# Can anyone help - advice for using pen with one hand



## Diabetesdoc27 (Oct 19, 2010)

Hi, wondered if anyone can help - I am a diabetes hospital doctor directed to this site by Diabetes UK - I am trying to findout if anyone has experience of using insulin pen devices with one hand - looking for gripping or clamp device to hold pen and or meter to allow needle change, cartridge change and to allow dialling dose. person needing this is currently in hospital, and can inject fine once dose dialled, but to live at home alone independantly needs to be able to deal with injections and test - our occupational therapy team can't come up with anything, and I just feel there must be people out there with similar problems either as result of injury / stroke / surgery. Have looked at various websites but struggling to find anything suitable. Any advice from anyone in similar situation or who has a solution gratefully accepted


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## Northerner (Oct 19, 2010)

Hi, we do have at least one member that I know of who uses only one hand. I will message her to make sure she sees this


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## Flutterby (Oct 19, 2010)

Hi, how lovely that you have bothered to try and find an answer.  I had a stroke two months ago which affected my right side and I too struggled to do my jabs.  It was an absolute nightmare, I'd get the needle in but then not be able to operate the pen.  I was lucky in that I soon regained reasonable use of my hand and also had my husband who sort of balanced the pen with his hand so I still felt "sort of" independent.  It's something I have thought about since and would be interested in someone finding a solution to this most basic requirement for anyone using insulin who is affected in a similar way.  Fortunately I am now able to use my hand fairly well.

Your patient is lucky to have such a thoughtful doctor as no-one even thought to ask me how I was coping.  Karen.


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## smile4loubie (Oct 19, 2010)

Northerner said:


> Hi, we do have at least one member that I know of who uses only one hand. I will message her to make sure she sees this


And here i am 
when i inject i hold the pen with the winding mechanism near my index finger and thumb. Close my hand around my pen and able to steady the pen while winding the pen to correct does with thumb and index finger. It does take some practice but once you got the hang of it its easy. As for testing the best blood lit I've come across is the aviva nano. It comes with a clear cap you put on which means you can test on your other arm. When i did test on my fingers I'd balance the finger pricker on my leg and use my elbow of my short arm (my left arm is missing just below my elbow) to push the button while lining up my finger on my right hand. I found my fingers got too sore to quickly as you can only really test on one side of your finger. With the aviva nano you don't need to code the test strips as there is a computer chip type thing you push into the device and its easy to get out again. Where is the patient based. I'm in surrey and if its not too far away i can try to come and show how i manage. If there's anything else i can help with please message me.


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## smile4loubie (Oct 19, 2010)

As for changing cartridges you can get prefilled pens for some insulin as you probably know but i can change cartridges again by holding pen under elbow of left hand to steady it while i use my right to untwist the pen. To wind the plunger back I'd hold the pen in my palm and use my index finger and thumb to twist then to put the cartridges in I'd steady the end of the pen on my leg using my elbow while sliding the cartridges in. To do the pen up again steady on my leg and twist. To put a needle on or off I'd either hold the pen in my arm pit and twist the needle on or again leaning pen on my leg. I also only inject into my legs as its easier and seems to be steadier.


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## katie (Oct 19, 2010)

Lou, just wondering, how do you get the needle cap off? and back on, if you do put it back on...


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## Einstein (Oct 19, 2010)

Hi,

I have severe neuropathy and have recently changed insulins to assist with this same issue. I am now on Lantus and Humalog (from NovaRapid and Levemir) simply to the fact that Owen Mumford make a pen that has two attachments, one being an easy dial dose knob and the other being a simple thumb operated, spring loaded release mechanism.

HOWEVER, this solution isn't perfect and I still need help in chaning the cartridges as the unit is a multi-turn screw thread (and quite stiff) and second the plunger does not rewind upon inserting a new cartridge, it too is quite stiff.

On the meter front the best one I have found is the Mobile by accuchek, it doesn't use individual test strips, but a tape of 50 test patches and a simple open/close door to turn on/off - the lancet is a simple multi-cartridge device, so essentially it could be changed weekly with the Lantus insulin by a visting nurse or friend.

The last remaining issue for consideration is loading and unloading needles on the pens - I would NOT use Owen Mumford needles, I find they can bend and therefore not pierce the cartridge when loaded. There are special easy to handle needles with a much longer case than normal needles available.

The makers of NovaRapid and Levemir do have their own one handed disposable 'pen' I found it fairly clunky and I bruised easily with it.

Hope you find something to assist.

Rgds, E


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## smile4loubie (Oct 19, 2010)

katie said:


> Lou, just wondering, how do you get the needle cap off? and back on, if you do put it back on...


I hold it in my arm pit to steady it or lean it on my leg


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## smile4loubie (Oct 19, 2010)

Einstein said:


> Hi,
> 
> I have severe neuropathy and have recently changed insulins to assist with this same issue. I am now on Lantus and Humalog (from NovaRapid and Levemir) simply to the fact that Owen Mumford make a pen that has two attachments, one being an easy dial dose knob and the other being a simple thumb operated, spring loaded release mechanism.
> 
> ...


I use pre filled pens of novorapid and levemir and have never had a problem. The good thing about the Nano is that the lancets for the finger pricker are in like a drum that hold's 6 at a time so no fiddly lancets to change.


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## grandma (Oct 19, 2010)

I have both hands but thought that Iwould let you know that I am on Humalog and Lantus ang both are in a prefilled. The Humalog KwikPen and the Lantus SoloStar. Very easey to use I have just been trying and I can do it with one hand.


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## katie (Oct 19, 2010)

smile4loubie said:


> I hold it in my arm pit to steady it or lean it on my leg



Thanks Lou  Must be difficult getting the cap back on without puncturing yourself, Ive stabbed myself a few times anyway


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## Einstein (Oct 19, 2010)

smile4loubie said:


> I use pre filled pens of novorapid and levemir and have never had a problem. The good thing about the Nano is that the lancets for the finger pricker are in like a drum that hold's 6 at a time so no fiddly lancets to change.



My issue with pre-filled and standard pens (even the NovoPen 4) was the pressure required to press the plunger to release the insulin.

The Owen Mumford pens while feeling very cheap compared to other makes does have the advantage of being one button you slide to inject and there is a cover to make it easier. Also it's on the side of the pen, so you just need to grip the pen with your thumb wrapped around it.

Many moons ago there was a superb pen produced by Novo, the whole pen fitted in the palm of your hand and a simple push button released the dialed dose, which was an easy to turn thumbwheel and the digital display showed how much you'd dialled up, but when you removed the pen from it's cover the display showed the last dose and how many hours ago it was - really neat!

Alas, it's no longer in production  there was also a meter as a sleeve you could get for it from AccuChek. A really good combination.

It certainly would have made my issues a whole lot easier if they were still available.


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## smile4loubie (Oct 20, 2010)

Einstein said:


> My issue with pre-filled and standard pens (even the NovoPen 4) was the pressure required to press the plunger to release the insulin.
> 
> The Owen Mumford pens while feeling very cheap compared to other makes does have the advantage of being one button you slide to inject and there is a cover to make it easier. Also it's on the side of the pen, so you just need to grip the pen with your thumb wrapped around it.
> 
> ...


The only time I've had a problem with pressure is if i haven't changed the needle or its blocked for some reason.


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## everydayupsanddowns (Oct 20, 2010)

Not for the first time this thread makes me think that the manufactureres should be encouraged/cajoled/forced into a standardised cartridge and needle attachment specification. They exist for so many objects (CDs, USBs and videos for those that remember them). In all those markets, competition still exists, but the consumer can choose from all products available.

That way if there is only one type of injection device which meets anyone's needs they still have access to the full range of insulins available.

To have to change insulins (as I did this year) to get the functionality of the injection pen (in my case a dose/timing memory) seems completely crazy.


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## Copepod (Oct 20, 2010)

Completely agree with everydayupsanddowns - compatible insulin pen devices, needles and cartridges would be a big improvement. Whenever I've discussed pen etc design with drug company reps, they've said that the increasing demand is for disposable pens, but I'm sure I'm not the only one who would hold out against using disposable items instead of reusable, on environmental grounds. 
Plus, some outher drugs are given in subcutaneous injections eg Byetta, Victoza, heparin etc, so the market for compatible pens is relatively large, but insulin is probably the biggest single drug, although of course, there are so many types of insulin. 
(Old enough to remember days of both VHS and Beta videos )


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## Caroline (Oct 20, 2010)

I hope you found an answer and were able to help your patient. I wish you wee my doctor for being so helpful and caring!


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## Monica (Oct 20, 2010)

Copepod said:


> Whenever I've discussed pen etc design with drug company reps, they've said that the increasing demand is for disposable pens, but I'm sure I'm not the only one who would hold out against using disposable items instead of reusable, on environmental grounds.



We, at first, used disposable pens for the simple reason that when I tested both for easiness of use, I thought the disposable was better. After changing the insulin regime (but not brand), the DSN decided we should use re-usable pens.( I guess she was thinking of fridge space, as it would have meant 3 big boxes of different insulins) I'm glad I made the change, as I found that the disposables were not easier to use after all.  But I agree with Copepod, I hate any waste and try my best to recycle.


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## Copepod (Oct 20, 2010)

Agreeing with Monica, space taken up in fridge is another important consideration, where cartridges win over disposable pens. As I live in a shared house, with up to 3 other adults, usually sharing food with just 1 of them daily, I cut up my foil strips of cartridges, leaving each cartridge still enclosed in foil / plastic, discard box and all but 1 leaflet for each type, and place some in a small plastic box and wrap the rest in a plastic bag, whoch reduces total volume by about 1/3.

I hope the advice about one handed handling of pens has been passed on, by the doctor who asked originally, to their patient. Also, very encouraging to learn that Diabetes UK directed them to this site!


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## JoeFreeman (Oct 21, 2010)

Copepod said:


> Also, very encouraging to learn that Diabetes UK directed them to this site!



Trying to make sure we tell more people about it - really is a great resource and I hear nothing but good about it from everyone involved 

Joe

Digitial Communities Manager
Diabetes UK


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## Einstein (Oct 23, 2010)

Copepod said:


> Agreeing with Monica, space taken up in fridge is another important consideration, where cartridges win over disposable pens. As I live in a shared house, with up to 3 other adults, usually sharing food with just 1 of them daily, I cut up my foil strips of cartridges, leaving each cartridge still enclosed in foil / plastic, discard box and all but 1 leaflet for each type, and place some in a small plastic box and wrap the rest in a plastic bag, whoch reduces total volume by about 1/3.
> 
> I hope the advice about one handed handling of pens has been passed on, by the doctor who asked originally, to their patient. Also, very encouraging to learn that Diabetes UK directed them to this site!



A couple of points on standards. The needles do fit all pens, however, the cartridges started as the same standard, only one of the big insulin producers invested time and money in pen development, while others 'got by' as such the healthcare professionals prescribed company a's pens with company b's insulins.

The result was they were selling huge numbers of pens compared to the volume of insulin. So vendor 'a' changed their cartidge style and launched a new pen.

I think it's fair when the only vendor in the market who is prepared to produce good quality, long lasting, fit for purpose pens and make the investment in doing so, should gain the reward of the whole package from their development efforts.

The issues of disposable pens we've touched on before relate to problems with the pen and the pharmacy and manufacturers attitude of throw it away and use a new one - more revenue for them, more cost for the NHS.

A second issue with disposable pens is the disposal of them. When I asked various bodies a couple of years ago the advice coming back was that unused insulins should be disposed of in a sharps bin. As the largest available at the time on an NHS prescription was 1 litre, I couldn't see how you got one pen easily in an empty bin.

The only options in order to dispose of the insulin as required would be to buy a larger sharps bin or to break the pen apart and put the cartridge in a 1 litre sharps bin and the plastic waste in the household waste. 

So you have to snap something in half with a glass cartridge in the middle of it.

Hence, I guess most end up in landfills.


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## smile4loubie (Oct 23, 2010)

Does anyone know if the doc has been back to read any of this since?


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## Steff (Oct 23, 2010)

smile4loubie said:


> Does anyone know if the doc has been back to read any of this since?



looking at his profile he was on the day after (20th) at ten past 2 in the morning


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## Diabetesdoc27 (Oct 25, 2010)

Yes have been back to look - thanks so much to everyone who replied to me and the discussion that carried on from that. The man in question is looking at getting a joiner friend to make some kind of clamp to stabilise his pen, and meantime is practicing using it one handed as discussed in previous replies. He is using a velcro patch on a board  with the other side of the velcro on the base of his meter to stabilise it, and that's working well. Have been really disappointed by the occupational therapy response to this query in our hospital - but we're still looking. Thanks again for your comments, and by the way I'm a "she" not a "he"!


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## Flutterby (Oct 25, 2010)

Oops - don't know why we assumed you were a "he", sorry!!  Sounds like the man has had some good ideas of his own.  Wish him well from us all.


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## josey (Apr 8, 2022)

I've just come across this post trying (as an occupational therapist) to support a patient to be independent with his insulin with one hand. We've discovered on many sharps bins there are areas you can 'clamp' the needle casing, which allows to remove backing from needle casing, draw up, put needle on, remove needle. We just placed the bin on non stick map, the patient found it much easier than trying to capture it in his elbow, arm pit or knees. Really appreciated the wisdom on here!


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## grovesy (Apr 8, 2022)

Einstein said:


> A couple of points on standards. The needles do fit all pens, however, the cartridges started as the same standard, only one of the big insulin producers invested time and money in pen development, while others 'got by' as such the healthcare professionals prescribed company a's pens with company b's insulins.
> 
> The result was they were selling huge numbers of pens compared to the volume of insulin. So vendor 'a' changed their cartidge style and launched a new pen.
> 
> ...


This is a an old thread and many of the posters on it have not visited the site for a number of years.


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