Patient education: How to use an insulin pen (The Basics)

What is insulin? — Insulin is a medicine many people with diabetes use as part of their treatment.

Diabetes is a disorder that disrupts the way a person's body uses sugar. This causes sugar to build up in the blood. Insulin lowers a person's blood sugar level.

What is an insulin pen? — Insulin is most often given as an "injection," or shot. The shot can be done with a small needle and syringe, or with an insulin pen.

An insulin pen looks like a writing pen, but has a small needle under the cap. The pen has a cartridge filled with insulin. You set the amount of insulin with each shot by turning a knob or dial on the pen. The amount can be changed each time you give yourself a shot. The needle is placed into fatty tissue right under the skin.

It might be easier to carry an insulin pen with you than a syringe and needle. The pen can also make it easier to give very small doses of insulin. But insulin pens and their needles can be more expensive.

What are the parts of an insulin pen? — There are many types of insulin pens. Look at the instructions that come with your pen.

All insulin pens have these parts (figure 1):

●Large outer needle cap

●Disposable needle with small inner needle cap

●Cartridge filled with insulin with a rubber stopper at the end

●Dial or knob to adjust the dose

●Window or area to view the dose

●Button to give the shot

Some insulin pens are disposable. This means that you throw them away when the insulin cartridge is empty. Other insulin pens are refilled by placing a new cartridge of insulin in the pen. Some insulin pens also have a pen cap that can cover the needle or rubber stopper.

There are many needle sizes. The needle goes over the rubber seal at the end of the cartridge. Each new needle has a small inner cap and a larger outer cap. Always remove the inner needle cap before you give your shot. If you forget, the insulin will not be injected into you.

If it hurts when you inject your insulin, ask your doctor for a different size of needle. Use a new needle each time you give yourself insulin. If you reuse a needle, it can cause problems like an infection, bleeding, bruising, or scarring.

Each insulin pen only contains a single kind of insulin. If you take more than 1 kind of insulin, you need more than 1 insulin pen.

Where do I inject the insulin? — Give yourself insulin in your belly, upper arms, buttocks, or thighs (figure 2). Change where you give yourself the shots each time. This helps avoid soreness, skin thickening, and fat deposits.

Different parts of the body absorb insulin differently. Insulin is absorbed more quickly if given in your belly. Try to avoid areas close to moles or scars. Do not inject insulin within 2 inches of your belly button.

What should I know about insulin? — Your doctor will work with you to make a treatment plan that tells you:

●When to use insulin – Some people use insulin with each meal. Others use insulin at the same time each day.

●What type of insulin to use – Some types of insulin start working faster. Other types last longer. You might use more than 1 kind of insulin.

●How much insulin to use – How much insulin you need is based on things like your blood sugar level and what you plan to eat. Other things like exercise and if you are sick can also change how much insulin you need.

How do I use an insulin pen? — Start by getting your supplies together:

●Wash and dry your hands.

●Gather the insulin pen, needle, and alcohol wipes. Make sure that you have the right kind of insulin pen, since you might use different pens throughout the day. A new cartridge or pen should sit at room temperature for 30 minutes.

●Check that the cartridge has enough insulin for your dose.

●Check your insulin regularly to make sure that the expiration date has not passed. If you have any medicine that has expired, call your doctor, nurse, or pharmacy to get a refill. Usually, your insulin pen is good for 7 to 28 days after first use. You do not need to keep it in the refrigerator during this time.

●Put the insulin cartridge in the pen. Some insulin pens come prefilled with the cartridge.

●Some types of insulin are clear and colorless. Others are cloudy. Make sure that you know if your insulin should be clear or cloudy. If your insulin is cloudy, it needs to be mixed. Do not shake the pen, since the insulin can clump together. Instead, gently roll the pen back and forth between your hands 10 times. Next, tip the pen up and down 10 times.

Get the insulin pen ready:

●Remove the pen cap, and save it. Clean the rubber stopper with an alcohol swab.

●Pull back the paper tab on a new needle, and attach it over the rubber stopper on the pen. Push it straight on the pen with the needle cap on. Turn it to the right until it won't turn anymore. The needle should be on straight.

●Take off the outer needle cap.

●Take off the small inner cap that covers the needle. If you do not take off the small inner cap, you won't inject the insulin into your body.

●Get the air out of the needle. This is sometimes called "priming the pen" or an "air shot" (figure 3):

•Point the pen with the needle straight up in the air. Turn the dial or knob, and set the dose to 2 units of insulin. Press the injection button with your thumb.

•You should see a drop of insulin at the tip of your needle. Repeat the above step if you don't see the drop of insulin.

•The number in the viewing area should return to 0. This lets you know that the dose of insulin has been pushed out of the pen.

●Turn the dial or knob, and set the number to the dose of insulin you need (figure 4).

●Look at the viewing area to make sure that the dose is correct.

Give the shot (figure 5):

●Wash and dry your hands.

●Clean the skin where you plan to give the shot with an alcohol wipe. Let the skin dry fully. The alcohol helps to prevent infections.

●Pinch 1 to 2 inches (2.5 to 5 cm) of skin between your fingers and thumb on 1 hand. This keeps the insulin from going into the muscle, where it is more slowly absorbed.

●Relax your muscles where you will give the shot.

●Grip the pen in your fist with your thumb on the injection button on the end of the pen. Insert the pen needle straight into the pinched-up skin. Children and people with less fatty tissue might need to inject the insulin at a 45° angle.

●Use your thumb to press the button all of the way down until it stops. Take your thumb off of the button, and keep the needle in the skin for 5 to 10 seconds.

●Let go of the skin, and pull the needle straight out. If you see blood or clear fluid when you remove the needle, press the area for about 5 seconds. Do not rub.

●Put the larger outer cap back in place over the needle. Unscrew the needle, and throw the used needle and caps in a special container made of thick plastic (picture 1).

●Replace the pen cap if you have one. Store your insulin in a cool dry place. Do not store the insulin pen with a needle attached to it.

●Wash and dry your hands.

What else should I know? — Checking your blood sugar levels will help you know if you are managing your diabetes well. Your doctor might want you to keep track of your levels. They might also want you to note when insulin was given and how much. Write down what you ate and when you exercised.

Your doctor might order a blood test called a "hemoglobin A1C" every 3 to 6 months. This test shows your average blood sugar level over a period of time. This can also let you know how you are doing and if you need any changes to your treatment plan.

When should I call the doctor? — Call for advice if:

●Your blood sugar levels are too high or too low.

●You do not know how much insulin to give yourself.

●You are not able to afford your insulin or supplies.

More on this topic

Patient education: Type 1 diabetes (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: Treatment for type 2 diabetes (The Basics)
Patient education: Using insulin (The Basics)
Patient education: Giving your child insulin (The Basics)
Patient education: Managing blood sugar in children with diabetes (The Basics)
Patient education: Checking your child's blood sugar level (The Basics)
Patient education: Low blood sugar in people with diabetes (The Basics)
Patient education: Should I switch to an insulin pump? (The Basics)
Patient education: Managing diabetes in school (The Basics)
Patient education: The ABCs of diabetes (The Basics)
Patient education: Hemoglobin A1C tests (The Basics)
Patient education: Checking your blood sugar at home (The Basics)
Patient education: Diabetes and diet (The Basics)
Patient education: Diabetic ketoacidosis (The Basics)
Patient education: How to dispose of needles and other sharps (The Basics)

Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Type 2 diabetes: Insulin treatment (Beyond the Basics)
Patient education: Glucose monitoring in diabetes (Beyond the Basics)
Patient education: Type 2 diabetes: Treatment (Beyond the Basics)
Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics)
Patient education: Exercise and medical care for people with type 2 diabetes (Beyond the Basics)
Patient education: Preventing complications from diabetes (Beyond the Basics)