Insulin pen – recommendation to change the needle

Insulin pen – recommendation to change the needle

Most diabetics use a so-called insulin pen as part of their insulin therapy. These are about the size of a pen and allow for easy dosing of the insulin units. The question often arises as to how often you have to change the insulin pen needles: After each use, or can the pen needles be used several times? In this article, you will learn how to use the insulin pen correctly, whether multiple use of insulin pen needles is possible and what risks this can entail. 

Which insulin pens are there?

First, a distinction is made between single-use pens and refillable pens. In single-use pens, the insulin ampoule cannot be replaced. Once this has been emptied, the pen cannot be reused.

There are also fully automatic and semi-automatic insulin pens:

  • With the semi-automatic pen, a spring is tensioned when the insulin dose is set. The insulin can be injected by gently pressing the release button.
  • If you don’t want to inject yourself, you should use a fully automatic insulin pen. When the release button is pressed, the cannula is pricked directly into the skin and the insulin is injected.


Using and adjusting the insulin pen correctly

The desired number of insulin units can be set by turning the dosing knob. The dose is displayed in analogue or digital form. For example, each dosing step is visible and audible through a clicking sound.

Proper insulin pen use is an essential element of effective insulin therapy. Insulin is injected into the subcutaneous fatty tissue (subcutaneously) in the abdomen (rapid insulin absorption) or in the outer thighs (slow insulin absorption). Still, the buttocks and upper arms are also conceivable. When injecting, a fold of skin is formed with the thumb and forefinger, thereby reducing the risk of injecting into the muscle.

To ensure optimal distribution of the insulin in the adipose tissue, the insulin should be injected slowly, and the needle should only be removed again ten seconds after the injection is complete. Another essential aspect of optimal insulin injection is the correct injection angle. If a skin fold is formed, you can pierce both at an angle (45 degrees) and perpendicularly (90 degrees) and choose the needle length according to the thickness of the sub-fatty tissue.

Cleaning agents containing alcohol must not be used to clean the insulin pen. A damp cloth is sufficient for cleaning. The pen must not be immersed in water.

How do you avoid pain during insulin injections?

Thinner, shorter and sharper needles with a particular lubricating film have been developed to significantly reduce the inconvenience of injecting insulin. The lubricating film ensures an almost painless injection. However, if reused, the performance and safety of the needles will be compromised. Both the loss of lubricant and damage to the needle tip increase the discomfort of the injection.


How often should the insulin pen needle be changed?

Pen needles are disposable. A new needle should be attached before each injection. Various problems can arise when pen needles are used multiple times. Among other things, reused needles can increase so-called lipohypertrophies. These are tissue changes with a visible thickening of the tissue at the puncture sites. In addition, pen needles that are used more than once can lead to painful injections due to blunting of the needle support.

What are the advantages of single-use pen needles?

The injection is generally less painful. On the one hand, the surface of the pen needle has an intact lubricating film; on the other hand, there is no risk that the needle tip is already bent. This also minimizes the occurrence of lipohypertrophy and promotes a more even uptake of insulin from the injection sites. This leads to a more stable blood sugar level in insulin therapy. Each time the pen needle is changed, residues of the previously injected insulin are avoided as crystalline residues and thus clog the needle.

Does the frequent needle change result in additional costs for the patient and the healthcare system?

For people with diabetes who have pen needles prescribed by their doctor, there are no higher costs. The advantage for you and our health system is, among other things, that blood sugar fluctuations as a result of lipohypertrophy can be better avoided. This leads to a more calculable supply of insulin, promoting reasonable control of blood sugar levels.

In the long term, good insulin therapy reduces secondary diseases such as amputations, blindness, dialysis, etc. Consistent single use of pen needles could thus contribute to long-term relief for health insurance companies, as the costs for treating secondary diabetes diseases are reduced.


What happens if you use a pen needle more than once?

The modern pen needles are skinny, finely ground and covered with a lubricating film. After each use, the needle becomes blunt or gets small deformations and loses its ability to slide due to the wear of the lubricating film. The repeated use of the pen needle can, therefore, result in various health risks for the patient:

  • Wear and tear on the tip of the needle can cause minor injuries and bleeding ( bruising ) in addition to the actual puncture. The injections then not only become increasingly painful, but the risk of the formation of so-called lipohypertrophies also increases. This change in the subcutaneous fatty tissue (fatty tissue proliferation) changes insulin absorption (uptake) at these points. The result is a valuable onset of insulin action and, thus, the risk of blood sugar fluctuations.
  • The pen needle is no longer sterile after the first use. In addition, tissue residues can adhere to the pen needle. Not only is this unhygienic, but it also increases the risk of infection.
  • Insulin that has crystallized out and remains of tissue adhering to it can lead to blockage of the pen needle and thus to underdosing of insulin.
  • Depending on the temperature, air bubbles in the insulin cartridge can continue to expand or form again when the needle is attached. As a result, insulin will drip from the needle after injection, and there is a risk of inaccurate dosing due to air injection.
  • More minor injuries are also caused by a needle that is used more than once. The growth of fat cells and scarring are then increasingly stimulated. The injection sites are more likely to form thickenings that are harder than normal subcutaneous fat and look like small mounds.

Is reusing pen needles unhygienic?

Brand-new insulin needles are sterile, i.e. germ-free. A used or directly touched needle, on the other hand, is covered with bacteria and other germs. This is not only unhygienic; the germs can also penetrate the skin if the needle is used several times and, in the worst case, cause infections. The first signs are small acne pimples and round redness in the puncture area; in the worst case, skin abscesses develop.

Can a pen needle that has been used more than once become clogged?

Suppose the needle is left on the insulin pen. In that case, the insulin remaining in the needle can crystallize between injections and cause a blockage, making it impossible to deliver insulin for the next injection. Reusing the pen needle can result in microscopic bending of the tip and wear of the lubricating film. Damage that cannot be seen with the naked eye. The damaged tip also leads to minimal injuries when the injection needle pierces the skin, which can be perceived as pain. In extreme cases, damage to the needle tip can also lead to small metal fragments splintering off and being stored in fatty tissue. In rare cases, the needle can even break.


What do doctors and diabetes consultants recommend when it comes to changing needles?

Doctors and diabetes consultants also recommend changing pen needles before each use. The experts point out that many patients underestimate the dangers of multiple use in practice. This statement is supported by international studies in our neighbouring European countries, where the awareness of changing needles is much more pronounced than in Germany. People with diabetes in France and Holland behave in a particularly exemplary manner: On average, the pen needle is only used once or at most twice.


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