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News: Prescriber's Letter January 2015

DIABETES

You’ll get questions about which insulin syringes or pen needles to use.

Ask what the patient prefers...and use these rules of thumb. 

Length.  Feel comfortable using the shortest needle available. 

PEN needles come as short as 4 mm.  But insulin SYRINGE needles are at least 6 mm...to extend past the vial’s rubber stopper. 

Reassure patients that a 4 mm pen needle works just as well as a longer one...even in patients who are obese or elderly.

In fact, needles OVER 5 mm have a higher chance of reaching muscle...leading to faster absorption and possibly hypoglycemia.

That’s why patients should “pinch an inch” when using needles OVER 5 mm...so they don’t go past the fatty layer.  But explain this usually isn’t needed for adults using a shorter pen needle unless they are thin.

Gauge.  Try to use the highest gauge, or thinnest, needle available to minimize pain.  A 31- or 32- gauge needle is fine for most patients.

Syringe volume.  Keep in mind that syringes come in 30-unit (0.3 mL), 50-unit (0.5 mL), and 100-unit (1 mL) volumes.

In general, give the smallest syringe that holds the max dose of insulin.  But allow for flexibility in case the dose is adjusted. 

Product selection.  Write a separate Rx for insulin syringes or pen needles.  Keep in mind that most pen needles are compatible with most insulin pens. 

When sending e-Rxs, select the length and gauge for needles...AND also volume for syringes.  You don’t need to specify a brand...that way pharmacists can pick what patients prefer.  Write quantity in “boxes.”

For example, write “insulin pen needle 32 G x 4 mm” with a quantity of 1 box of 100 for a patient who uses insulin TID.

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