with smaller doses
Decreased fear and pain due to smaller, thinner needles.
Can preset doses using dial.
Saves time as they are prefilled/preloaded with insulin
Many are disposable and can be thrown away after use.
Some have a memory feature that recalls time and amount of dose.
Highly intuitive to use with some requiring little to no instruction.
Can avoid mixing insulins as premixed are available in pen form.
Require fewer steps.
Color coded and differently designed for easily identification.
Come in newer insulin concentrations which makes dosing easier (syringe and vial would require additional calculations).
“Smart” pens exist that can calculate appropriate doses of insulin and provide a report on insulin usage for the user to download among other smart features.
Can only be used for self-injection.
Usually, higher cost than syringe and vial.
Lack of universal coverage by some insurances.
Requires a separate pen needle tip.
Can be easily lost.
May require a second shot if insulin in pen is insufficient.
In 2018, Diabetes Care reported that a slight majority of the 7.4 million Americans on insulin chose vials and syringes to inject insulin. The Health Care Cost Institute went further to state that vials made up 53 percent usage while prefilled insulin pens were used by 46 percent. Reusable pens with cartridges made up less than 1 percent annually. An additional study published in the Journal of Clinical Medicine in January 2016 estimated that 350,000 Americans used an insulin pump. Unlike the U.S., pens are widely used by Europeans with percent use at 80% according to a review published by The International Journal of Pharmaceutical Investigation in their January to March 2016 issue.
Different pens are compatible with different types of insulin. Some can hold larger doses. Some pens provide 1-unit increments, others ½ unit. Some have added features like the pairing with a smartphone to calculate insulin doses among other attributes. The chart below identifies the company, the pen(s) it makes, the name of the insulin, the total insulin capacity of the pen, whether it is disposable or refillable, and lastly, features. When selecting an insulin and pen type, and for precise dosing, seek the advice of your physician or diabetes educator.
Can dose up to 30 units, in ½ unit increments, pairs with smartphone app with Bluetooth to show the amount and time of last insulin dose, calculates doses, sends reminders, monitors insulin temperature, shares data with doctor or family
Single Insulins and in Combination
Currently the only medication/insulin combination pen is Soliqua.
Name of medication
How it works
Soliqua – medication combined with a long-acting insulin
Adjunct to diet and exercise to improve blood glucose control by heling pancreas to produce insulin more when blood sugar levels are high. Decreases glucagon secretion and improves stomach emptying.
The injectable medications have many functions and work on the pancreas, liver, stomach, and intestine all with the goal of normalizing blood glucose levels in the body. The chart below identifies each injectable medication, it’s function(s), and how often it is taken. For precise dosing seek the advice of your physician or diabetes educator. Side effects can be viewed on the prescription insert or can be ascertained through your diabetes care team including your pharmacist.
Name of medication
How it works
Adjunct to diet and exercise and any oral medication currently being taken. Helps the pancreas release insulin when needed. Prevents the release of sugar when it’s not needed. Slows down how quickly the stomach digests food, to send sugar into the bloodstream more slowly. Helps reduce the amount of food intake.
Weekly, with or without meals
Adjunct to diet, exercise, and long-acting insulin such as Lantus. Increases secretion of insulin from the pancreas. Reduces the action of glucagon (the natural hormone that raises blood glucose). Slows absorption of glucose from the gut, thereby lowers blood glucose level in the bloodstream and reduces appetite.
Limits how much sugar gets into the bloodstream from the liver. Slows down how quicky food leaves the stomach, helps the pancreas release insulin in response to high levels of sugar in the blood after eating.
Helps pancreas release more insulin and slows down digestion to help the body better metabolize food eaten.
Helps the pancreas release the right amount of insulin to move sugar from the blood into the cells. Slows down the time it takes for food to leave the stomach, which can help the body manage its blood sugar level. Prevents liver from releasing too much sugar by lowering the amount of glucagon.
Adjunct used with diet and exercise. Tells the body to release more insulin. Stops the body from releasing more glucose. Slows down digestion.
Slows stomach emptying of food (glucose)into the intestine for absorption. Reduces the production of glucose by the liver.
Just before major meals of 30 grams carbohydrate or more
Glucagon Injection Pens
Glucagon is a natural hormone produced in the pancreas that stimulates the liver to release stored glucose into the bloodstream when blood glucose levels are becoming too low. It is used if a person is experiencing very severe hypoglycemia. Glucagon can be obtained in a kit format containing 1 vial/dose of glucagon powder and 1 disposable syringe with sterile water for reconstitution. It should be used immediately after mixing. Glucagon can also be obtained as a premixed autoinjector pen.
Low blood glucose levels begin at 70 mg/dL. Often a person with diabetes can self-treat at this point. As blood glucose levels drop further the person may exhibit confusion, irritability, sweating, and trembling. As blood glucose levels drop to 50 mg/dL the person may be unable to eat or drink, experience disorientation, seizures, and loss of consciousness. During this period a person would require treatment by another individual and the administration of glucagon will be needed. Glucagon should be always kept on hand and family; friends and co-workers should be aware of where the glucagon is stored and should be instructed in its use.
It should be kept at room temperature and not in the refrigerator. It is important to keep glucagon in its original package and out of sunlight. The glucagon pen/kit contains only one dose. After administering glucagon, the first time the caregiver should immediately call emergency assistance. Another dose can be administered after 15 minutes if the person remains unresponsive. The injection is given under the skin. Several glucagon kits should be obtained, one for home and at least one for place of work.