Smart Or Connected Insulin Pens
Generally reusable pens, they are able to record and transmit data wirelessly, often paired with a mobile app or a continuous glucose monitor . Functions vary by pen, but the most integrated smart pens log glucose level, carbohydrate intake, and the number of insulin doses administered, says Dr. Bzowyckyj.
Many of these insulin pens sync with an app via Bluetooth technology to help log a lot of these important elements of a persons care plan, says Bzowyckyj. Many times, I hear patients say they may not remember if they administered their insulin dose before a meal for a variety of reasons, which then stresses them out because they do not want to double dose and risk hypoglycemia . Not only can insulin pen technology help document doses administered, but it can also help patients determine the best dose to administer by factoring in variables such as anticipated carbohydrate intake, active insulin time, and current and goal glucose levels.
The apps may also track additional health data, such as patient weight and steps or physical activity, either by syncing with a fitness tracker or when the user manually logs in the data, Bzowyckyj adds.
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Get The Insulin Pen Ready
Figure 4. Pull the pen cap off the insulin pen
Figure 5. Take off the protective tab
Figure 6. Twist the pen needle onto the insulin pen
Figure 7. Take off the outer needle cap
Figure 8. Take off the inner needle cap.
You’ll Need To Calculate Some Of Your Insulin Doses
You’ll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight.
Your provider will prescribe an insulin dose regimen for you however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars.
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How To Choose An Injection Site
Insulin should be injected into the fatty tissue just under your skin. Avoid injecting insulin into your muscle. Choose one of the following injection sites :
- Your abdomen , except for the 2-inch area around your belly button. If youre injecting rapid-acting insulin, this is the best site to use.
- The upper and outer part of your thighs. If youre injecting long-acting insulin, this is the best site to use.
- The upper outer part of your buttocks .
- The back part of your upper arms.
- Only use this injection site if someone else is giving you the injection. If youre giving yourself the injection, its too hard for you to reach the correct area at the back of your arm.
Figure 3. Injection sites
Keep track of the injection site you use. Be sure to rotate the injection sites with each injection. Within each injection site, always inject 1 to 2 inches away from the last place you injected. This can help you avoid soreness and scar tissue.
Make sure to inject at least 2 inches away from any incisions , scars, or stretch marks.
Dont inject into an area thats tender, red, bruised, or hard.
Why Might I Not Like Insulin Pens
Insulin pens are not right for 100% of diabetes patients. Insulin in pens and cartridges is generally more expensive than bottled insulin and syringes. When pens are used a small quantity of insulin is wasted, making the process less economical.
Not all types of insulin are available to be used in insulin pen cartridges at this stage. Furthermore, insulin pens do not let you mix two different types of insulin, meaning in some cases two separate injections will need to be administered.
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What Type Of Insulin Is Best For My Diabetes
Your doctor will work with you to prescribe the type of insulin that’s best for you and your diabetes. Making that choice will depend on many things, including:
- How you respond to insulin.
- Lifestyle choices. The type of food you eat, how much alcohol you drink, or how much exercise you get will all affect how your body uses insulin.
- Your willingness to give yourself multiple injections per day
- Your age
- Your goals for managing your blood sugar
Your doctor may prescribe more than one type. You might need to take insulin more than once daily, to space your doses throughout the day, or to add other medicines.
Afrezza, a rapid-acting inhaled insulin, is FDA-approved for use before meals for both type 1 and type 2 diabetes. The drug peaks in your blood in about 15-20 minutes and it clears your body in 2-3 hours. It must be used along with long-acting insulin in people with type 1 diabetes.
The chart below lists the types of injectable insulin with details about onset , peak and duration . These three things may vary. The final column offers some insight into the “coverage” provided by the different insulin types in relation to mealtime.
| Type of Insulin & Brand Names | Onset |
| 30 min.-2 1/2 hours | 16-20 hours |
| *Premixed insulins combine specific amounts of intermediate-acting and short-acting insulin in one bottle or insulin pen. |
Important Tips To Remember About Using An Insulin Pen:
- Always check your medicine type and the expiration date printed on the box before you leave the pharmacy.
- Store unopened pens in the refrigerator. They will be good until the expiration date printed on the box. Write the date on the insulin pen when you first open it.
- Store open insulin pens at room temperature. Avoid temperatures that are too hot or too cold. This can change how the insulin works.
- Most pens are good for 28 days once opened. Check with your pharmacist or read the drug insert for exact instructions.
- Do not use insulin pens that have lumps, are discolored or have been frozen.
- Place used pen needles and lancets for blood sugar testing in a hard plastic or metal container with a screw-on or tight lid, or a commercial sharps container.
- If you have questions about the subcutaneous injection procedure, please ask your healthcare providers.
- The most common side effect of insulin is low blood sugar, or hypoglycemia. Low blood sugar happens when the level of sugar in the blood falls below 70 mg/dl. Symptoms include sleepiness, shaking, sweating, dizziness and hunger. Be sure you know how to treat low blood sugar before you start using insulin.
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Health Economics Of Continuous Subcutaneous Insulin Infusion
To date, only one cost-effectiveness analysis comparing CSII with MDI in patients with diabetes in the United States has been published. A previously validated health economic model was used to determine the incremental cost-effectiveness ratio of CSII compared with MDI using published clinical and cost data. The primary input variable was change in A1C and was assumed to be an improvement of 0.9% in children/young adults and 1.2% in adults for CSII compared with MDI. A series of Markov constructs simulated the progression of diabetes-related complications. The time horizon for the simulation was set to 60 years to capture the remainder of a type 1 diabetes patient’s lifetime. Continuous subcutaneous insulin infusion was associated with an improvement in quality-adjusted life years gained of 1.061 versus MDI for adults and 0.799 versus MDI for children/young adults. The incremental cost-effectiveness ratio for CSII versus MDI in adults was $16,992 per QALY gained and in children/young adults was $27,195 per QALY gained. Assuming a cost-effectiveness threshold of $50,000 per QALY gained, CSII is thus estimated to be a cost-effective option for U.S. patients with type 1 diabetes.
How To Give An Insulin Injection
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Safety And Insulin Pens
We have done this research on the accessibility and usability of diabetes self-care devices over the years both to show manufacturers how they can improve their devices and to inform our AccessWorld readers. We hope we have made you more aware of the issues involved in the use of insulin pens, but we also want to convey the seriousness of properly using an insulin pen. These pens are dangerous if they are used improperly, and we have seen numerous warnings against using them alone if you are blind or have low vision. In fact, the manuals for five of the pens specifically say that they are not designed to be used by people who are blind or have low vision.
Finally, we want to stress that if you have diabetes, you should always consult your health care provider about insulin delivery, and please do not rely on this article alone.
This is just a general overview of the accessibility and usability of insulin pens and should not replace the information provided by your certified diabetes educator or physician. This article should make you more aware of your options when consulting your health care provider, and you should proceed only under the direction of your physician or certified diabetes educator.
Note: Just prior to publication of this article, Novo Nordisk stopped producing the InDuo. We reported on it in this article, however, because it is still being sold by some distributors and is still being used by many people. The supplies for it are also still being sold.
Example #: Carbohydrate Coverage At A Meal
First, you have to calculate the carbohydrate coverage insulin dose using this formula:
CHO insulin dose = Total grams of CHO in the meal ÷ grams of CHO disposed by 1 unit of insulin .
For Example #1, assume:
- You are going to eat 60 grams of carbohydrate for lunch
- Your Insulin: CHO ratio is 1:10
To get the CHO insulin dose, plug the numbers into the formula:
CHO insulin dose =
- The carbohydrate coverage dose is 6 units of rapid acting insulin.
- The high blood sugar correction dose is 2 units of rapid acting insulin.
Now, add the two doses together to calculate your total meal dose.
Carbohydrate coverage dose + high sugar correction dose = 8 units total meal dose!
The total lunch insulin dose is 8 units of rapid acting insulin.
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The High Blood Sugar Correction Factor:
Correction Factor = 1800 ÷Total Daily Insulin Dose = 1 unit of insulin will reduce the blood sugar so many mg/dl
This can be calculated using the Rule of 1800.
Example:
= 1800 ÷ TDI = 1 unit insulin will drop reduce the blood sugar level by 45 mg/dl
While the calculation is 1 unit will drop the blood sugar 45 mg/dl, to make it easier most people will round up or round down the number so the suggested correction factor may be 1 unit of rapid acting insulin will drop the blood sugar 40-50 mg/dl.
Please keep in mind, the estimated insulin regimen is an initial best guess and the dose may need to be modified to keep your blood sugar on target.
Also, there are many variations of insulin therapy. You will need to work out your specific insulin requirements and dose regimen with your medical provider and diabetes team.
Traditional Insulins Are Cheaper Than Modern Insulins
Average retail prices of Novolin and Humulin have gone down, or held steady, while prices of modern rapid- and long-acting insulins continue to go up. On average, traditional insulins now cost less than half of what modern insulins cost.
Why? Traditional insulins have historically been cheaper than their newer competitors. Modern insulins offer better blood sugar control but are synthetic analogs of traditional insulins, which makes them more difficult to produce.
Additionally, when patents on Humulin and Novolin expired around 2000, manufacturers Eli Lilly and Novo Nordisk had to test new pricing strategies to remain competitive.
In 2017, for example, Novo Nordisk partnered with CVS to offer Novolin at roughly 80% less than its list price. Both Novo Nordisk and Eli Lilly have also worked with Walmart to heavily discount Novolin and Humulin under Walmarts ReliOn line of insulin products.
Retail partnerships havent been their only strategy. Eli Lilly had been increasing prices for Humulin every 6 months until May 2017, when they decided to stop anymore increases. In fact, prices of traditional Humulin and Novolin insulins, their rapid-acting analogs , and their mixed products have not gone up since then.
and are currently the cheapest traditional insulins, with average unit prices of around $0.10.
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Diabetes And Visual Impairment: Are Insulin Pens Accessible
Over the past five years, AccessWorld has periodically published the results of projects at AFB TECH that have evaluated the accessibility and usability of diabetes self-care devices. You can read about blood glucose monitors in the , insulin pumps in the , and blood pressure monitors in the . This article examines insulin pens, another device that can be used to manage diabetes. We have gathered and evaluated all eight pens that are currently on the U.S. market.
How To Store And Dispose Of Your Home Medical Sharps
Dont throw your medical sharps directly into the trash or flush them down the toilet. Put them into a sharps container. You can use an empty, hard, opaque plastic container that has a screw-on cap, such as a laundry detergent bottle. Dont store sharps in glass bottles, soda bottles, milk jugs, aluminum cans, coffee cans, or paper or plastic bags. For more information, read the resource How to Store and Get Rid of Your Home Medical Sharps.
Stop using your sharps container when its a little more than half full. Wrap the lid or cap with strong tape to create a more secure seal and keep it from leaking. Label the bottle by writing on it Home Sharps: not for recycling.
If you live in New York City, you can place the sealed container in with your regular trash for collection. Dont put it with your recyclables. If you live in a different county of New York or another state, check with your local department of health. You can also use the resources below to find more information specific to your area.
- Safe Needle Disposal
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Robin Feldman Professor Of Law Uc Hastings College Of Law San Francisco
One would have to see how these orders were implemented to know how powerful and effective they will be.
We are still seeing many struggle in clinical practice with affordability, says Redmond. So it is unclear to most healthcare providers who gets these insulin cap benefits. Even myself as an expert would really love any more guidance on this. There are eligibility requirements that many patients still dont meet.
As with any legal order, the devil’s in the detail, Robin Feldman, Arthur J. Goldberg Distinguished Professor of Law at UC Hastings College of Law San Francisco, tells Verywell. One would have to see how these orders were implemented to know how powerful and effective they will be. We are, however, going to need some systemic changes to try to address the problems that are driving drug prices higher in general, and insulin prices higher specifically.