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April 29, 2003

Blood Tests and Insulin Injections

Question from Wichita, Kansas, USA:

I had a patient inject using a Lilly pen device, and when the star was visible, the patient withdrew the pen needle, pushed the plunger again, and it appeared several units came out. We played with the pen and tried doing it again. As as soon as the diamond appeared, we stopped and dialed to 1 unit, pushed the plunger, and many units came out, so I'm not comfortable with this device. Are there any pens that have confirmation of delivered dose? What's your advice?


The FDA would not approve any insulin pen unless it was proven to be safe. If it is any comfort to you, at this point so many people are successfully using it that one can assume it is delivering its dose when used correctly. Because the pen needles are so thin, it is very important to inject the needle, depress the plunger fully and then count to five or six (according to the manufacturers) to allow all the insulin enough time to be infused through that tiny opening of the pen needle. One last thing — make sure you stress the importance of removing the used pen needle after injecting to prevent clogging and leakage.

I hope this makes you feel more comfortable recommending insulin pens. I recommend them to most of my patients because of the ease of use and portability of them.

Additional comments from Dr. Donough O’Brien:

Try pressing the button down a little harder and keeping it down a little longer after you hear the click.

Additional comments from Dr. Larry Deeb:

With this pen, you must push until you notice an audible and tactile click. If you just wait for the diamond, you’ve not finished. It is. You must also wait, and count to at least five to let the pressure equalize in the system or it will drip out.

Additional comments from Dr. David Schwartz:

This is not really unique to this pen, but to help ease a level of comfort, Novo’s Innovo� device (separately or as part of the InDuo ) has an LCD ‘clock’ on the display that indicates when the injection is complete.

Additional comments from Dr. Jim Lane:

I have discussed this question with my diabetes education staff. The response is that patients must be instructed to press down squarely in the middle of the gray part of the “plunger.” It is possible to press on the edge of the grey and the white collar surrounding the grey and not get the full dose because the white collar depresses and causes the diamond to show in the window and only part of the dose is delivered. The grey part of the “plunger” can still be depressed further and the rest of the dose is delivered. We instruct our patients to use the tip of the thumb to depress the grey part. This problem may not be the case with other pens.