Pen systems for giving insulin


        PEN SYSTEMS FOR GIVING INSULIN

There are a number of devices to make injections of insulin more convenient. One of these is the insulin pen and this works on the same system as the fountain pen for writing: it is shaped rather like a pen, has an internal reservoir or cartridge of insulin which is replaceable and a needle where the pen would normally have a nib. The needle is replaceable as needed, generally after a few days of use and the insulin cartridges hold between 150 and 250 units.
There are insulin cartridges for both long and fast acting insulins and some insulin mixtures. The first of these pens introduced to the market here was designed by Novo Industries and called the Novopen, and some people use the term to refer to all the available pen systems. There are however other types including Insuject by Nordisk. Moreover there are different pens for long acting and for short acting insulin. Thus, Novo pen I is usually used for Actrapid insulin and Novopen II for Protaphane, Ultratard and Actraphane. Insuject is used for Velosulin and Insuject-X used for Insulatard, Mixtard and Initard.
The original intent of the pens was to allow quick acting insulin to be administered conveniently before each meal. This mimics to some extent the way the pancreas releases insulin when we eat. In addition to these three insulin injections, an injection of long or moderately long acting insulin is given at night, usually before bed. This provides a supply of insulin throughout the night and into the next day.
The pen makes it relatively easy to have insulin at lunch time at school or work by carrying the pen in a pocket or bag. It makes it more convenient to accept invitations for meals away from home and gives more flexibility in timing and insulin dosage. Some people vary their dose of quick acting insulin according to their blood glucose level (more if it is very high) and most people vary the dose according to the degree of exercise they expect to have following the injection. A young person would therefore lower the dose if he was going swimming or had a football match. Some people have a little more quick acting insulin if they are at a social occasion and expect to be eating a bit extra.
The ability to vary the dose in this way depends on doing extra blood glucose estimates at times, especially when getting used to the system.
The pre-mixed insulins make it possible for some people to use the pen for twice daily injections. This does have the advantage of convenience but the disadvantage that it is not possible to vary the portions of the fast and slow acting insulins when they are pre-mixed. The insulin manufacturers may develop systems where the proportions of the insulins can be varied. If this happens, it is likely that the pen systems will largely replace the conventional syringes and bottles of insulin.
One disadvantage of the system is that it is not always possible to check that the full dose has been given. Using the syringe, the dose can be checked when it has been drawn into the syringe and it is obvious when the full dose has been given and the syringe has been emptied. With the pen, it is possible for malfunctioning of the pen or for a blocked needle to occur so that some or even all of the dose is not given properly. It is also possible for a young child to make errors. This can be partly overcome by expelling two to four units of insulin into the air to check that the pen is working before administering the insulin dose beneath the skin.
Some people choose to use the four injections a day pen system for convenience. Others do so to get the best possible control of their diabetes. Most people, when they first develop diabetes, prefer to start with one or two injections a day and feel it is best to become familiar with the syringe before trying the pen system, particularly as it does not necessarily lead to better control. Like all gadgets, they can become lost or broken and it is important to have the conventional syringe as a standby.

Adjustment of insulin dose using the pen system
It usually works out that between a third and a half of the total insulin requirements for the day is given as an injection of slow acting insulin at night. The remainder of the total dose is given as three injections of quick acting insulin before each meal, in about equal proportions. These proportions, and the total amount of insulin for the day, depend upon a person's total insulin requirements, their pattern of response to insulin and their usual meal and activity habits. They would normally be worked out by your doctor.
After a few days, a pattern of response will probably develop and based on blood tests, dose adjustments can be made.

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