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Using Pens – Keep It In and Hold It Down!

Nov 24, 2020


A lesson in proper technique for using insulin pens….

Susan received a phone call from her clinicians office, recommending that she start using a pen for her insulin. She had also been prescribed a GLP-1 receptor agonist and was to go to the pharmacy to pick them up. 


She went and signed up for the long discourse patients receive when they pick up new meds, including questions such as whether or not the pharmacist had offered instructions and pages of small print. Like many of our patients, she signed the sheets and went on her way without ever talking to a pharmacist or asking questions. 

She came into my office with no improvement in her glucose levels after increasing her doses several times. Neither did we notice any of the expected effects/side effects of her GLP-1 receptor agonist. She told me she didnt think she was getting her medications. 

I then asked her to show me her technique. She prepared her pen correctly, but after injecting and pushing the dose button (push button, injection button), she did not continue to hold it down the recommended 5 to 10 seconds after seeing the 0. Her site was not just a small drip wet, but it seemed the entire amount of medication she should have gotten was on her skin, not in her subcutaneous tissue. 

Once I saw this, I decreased her dosages and taught her to make sure she held the dose buttondown and counted to 10 before removing the needle from her site. She did so. We immediately saw improvements in her glucose levels and effects from the GLP-1 at the lower doses. 

Her numbers soon started to come down, and we also saw effects from the GLP-1 receptor agonist. We did not have to increase her doses. 

Lessons Learned: 

  1. When the results arent as I expect, always assess my patients technique using insulin pens.
  2. Always assess my patients techniques. Yes, this is a repeat. This cant be said enough. 
  3. When teaching patients to use pens, always stress the importance of holding the button down, keeping the needle in, and counting to 10 once the dose button goes to 0 or its base. Why? The pen is a different delivery system than the syringe; it is slower. 


If you have a “Diabetes Disaster Averted” story like this one about using insulin pens, please let us know! If we feature your Disaster Averted in our Diabetes Clinical Mastery Series e-newsletter, you will receive a $25 gift card. Please click here to submit a short summary of the incident, what you feel you learned from handling the incident, and your name and title. If you prefer to remain anonymous, please let us know, but still give us your name and address (so we can send you the gift card).







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