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Does Anyone Have a Pen?

by Thomas Rivera Ley

Insulin pens have been available for over a decade as an alternative to traditional insulin syringes and are an increasingly popular option for insulin delivery. Pens are more convenient than syringes and are quite accessible for diabetics with blindness, low vision or fluctuating vision.

What is the difference?
An insulin pen lays beside its case.The basic insulin syringe comes unfilled and is intended for a single use, although many diabetics choose to reuse syringes. You must fill the syringe manually each time a dose is required. Unfortunately, if you are blind or suffer from low or fluctuating vision, you need a special device like the Count-A-Dose (available from the NFB’s Independence Market) to fill the syringe independently and accurately.

Insulin pens are not disposable. Their base holds a 300-unit insulin cartridge which connects to a disposable screw-on needle. This cartridge stays attached until it is empty or until it has been out of refrigeration for over thirty days.

The screw-on needles are intended for a single use. However, many diabetics choose to use the pen needle for a day or so.

Dosing Dilemma Solved
Dosing with an insulin pen is incredibly quick and simple, even if you have limited vision. The base piece has a dial or knob on the end opposite the insulin cartridge and needle. The insulin dose is both measured and administered from the pen using the dial.

In all of the pens that we tested, turning the dial creates both an audible and tactile click. Some pens measure by half units while others measure by whole units. For example, if your pen doses in whole units and you wish to measure seven units, you simply twist the dial seven clicks.

Because of innovative design, no air enters the cartridge, eliminating another concern for visually impaired diabetics. After measuring the insulin, you simply insert the needle tip under the skin and push the dial until it clicks or stops.

To Prime or not to Prime?
Some pen users think priming wastes insulin, but we recommend that you prime your pen prior to each use and after changing the needle. Priming simply means squirting a unit of insulin into the air (not into yourself) to ensure that the pen and needle are working properly. If you are blind or visually impaired, you can position the needle tip over your hand so that when the priming dose is squirted out, you can feel the insulin as it wets your skin. For those of you with diabetic neuropathy, you can touch your hand to your lips and sniff. The moisture on your lips coupled with the distinct smell of the insulin will assure you that insulin is, in fact, being delivered.

Replacing the Cartridge
It is also relatively easy to change the insulin cartridges and screw-on needles without vision, as is determining when the cartridge is nearly or completely empty. The pen will not prime or operate easily when the cartridge is nearly or completely empty. To estimate how many days a cartridge will last, you can divide 300 units by the average number of units you use each day.

Pricing the Pen
You may find that switching to a pen may increase your monthly diabetes expenses, depending on your insurance. Some diabetes educators report that insurance companies will not pay for a patient to use a pen (although insulin pump therapy is usually more costly). We have also heard, however, that healthcare professionals have successfully advocated for their blind and visually impaired patients who want to use the insulin pen, because it promotes independence and compliance.

Selecting your Pen
Pens are now available for many types of insulin including Lantos, Novolog and Humalog. This is not a complete list, so check with your doctor to see if the particular insulin you take is available in pen form. Although pen manufacturers have previously shied away from recommending their insulin pens to those with reduced vision, the successful experiences of blind diabetics tell the real story of insulin pen safety.

If you are searching for an easier, more convenient way to carry and dose your insulin, you will definitely want to investigate using insulin pens.