Q: I saw an advertisement in a magazine for a needle-free insulin pen. Can you tell me more about how this works and is it something I can get from the pharmacy?
The first needle-free insulin pen became available in Canada in the fall and is called InsuJet™. Although I have not worked with any patients who use this pen to administer insulin, I have a demonstration kit and have been able to show people how it works.
It is approved for use in adults and children over the age of six and it is compatible with most insulins. A survey reported approximately nine out of every 10 people who use this pen have a needle phobia. Needle phobia causes people to experience varying levels of anxiety with injections. In some cases, this results in them skipping their insulin injections and having poor control of their blood sugar levels.
The InsuJet™ pen has a special nozzle that creates a very fine, high-pressure stream of insulin that easily penetrates through your skin without requiring a needle. The diameter of the insulin stream is smaller than the finest insulin needles. Administration is often painless, but sometimes you may feel a small prick.
Another difference with the needleless pen is that you do not load the insulin cartridge into the pen. Instead, you draw insulin into the nozzle of the pen before each use. An adaptor attaches to the top of the vial or cartridge of insulin and then the nozzle attaches to the adaptor and draws in the number of units of insulin that you have selected on the pen. You then detach the nozzle from the adaptor and place a comfort ring around the nozzle. Using a comfort ring is optional but is recommended to improve your comfort level when you push the nozzle against your skin.
As you press the nozzle of the pen against your skin, you will hear a click to let you know your dose is being administered. You will need to apply continuous pressure for five more seconds to allow your dose to complete. The pen can administer doses ranging from four to 50 units.
Afterwards, put the covers back on the nozzle and the adaptor. The pen and the insulin you are using should be stored together in a carrying case at room temperature. Putting insulin back in the fridge between injections can potentially affect its potency.
When you administer insulin using the InsuJet™ pen, it spreads out more evenly under your skin. This enables your body to absorb the insulin faster. Some people may notice their fasting acting insulins start working quicker to lower high blood sugar levels after a meal. However, there are no differences in the total amount of insulin absorbed, the total action of the insulin or total blood sugar lowering effects when compared to insulin given by needle.
These pens are available as specialty order items through most pharmacies; however, cost is a major consideration. You should contact your private insurance plan to discuss your coverage before ordering. The starter kit includes a pen, nozzles, comfort rings, adaptors and a carry case, and each item can be ordered individually as they need to be replaced. Speak to your pharmacist about your options.
The pen can be used up to 5,000 times, which averages about two to three years, depending on your number of daily uses. It is recommended you use a different pen for each type of insulin you use as small amounts of insulin may remain in the nozzle after use, and this may affect your other insulin.
Nozzles have a maximum of 56 uses. If you do not change them, insulin may start to leak from the nozzle and affect your dose. With each new nozzle, you should also replace the comfort ring. Adaptors have no maximum number of uses, but a new one should be used with each new vial or cartridge of insulin.
If you plan on changing over to this system, you should first discuss the change with your healthcare team. Increased self-monitoring of your blood glucose levels is required during the change-over period, and your health-care team should be monitoring your A1C levels to assess how well your diabetic medications are working for you.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.