# Insulin pens



## Barb (Jul 27, 2010)

Am I the exception or is everyone out there happy with current insulin pens?

I've had diabetes for over 30 years and was delighted when Novo Nordisk introduced their uber cool silver metal design around 25 years ago. It looked like a normal pen, ie was unobtrusive, could happily be used in public, and most important of all, was accurate.

Then pens had to meet with European requirements - out went the 1.5 glass insulin vials and in came the bulkier 3 ml ones, which meant my wonderful old pen was phased out. In came click-count versions and various plasticky pens which I've tried to like, but have to admit I hate.

For a start, you wouldn't want to use them in public. The design is tacky and has a large aperture showing the glass vial within. Streamlined? Forget it. More crucially, the old metal piston has been replaced with a plastic one which has a tendency to slip back at crucial moments meaning you are as likely to inject air as insulin. 

And the latest design innovation? To get rid of the hard (rather smart and easy to use) case formerly found on my daytime-use Novopen 
and introduce a soft-top zipped case which is hard to undo and looks remarkably similar to the velcro model used for night-time injections. Now it's very easy to confuse the two and administer the wrong injection. Such is progress.


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## Northerner (Jul 27, 2010)

Hi Barb, welcome to the forum  I've only been diagnosed for a couple of years so don't have much experience of different pens. I quite like my novopen 3, but can see that it seems the build quality must have declined from what you say. I'm not keen on the autopen 24 for my lantus - it sometimes sticks and the thread is difficult to connect when replacing cartridges, and it is VERY plasticky!


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## Barb (Jul 27, 2010)

*New Novopen*

Hi Northerner,

Nice to get your feedback. Please try to hold onto your NovoPen 3 if you like it, because, horror of horrors, it's now been replaced by NovoPen 4 which is a little less user-friendly.

The new version administers insulin in one whoosh, or doesn't as the case may be. The earlier model gave some reassurance in that you felt the resistance as each unit went in. Not so with the new model. A friend has just got hers and refuses to use it for that reason. It's also necessary to prime these new pens repeatedly to make sure insulin is coming out which is very wasteful.

On the plus side, if the new pens are all you've ever been used to, and you're happy with them, that's all that matters. But I do feel we diabetics deserve a better deal. The manufacturers have the technology but choose not to use it.


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## am64 (Jul 27, 2010)

hello barb ...sorry i know nothing about the pens ..im a T2 on meds but i just wanted to say welcome to the forum x


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## Northerner (Jul 27, 2010)

Thanks Barb, I'll bear that in mind about the novopen 3 - I have a spare which I've never used so that should keep me going for a while should my original fail! The autopen delivers in one rapid hit (or fails to!), which is one of the things I don't like about it. I often wonder why, after all these years, there aren't just a few designs that are proven and acceptable (I was shown about 30 different kinds shortly after diagnosis!). It's one of those things, like corkscrews or tin openers, where you think they'd have it all worked out by now!


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## Barb (Jul 27, 2010)

*Hi*



am64 said:


> hello barb ...sorry i know nothing about the pens ..im a T2 on meds but i just wanted to say welcome to the forum x



Thanks am64. I'll try not to get into rant mode too often but insulin pens are something I feel very strongly about.


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## am64 (Jul 27, 2010)

no problems this place is great for a good rant !!


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## Robster65 (Jul 27, 2010)

Hi Barb.

Welcome in from another newbie (to the forum). I'm using the Autopen24 and the Lilly Humapen luxura.

The autopen is also very plasticky and the ratchet mechanism is a pain to wind back in when replacing vials but the Humapen is way better than the original Humapen I had, which used to wear and crack after about a year.

I wouldn't want to go back to syringes so I guess I see them as a welcome progression, despite their bulkiness and little 'quirks'. 

Rob


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## Barb (Jul 27, 2010)

Hi Rob,

Pleased you have one pen you are happy with. There are a lot of designs out there, and despite my criticisms, I think Novo do one of the better lot. Their metal pens look the business at first but the design falls down badly once you take the top off! And there are a lot of operational problems which doesn't give me much confidence in the product.

As far as testing and diabetic control in general go, we've come a long way but, sadly, pen design seems to have gone backwards.


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## Northerner (Jul 27, 2010)

I'd be interested to know if you long-timers re-use your needles? I remember reading a parliamentary debate from the late '90s where one of the advantages of pens was seen to be the reusability of needles, reducing costs - but I was told to use a new needle every time by my DSN. She said re-use was possible, but there were various reasons not to re-use. Just wondering what the advice and practice was when they first appeared.


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## shiv (Jul 27, 2010)

I was diagnosed in 1991 and as far as I can recall I used hypodermic needles for the first 11 or so years - we did (we being me and my parents) did reuse them, but only a few times. Since going onto pens about 8 years ago I was always taught to change the needle after each use. I generally stick to that advice but will often use the needle twice before changing it.

When I did DAFNE, there were 2 guys on my course that were diagnosed back in the glass syringe days and they said they had always been taught to reuse the needles until they were blunt, basically. With the new pens, they said they would change the needle only when changing the cartridge of insulin! ! Ouch!


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## DanW81 (Jul 27, 2010)

whatever the DSN's tell me I think it is pretty pointless changing the needle after EVERY injection and for me it would be difficult to do this. Maybe if i had been told this at diagnosis time I might think different, but it was never mentioned. I only ever change my needle when injections begin to get a bit painful. I remember when i went on DAFNE and told everyone this they were all shocked, but then again so was I when they said they changed after every injection! hey, it works for me...


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## Copepod (Jul 27, 2010)

*observation on cases rather than pens*

Hi Barb 
Pens haven't changed too much in the 15 years since my diagnosis, apart from the change from 1.5ml to 3ml cartridges. 
However, I've never found a pen case (supplied with a pen) that really suits me - I find eg Humapen Luxura cases too heavy and bulky, with no space for spare cartridges (I prefer to carry spares of each type of insulin) or more than 3 needles. For morning / bedtime long acting insulin pens, I still use a really old black fabric case into which a pen slots, with a long zipped side pocket, but can't remember which pen it came with. For out and about daily use, I use a cheap pencil case, which can hold pen, spare syringe, spare cartridges, a couple of plasters in case of a leaking injection site etc. 
I don't change needles each time, because it doesn't hurt until at least 20 times, and I prefer not to waste resources, both NHS finances and environmental, plus it's quicker and easier to change when it's convenient and not so rushed at home every week or so. I realise it's not recommended practice, but it works for me, even in situations when washing / hygiene is difficult eg marshalling a 24 hour adventure race this weekend, several expeditions of weeks or months in tropical, temperate and sub Antarctic regions.


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## Robster65 (Jul 27, 2010)

I always used to re use needles from the st/steel ones right through to the current novofines until a few years ago when my DN gave me a right telling off.
I don't remember the exact details but I know that a blunt needle can damage the injection site and cause problems. My reasoning before to save NHS funds and to avoid so many trips to the chemist.

I now use once only. I think there must be enough damage done from 4+ injections per day without trying to force a less than sharp needle through the skin. All I need now is to get over the guilt of using so many test strips while we re adjust. 

Rob


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## Steff (Jul 27, 2010)

Hi Barb and welcome to the forum just wanted to say hello, im a type 2 on injections (byetta) X


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## NiVZ (Jul 27, 2010)

Hello,

As a Diabetic of 15 years I've used a few different pens in my time.

So far my favourite pen of all time is still the Humapen Luxura (and HD - for half doses).  Available in Gold and Burgunday (the HD is green).  It's a metal pen, comes in a hard case with space for a spare vial and spare needle tips.  The Humapen Memoir is also good as it's metal and tells you the date and time of your last dose, although this made the top end of the pen a bit bulky for my liking.

The worst pen is still the Autopen 24.  I've had two of these break during insulin delivery and are so bad I refused to use them, instead preferring to stuff my lantus cartridges into the Humapen Luxura (which I got told off for a few times)

I've now been using the Clikstar pen for just over a week to administer my lantus and although it is plastic it is a million times better than the Autopen.

Think I've had a few Novonordisk pens (blue and yellow one?) too which were ok, but the colours (especially the multi-coloured soft puch) were a bit garish.

NiVZ


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## Monica (Jul 27, 2010)

C started off with the disposable plasticky novopens filled with novomix30. When we changed to the MDI, we also changed to the novopen 3. Then last year her DSN gave her a novopen 4. C much prefers the 4 to the 3, just because it does go down with a whoosh and not click, click. And, as with the disposables, you can find out beforehand whether there's enough insulin in the pen. Just dial up and it will stop at the amount that's left in the cartridge. That way there's no chance of you not having enough insulin and having to do a second injection (unless you don't check in the first place).

As to the cases, the new zipped case it much better, that the old hard case, as C uses the Autocover needles which wouldn't even fit in the grooves intended for 3 needles in the old hard case. Those wallets I found absolute rubbish though.

When C was using the disposable pens, we weren't given any cases, so I went out and bought a pencil case to put it all in.

C can't re-use her needles as the are "locked" after the first use. She uses the Autocover needles.


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## Flutterby (Jul 27, 2010)

I use the autopen 24 and it's rubbish really.  Quite awkward to use at times and I've noticed the gold numbers on the dose dial rub off quite quickly.  It's like a toy and it's only good point is that its lightweight.  I use the humapen luxura for my shortacting insulin and like it much better than the old one I had.  The case though is too heavy as somebody has already said.  I now carry both pens in a frio case which is ok but there's nowhere to put extras like needles.  I reuse needles until they become uncomfortable, it's just habit and laziness!  I too come from the age of glass syringes and the old ways of using the needle till it's blunt - you just kind of get used to it!


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## Flutterby (Jul 27, 2010)

Just noticed what NiVZ said about the Clikstar pen - what makes it better than the autopen?  Might try and get one, although I've just ordered a new autopen so I will probably have to lie and say it broke!!  As if any of us would do that!!


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## Northerner (Jul 27, 2010)

There are some pictures of the various pens on this NHS page. 

http://www.diabetes.nhs.uk/safe_use_of_insulin/insulin_devices/insulin_reusable_pens/

The luxura looks very smart  I notice that they are too embarassed to show the autopens - they have kept them in the boxes!


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## newbs (Jul 27, 2010)

I have recently been given the Novopen 4 and am actually quite happy with it.  I do find the plastic mechanism inside a bit flimsy but prefer it to the Novopen 3 as I find the insulin delivery better and like the fact that you can just click to see how many units are left in the pen too.  I don't use the cases anyway as I keep the pen with my blood test kit.

I use Levemir prefilled pens and I do not like these at all.  They are very plastiky and the dial is quite hard to press to inject the insulin.

I do not personally use a new needle each time I inject, I replace the needle when it does not go in easily or each time I change the insulin phial, whichever comes first.


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## Moddey (Jul 27, 2010)

*Used needles*

I've been told the same: needles used more than once will damage the tissue more, making it impossible to take care of your injection sites. 
And no, the person who told me this did not work for NovoFine 
There are different needles but the thinner it gets, the easier it's damaged.

I'll share this with you, it does make a good point. Even though it is by BD 

http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7266


Obviously it's very easy for me to choose to use the needles once when we can get an unlimited amount of supplies for E, there's no limitations on supplies for diabetic children.


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## richardq (Jul 27, 2010)

I use the novoflex pens for both novorapid and levemir which I like a lot, as you can hear the clicks going both ways, and know how much you've got left in each pen.

With regard to needles, I only use each one once, because I was told that it can cause problems with the injection site, and gets more painful as they get blunt, but also if you leave the needle in the pen then there is an open tube into the insulin for pathogens to get down, and if you take the needle off and then use it again, it hasn't been kept sterile inbetween uses.  Also, leaving the needle on the pen increased the possibility of air getting into the pen.


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## aymes (Jul 27, 2010)

I quite like my novopen, never had any mechanical problems with it to date and think it looks fine, I have the demi pen which is blue and orange. The case doesn't bother me as I put my pens, needles, test kit etc in a pencil case to carry around.
I only use needles once. I too was told never to leave a needle in the pen as it was an air supply into the cartridge. As I don't leave it on I always put a fresh one on as it no more hassle than it would be to put on old one back on. Now lancets, that's a whole other ball game!


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## D_G (Jul 27, 2010)

I have a blue novapen 4 that i use for my levemir and i am happy with that, i also use the blue and orange demipen for my novorapid, which at first i did not like as i felt i was not getting the same amount of insulin out of it compared to the novopen and was scared to use it! However after a talk and a little test that the DSN did with me i was satisfied it was giving me the right amount of insulin and i was just being paranoid!

I dont use the cases i just carry them with my meter case and they stick out of the top, but it keeps it all together  as for needles i do use them only once per injection....but if i am out and have forgoten to put new ones in my kit then needs must!!


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## Barb (Jul 28, 2010)

*cases*

Hi Copepod,

Maybe manufacturers should look more closely at case design too. You've been very inventive with a substitute. Sounds like you have a very adventurous lifestyle - great.




Copepod said:


> Hi Barb
> Pens haven't changed too much in the 15 years since my diagnosis, apart from the change from 1.5ml to 3ml cartridges.
> However, I've never found a pen case (supplied with a pen) that really suits me - I find eg Humapen Luxura cases too heavy and bulky, with no space for spare cartridges (I prefer to carry spares of each type of insulin) or more than 3 needles. For morning / bedtime long acting insulin pens, I still use a really old black fabric case into which a pen slots, with a long zipped side pocket, but can't remember which pen it came with. For out and about daily use, I use a cheap pencil case, which can hold pen, spare syringe, spare cartridges, a couple of plasters in case of a leaking injection site etc.
> I don't change needles each time, because it doesn't hurt until at least 20 times, and I prefer not to waste resources, both NHS finances and environmental, plus it's quicker and easier to change when it's convenient and not so rushed at home every week or so. I realise it's not recommended practice, but it works for me, even in situations when washing / hygiene is difficult eg marshalling a 24 hour adventure race this weekend, several expeditions of weeks or months in tropical, temperate and sub Antarctic regions.


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## Barb (Jul 28, 2010)

Steffie said:


> Hi Barb and welcome to the forum just wanted to say hello, im a type 2 on injections (byetta) X



Thanks Steffie. The forum is much needed.


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## Barb (Jul 28, 2010)

*pens*

Quite jealous of users of Humapen Luxura and Memoir pens - they look good.

Sadly, I'm not on the Eli Lilly regime (tried their insulins but am much happier with Novo Rapid and Levemir). The only downside at present is the pens but I live in hope.




NiVZ said:


> Hello,
> 
> As a Diabetic of 15 years I've used a few different pens in my time.
> 
> ...


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## Barb (Jul 28, 2010)

*pens*

Pleased you get on with your pen, there are good and bad features with all models.

One of my main gripes is the disposable nature of current pens - they used to be made to last and consequently were made of more resilient materials. I think I paid around ?20 for my original NovoPen and it was well worth the outlay. Rather than the flimsy freebies of today I'd be happy to pay for a reliable model. Today, I follow user instructions to the letter but still have problems, even with brand new pens.

Occasionally I will use a needle more than once. When you need to do injections in a public place you need some privacy but when you have to change needles and prime pens before using them you can draw a lot of unwanted attention! Oh for a reliable device you can bung into your calf under a restaurant table without anyone noticing!

OTE=aymes;154480]I quite like my novopen, never had any mechanical problems with it to date and think it looks fine, I have the demi pen which is blue and orange. The case doesn't bother me as I put my pens, needles, test kit etc in a pencil case to carry around.
I only use needles once. I too was told never to leave a needle in the pen as it was an air supply into the cartridge. As I don't leave it on I always put a fresh one on as it no more hassle than it would be to put on old one back on. Now lancets, that's a whole other ball game![/QUOTE]


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## DanW81 (Jul 28, 2010)

i used to have a novopen 3 for ages, but a guy at work showed me his luxura pen and it was so much better! i now have all 3 of the different colours of the luxura pen! and a rubbish autopen 24 with all the low unit numbers rubbed off for lantus! (although i use a luxura when im working away from home)


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## Northerner (Jul 28, 2010)

It would seem that Autopens are univerally disliked!


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## NiVZ (Jul 28, 2010)

hello,

The Clikstar pen has a 'normal' plunger instead of the useless button on the Autopen which then plunges the dose automatically.

It's that part of the mechanism that broke on me twice during Autopen injections.  Instead of the plunger coming down when I pressed the button it sprang up the way and completely off the pen rendering it unusable and delivering no insulin.

NiVZ




Flutterby said:


> I use the autopen 24 and it's rubbish really.  Quite awkward to use at times and I've noticed the gold numbers on the dose dial rub off quite quickly.  It's like a toy and it's only good point is that its lightweight.  I use the humapen luxura for my shortacting insulin and like it much better than the old one I had.  The case though is too heavy as somebody has already said.  I now carry both pens in a frio case which is ok but there's nowhere to put extras like needles.  I reuse needles until they become uncomfortable, it's just habit and laziness!  I too come from the age of glass syringes and the old ways of using the needle till it's blunt - you just kind of get used to it!


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## Northerner (Jul 28, 2010)

NiVZ said:


> hello,
> 
> The Clikstar pen has a 'normal' plunger instead of the useless button on the Autopen which then plunges the dose automatically.
> 
> ...



I've had occasions where I've had to press the button several times before the thing spins round and delivers the dose, or sometimes it'll do part of the dose and I have to press it again. I'm on the hunt for a Clikstar at my next GP appt.! What units do they do? I had to change my 2-unit Autopen when my lantus requirements dropped from 20 to 7 and I needed 1-unit adjustments.


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## NiVZ (Jul 28, 2010)

Hi Northener,

The Clikstar goes up in 1 unit clicks up to 57 units (although there is a number for 58 I can't get it to turn the last click)

NiVZ


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## Northerner (Jul 28, 2010)

NiVZ said:


> Hi Northener,
> 
> The Clikstar goes up in 1 unit clicks up to 57 units (although there is a number for 58 I can't get it to turn the last click)
> 
> NiVZ



Wow! That's a big improvement on the autopen choice of 2-42 or 1-21! Think I'm due a new pen after 2 years! Wonder if I can flog the autopens on ebay?  Actually, I'd probably just give them back to the DSN


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## sofaraway (Jul 28, 2010)

NiVZ said:


> Hi Northener,
> 
> The Clikstar goes up in 1 unit clicks up to 57 units (although there is a number for 58 I can't get it to turn the last click)
> 
> NiVZ



Which colour one have you got? I've got the blue clikstar and it goes from 1-80. 
You should be able to get them on prescription now as they are officially out.

I like my novopen demi, but do wish that a novopen4 would come out that does half units.


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## Flutterby (Jul 28, 2010)

NiVZ said:


> hello,
> 
> The Clikstar pen has a 'normal' plunger instead of the useless button on the Autopen which then plunges the dose automatically.
> 
> ...



Hi NiVZ, that sounds loads better than my autopen.  Hadn't realised how much I hate it till I got chatting on here!  I'm definitely going to pester my DSN for a Clikstar on my next appt - thanks for the info.


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## NiVZ (Jul 28, 2010)

Hi Sofaraway,

I also went for a blue one and you're right it does go up to 80 units.

However, if theres less than 80 units left in the vial it will only let you dial up how much is left!  Earlier it was 57 and now I can only dial 32 as thats what is left.

Now thats clever - liking this pen more and more 

NiVZ


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## sofaraway (Jul 28, 2010)

Yeah I like that too, very frustrating with the autopen24 when you dial the dose and inject and realise that there wasn't enough to give full dose and you have to change cartridge and jab again.


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## Northerner (Jul 28, 2010)

NiVZ said:


> Hi Sofaraway,
> 
> I also went for a blue one and you're right it does go up to 80 units.
> 
> ...



Now I REALLY want one!  Actually, I want two because I'll need a spare, or do you think that's asking too much and I should just keep the autopens as standbys?


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## Emzi (Jul 29, 2010)

I use the novo 3 and the novo 4, one for levemir and one for novorapid, it took me a while to get use to the plunge on the novo 4 but actually now im use to it its pretty good


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