Reviewed by Dave Joffe, CDE, FACA, Editor-in-Chief
and Katie Maneely, PharmD Intern, University of Florida
The new BD Nano Pen Needles are much smaller than the original BD needles. These new needles are both shorter (4mm) and thinner (32G) than standard needles, potentially offering a less painful way to deliver insulin to patients.
While we were excited to learn about a product that could potentially help our diabetic patients, we were concerned about the efficacy of smaller needles. In order to see if these needles would be a good choice for my patients, we searched the literature.
The first concern was injection site leakage however the amount of leakage is actually the same as other pen needles on the market (about 1 unit). (1)
Since so many of our Type 2 patients are obese we were also concerned that these needles may not be long enough for them; however, the Nano Pen Needles are just as effective. (2) The skin is less than 3 mm thick at all injection sites for almost all patients and a recent study analyzing skin thickness at injection sites in adults with diabetes showed that skin thickness almost always remains less than 3 mm at all injection sites despite differences in race, age, sex, and BMI.
Although skin thickness is consistent across demographics, depth of subcutaneous tissue varies significantly depending on sex and BMI. All men and people with a BMI < 25 kg/m2 typically have less subcutaneous adipose tissue. Using longer pen needles in these patients has often resulted in intramuscular injections, leading to erratic absorption of insulin, increased pain, and greater potential for hypoglycemia. Using the shorter Nano Pen Needles decreases the chance of an intramuscular injection.
No Pinch Up Required
Compared to both the 5 mm and 8 mm pen needles the Nano needles are 25% and 50% shorter respectively and patients preferred them over those needles and they unanimously thought the Nano was less painful during both insertion of the needle and injection of the insulin. Studies also show that patients found the Nano to be less intimidating, not surprisingly. We can now go back to patients who were afraid to inject their insulin, and with this new shorter needle they may be more likely to be compliant with their therapy, thus making it possible for more of them to achieve their glycemic goals.
As many of you know my interns get to spend much of their rotation living like they have Type 1 diabetes and Katie was no exception. I have them try all the different devices and when she used that new 4mm pen needle all of a sudden she felt the 5mm was way too big. (Good thing I never showed her the 12.7mm one!)
In sum, we believe the Nano pen needle is a remarkable innovation because it lowers multiple barriers to effective patient self care. This brand new option is something that we can all, clinicians and patients, be more “comfortable with.”
You can learn more about the Nano here: BD Nano Pen Needle.
- Gibney MA, Arce CH, Byron KJ, Hirsch LJ. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Curr Med Res Opin. 2010; 26 (6): 1519–1530.
- Hirsch LJ, Gibney MA, Albanese J, et al. Comparative glycemic control, safety and patient ratings
Editor’s personal note: Katie is an exceptional intern and very dedicated to pharmacy and her patients. She is currently ranked number 1 in her class of over 300 PharmD Candidates at the University of Florida College of Pharmacy, will graduate Summa Cum Laude. She has been able to maintain this level of academic excellence while raising a little one year old.