Insulin Pens

What to Expect

You or your child will follow a personalized insulin regimen that is based on the type of diabetes your child has and his or her individual insulin needs.

The insulin regimen used most often involves checking the blood sugar before breakfast, lunch and dinner. A corrective dose is given at that time to bring down any high blood sugars. A food dose is also given based on the number of carbohydrates eaten. These two doses are combined into one injection.

Snacks high in carbohydrates require a food dose. Your child's blood sugar may not need to be checked at snack times because a corrective dose is not always given with snacks. Corrective doses at bedtime may also be needed if the blood sugar is greater than 250 or 300 mg/dL. Check with your child's doctor to see if he or she needs a corrective dose at snack time or bedtime.

Food and corrective doses are given with fast-acting insulin pens, such as Humalog, NovoLog and Apidra. Fast-acting insulin doses must be separated by at least two hours. If given closer than that, a low blood sugar could result. Blood sugars between meals are controlled by a long-acting insulin pen, such as Lantus or Levemir. Lantus is given once a day at the same time every day. Your family chooses a time that works with your schedule. The dose is the same every day. Levemir can be given once or twice a day at a fixed time with a fixed dose.

Another insulin regimen uses a sliding scale to determine the insulin dose. Use of the sliding scale regimen requires eating a fixed amount of carbohydrates at each meal and snack. Therefore, a food dose is not needed. Blood sugar is checked before the meal or snack, and the insulin dose is chosen from a sliding scale based on the blood sugar. The insulin for the food is built into the scale. The long-acting insulin is still a set amount given at a set time once or twice a day.

At first, insulin regimens can be confusing. Your diabetes educator will explain your child's regimen to you in detail.

Keeping track of your child’s blood sugar is an essential part of managing diabetes. Some parents like using a logbook or software spreadsheet. There are also apps for smart phones that can be used. Below are forms we have created that you can use as well:

• Logbook for Kids on Injections–Ratio
• Logbook for Kids on Injections–Sliding Scale

How to Use an Insulin Pen

Follow the steps below to administer a dose of insulin with a pen:

• Wash your hands.
• Take the lid off the insulin pen.
• Wipe off the top of the pen with an alcohol swab.
• Attach the pen needle to the pen. Make sure it is on tight and remove both caps: The big clear cap covers the entire pen needle apparatus, while the small cap covers only the needle.
• Dial an air dose great enough to see a few drops of insulin (usually one or two units, unless using a brand new cartridge).
• Hold the insulin pen upright and push out air until you see a few drops of insulin.
• Dial the prescribed dose.
• Select the site for injection and wipe with alcohol.
• Pinch up the skin and insert the needle all the way in. Push the top of the pen in all the way. Make sure the dial returns to zero. Wait five seconds. Take your thumb off the top of the pen and release the pinch before you pull the needle out. This will prevent insulin from leaking back out.
• Replace the big, clear needle cap. Unscrew the needle and place it in a sharps container.

If insulin or blood leaks out of the injection site or your child experiences pain or bruising, follow the advice below:

• Insulin leaks out. Be sure to release the pinch before pulling the needle out of the skin. If the leak back continues, finish injecting the insulin, release the pinch and count to five before pulling the needle out. This should allow the fat layer below the skin to accept the insulin more easily.
• Blood leaks out. When giving the injection, stay away from visible capillaries just under the skin. If one of these is hit with the needle, blood will leak from the injection site. Occasionally, you will still experience some bleeding from the injection site, but it should not occur routinely.
• A bruise forms after the injection. Avoid injecting the needle into visible capillaries and make sure that the skin is pinched adequately. You should also avoid getting too close to the muscle under the fat layer.
• Pain is felt during or after the injection. Review your injection techniques to make sure you are following each step correctly. Talk to your diabetes educator to learn about other techniques that may reduce pain.

Key Points to Remember

• Insulin pens provide an easy way to deliver insulin to children with Type 1 or Type 2 diabetes.
• Long-acting insulin pens start to lower your child's blood glucose within one to two hours and continue to lower blood glucose for up to 24 hours.
• Fast-acting insulin pens begin to lower your child's blood glucose within 15 minutes but only last for three to four hours.
• Read the information that comes with the insulin pen; most insulin pens are good for 28 days once opened, though some are only good for 14 days.
• If your child uses an insulin pen, he or she will receive a personalized insulin regimen that is based on the type of diabetes your child has and his or her individual insulin needs.