Health Promotion and Maintenance Q 108
Patricia, a 20-year-old college student with diabetes mellitus, requests additional information about the advantages of using a pen-like insulin delivery device. The nurse explains that the advantages of these devices over syringes include:
A. Accurate dose delivery
B. Shorter injection time
C. Lower cost with reusable insulin cartridges
D. Use of a smaller gauge needle.
Correct Answer: A. Accurate dose delivery
These devices are more accurate because they are easy to use and have improved adherence to insulin regimens by young people because the medication can be administered discreetly. Once in use, most insulin analog vials, cartridges, and prefilled pens must be discarded after 28 days. This means that many patients who use a 10-ml vial end up either wasting insulin or using insulin beyond its recommended discard date. This is rarely a problem for patients using either a 3-ml prefilled pen or a reusable pen containing a 3-ml insulin cartridge.
Option B: Injection time of insulin pens and the traditional insulin syringes have no significant difference. Patients must therefore keep the device in place with the button pressed in for 5–10 seconds. If the patient is using more than 50 units of insulin per dose, a good rule of thumb might be to instruct them to count to 10 regardless of the pen they are using to ensure complete absorption of the insulin.
Option C: An additional issue is the greater prescription cost of insulin cartridges and prefilled insulin pens compared with insulin vials, although the cost to the patient may be the same depending on their coverage; in fact, if they have one copay per box of pens, the cost to the patient may actually be less per unit of insulin. It should be noted, however, that despite the higher unit cost of insulin in pen devices versus vials, several studies have found that overall diabetes-related treatment costs are lower with pen devices than with vial and syringe.
Option D: For all insulin pen devices, a separate prescription for pen needles is required, with gauges ranging from 29 to 32 and in lengths from 5 to 12.7 mm, much like the traditional insulin syringes used. More recent developments have resulted in the introduction of safety needles with protective shields that not only reduce needle-stick injuries but may also allay patient anxieties about needle use.