1. INSULIN BY PEN
12/2008

2. Goal: Optimal Student Health and Learning
Accurate and timely
insulin dosing
is a vital piece of a comprehensive plan.
This training component is one of thirteen components created
specifically for school nurses and non-medical school personnel who
perform diabetes care tasks at school.
These components are:
• Diabetes Basics
• Diabetes Medical Management Plan
• Hypoglycemia
• Hyperglycemia
• Blood Glucose Monitoring
• Glucagon Administration
• Insulin Basics
• Insulin by Syringe and Vial
• Insulin by Pen
• Insulin by Pump
• Ketones
• Nutrition and Physical Activity
• Legal Considerations
This unit is Insulin by Pen.

3. Learning Objectives Participants will be able to understand:
Types of insulin pens
Where on the body to inject insulin
Preparation steps for insulin pen injection
Participants will be able to demonstrate:
How to dose with an insulin pen
How to inject with an insulin pen
Participants will be able to understand:
Types of insulin pens
Where on the body to inject insulin
Preparation steps for insulin pen injection
Participants will be able to demonstrate:
How to dose with an insulin pen
How to inject with an insulin pen
In addition to understanding insulin dosing and delivery using an insulin pen, it is important school staff who administers insulin to a student or assists a student with insulin administration understand the fundamentals of insulin action, dosing and delivery. These general concepts are covered in the unit entitled “Insulin Basics.”

4. Insulin Pens
Techniques for dosing and insulin delivery are similiar for both types of pen devices:
Prefilled pens
Reusable (cartridge) pens
Both long-acting or basal insulin and rapid-acting or bolus insulin are available in pens
Most students will only take rapid-acting or bolus insulin in school
Regardless of whether a student uses a pre-filled or a reusable pen design, the techniques for dose preparation and insulin delivery are generally similar.
Pre-filled pens
Pre-filled pens contain a built-in, insulin cartridge. Because this device requires no loading by the student/parent/guardian, it is especially convenient and easy to use.
Reusable pens
With the reusable pen, an insulin cartridge is inserted into the pen's delivery chamber.
Check the package insert for the specific guidelines for product expiration, as pens vary from vials.
Injection basics with a pen:
Once a disposable needle is screwed on to the pen and the pen is primed, pen is dialed to the appropriate dose, which can be seen in the device's display window and can be heard as audible clicks in many pen devices. The needle is inserted subcutaneously, and the plunger injection button is depressed to deliver the dose. The pen needle should remain in the subcutaneous tissue for 5 seconds after complete depression of the plunger.

5. Where to Give Insulin: On Target!
Insulin works best when it is injected into a layer of fat under the skin, above the muscle tissue
Rotating sites is important to insulin absorption
Common preferred sites are the abdomen, thighs, buttocks, and upper arms
Student should help choose injection site
Inject into fat layer under skin
Rotate sites
Student should choose site
Common sites: abdomen, thigh buttocks, upper arms 5

6. Insulin Pen: Preparation
1. Gather supplies. Verify insulin type
pen device (with cartridge)
pen needle
alcohol wipe
sharps container
2. Wash hands
3. Apply gloves
4. Have student chose injection site
5. Clean injection site
6. Screw on pen needle
Here are the steps for administering insulin with an insulin pen device:
Gather supplies: You will need the pen device (with insulin cartridge), pen needle, alcohol wipe, sharps container
Wash hands
Apply gloves
Chose injection site
Clean the area where you plan to give the injection
Screw the pen needle onto the pen device

7. Insulin Pen: Dosing
7. Prime: Dial “2” units. If the pen is being used for the first time, prime 4-6 units as per manufacturer’s instruction 8. Hold upright. Remove air by pressing the plunger. Repeat “Prime” if no insulin shows at end of needle 9. Dial number of units to be administered as per DMMP
7. Dial “2” units
8. Holding the pen upright, needle end up, press the plunger at the base or bottom of the pen to remove air until a few drops of insulin come out of the end of the needle
9. Dial number of units to be administered as per DMMP
Note: A brand new pen will need to be “primed” with 4-6 units until a few drops of insulin come out of the needle. The purpose of priming is to clear any air out of the syringe that could affect dosing. Priming should be done into the air and not at the student.

8. Insulin Pen: Injecting
10. Pinch up the skin
11. Push the needle into the skin at 90
12. Release pinched skin
13. Push down on the plunger
14. Count to “5”
15. Remove and dispose of pen needle
16. Document time, dose, site, and blood glucose value
10. Pinch up the skin
11. Push the needle into the skin at 90 into the chosen injection site
12. Release pinched skin
13. Push down on the plunger at the base or bottom of the pen
14. Count to “5”
15. Remove and dispose of pen needle
16. Document time, dose, site, and blood glucose value
The needle should be removed after each dose to prevent leakage of insulin from the pen.
School personnel should allow the child to remove the needle if s/he is deemed competent to do so according to care plan agreements with the parent/guardian, student, and school nurse.
If school personnel remove the needle, caution should be taken to carefully replace the outer cap of the needle without touching the outer cap itself.