Pen versus syringe for insulin delivery?

I have just started using insulin and am having problems with my Novopen Junior. I’m 53, newly diagnosed with LADA, A1c was 7.2 initially but got it down to 5.8 through extreme low carb diet, resulting in 25 pounds weight loss and still losing, though I am 5’7’ and down to 115 pounds. I was getting a spike of 180 after eating 20g carb at a meal- and my fasting BG is in the 80s still, so that was very uncomfortable, especially when it would then fall to the 70s within an hour or two. I tried precose and that upset my stomach and still didn’t let me eat enough carbs to maintain weight. My doctor suggested Januvia, but I don’t want to mess with an unproven safety record, so we settled on trying insulin. I got the Junior pen because it doses in 1/2 units but I am finding it’s accuracy is uncertain. Sometimes it leaves a large drop of insulin on my skin. One day I’ll do 3 units and eat 50 grams and my BG goes up to 140. Another time, it dropped to 50. Does anyone else have problems with a pen, and is a syringe a more accurate delivery system? It may be that I need to experiment more. Any suggestions? I’m so glad I found this site as I only know people with Type 2 and my problems are a bit different.

I love my pen! I guess I’ve been using pens for 10 years now… have they been around that long? They’re so much more portable than a case to carry vials and syringes.
I started with the aluminum ones you had to load with the cartridge, and eventually began to wonder if the clicker dial for dosing was wearing out? Asked my doc, and he recommended the disposable which I’ve been using since.
Are these drops seeping out of the site after the injection? I get that sometimes too… but doesn’t happen often enough that I’m concerned about it yet. Maybe a needle cap of a longer length would help the insulin stay in? To avoid this I will leave the needle in my skin for an extra 5 seconds and that seems to help avoid it seeping back out.
My post meal target (2 hours) is 100-180, usually at the upper end. If I’m beneath 100 @ 2hrs, I’ll be hypo in another hour or less. I’m T1 your mileage may vary.

I am 59 years old with MODY (misdiagnosed at Type 2). I was doing very low carb for many years as I couldn’t get a decent diagnosis, and eventually started on insulin when I was spiking to 140 on 10 grams at breakfast–which was when it became blindingly obvious I wasn’t an insulin resistant type 2 as I was hypoing 8 units.

My usual dose is 2,5-3 units if I’m taking Metformin, 4.5-5 if I’m not. My major difference with you is my fasting bg on its own will be 110-120 mg/dl. And my diabetes is not autoimmune, it’s a defect in secretion that only affected my post-meal blood sugar until very recently.

I do MUCH better on R insulin than the Analogs, With the analogs, it is too easy to miss the spike because the insulin is sometimes faster than the food. Plus, my digestion some days is much faster than others. I could NEVER make Humalog work. I’d go high at one hour and plummet in 3 hours. Novolog worked better for me and I will use it sometimes if I am in a restaurant, but I noticed that after I use it, I get hungry a couple hours later, and when I used it exclusively I started putting on weight, probably because of that hunger which hasn’t been an issue with R for more than a year.

I know exactly what you mean about not trusting the pen, too! It just keeps seeping out and since I’m very sensitive to 1/2 unit changes in dosage, those seeps at the very low dose worried me. I tried injecting the pen into a syringe to see how accurate it was, and it did seem pretty accurate, but I would always be a bit nervous and do prefer the syringe.

Not only that, but the pen is supposed to be more “friendly”–probably because it doesn’t look like a scary injection needle, but I found it a huge pain in a restaurant to have to take the pen out, and stick the needle on it, and dial etc etc. With the syringe, I fill it at home, stick it in the pocket of my blood sugar meter case and can whip it out, inject (through clothes if necessary) and put it away in seconds. Much less obtrusive. And the needle is thinner too.

WIth R it helps to inject an hour before eating, which is the only draw back, but it comes on so much more slowly that I never get into any kind of panic state and if I do start to go a bit low at 3 hours, well a couple grams of carbs will nudge it back up.

I credit my good control to my Novolog pen. It just makes it so much easier to dose in public, as well as to take care of additional bolus needs that may come up.

Hey, Libby - Check out Insulin Pen Users group.

I too have a large drop after I inject…sometimes on the skin, but almost always on the tip on the needle. The instructions say to leave in for 8 seconds, and I have the drop even if I leave it in for 30 seconds. I’m going to try the advice just noted in this thread about not pinching (or at least releasing the skin pinch) and see how that works.

I’ve thought about the Novo Jr. pens myself, since I’m sensitive enough to need the half-units…although I have a stockpile of about 15 regular pens already in the fridge! I’m actually hoping to go to a pump in the next few months, but would love to resolve these pen issues in the meantime.

I had the same problem with the Novopen Junior, so I stopped using it. I’ve heard many people like it just fine, though. In my case, I ended up going back to syringe and vial. BD makes syringes with half unit markings, so you can eyeball quarter units if you want. If you need even tinier doses, there’s also diluted Humalog (but Novolog can’t be diluted, at least in the US).

I am happy to report that since I stopped pinching my skin, I am not seeing a large drop after injecting. Part of the problem was that the needle is wet after the air shot and that was waht I was seeing sometimes. My doctor showed me the vial and syringe yesterday and it looked harder to try and give myself 2 units that way. The last two times I did 2 units, ate 30 grams and had no change in BG so fingers crossed that continues!

I only use pens when I’m not on my pump. I use Novolog and Levemir pens. I fill my pump pods with Novolog from a vial.

Drops of insulin on the skin after pen injections is common, you can minimize it by waiting 5-10 seconds after injection before removing the needle. It it’s really a problem you can op for longer pen needles. Ask you doctor.

I’m not so sure that it’s pen vs syringe here, it may have something more to do with the needle.

Short needles are available for both syringes and pens. Long needles are available for both syringes and pens.

I’m not an expert with the Novopen Jr but I’m willing to bet that by default it comes with a short needle. That might be appropriate for a kid but I’m not so sure it’s appropriate for an adult.

I’ve tried both long and short needles.

I personally prefer long needles, because I end up with fewest drops of insulin on the skin, and I also feel that I get more consistent insulin absorption.

It’s possible that your variance in bg, is not so much because of insulin delivery, but because your pancreas may be intermittently still working. I understand in LADA the honeymoon can be quite long.

I am type 2 and have been on insulin for 16 months. I take Lantus (38) units at night and Novolog before meals. I do very low carbs and I shoot to adjust my reading before a meal. If I am 140 prior to a meal I will shoot 4 units. If I am going to cheat a little I use 1 unit per 10 grams of carbs. I also take glimiperide for insulin resistance. I have recently played with how much and when I take it because I was having lows 3am to 5am. I am now taking just one 4mg tablet in the am and it seems to be working well.
For Father’s Day I had 2 pancakes and a fried egg. I made a blueberry syurp from fresh blueberries and sugar water made with a sugar substitute. It was a great breakfast and I shot 5 units to adjust before the meal.
I hope all the fathers had a great day yesterday.

With your relative small stature, and type 1 diabetes it’s especially important that you eat a balanced diet in an amount that is matched to your metabolism and your activities to maintain body weight.

If you are losing weight beyond your optimum BM, you need to change your diet. It’s not necessary or desirable to radically reduce carb intake long term (see note*). An extreme low carb diet could be the root cause of your problems. An extreme low carb diet is equivalent to the original Atkins diet or the first two phases of the new Atlkins diet.

A very low carb intake causes your body to burn fat for energy, the fat stored by your liver being used first in preference to dietary fat. This causes a dangerous condition called ketoacidosis - which is why the original Atkins diet had to be significantly modified. When your stored fat runs low, it burns muscle tissue. The loss of muscle mass and body fat changes your basal metabolic rate. As a result, not only can your correction factor be off, your basal insulin dose may also be off.

A pen injector is a convenience device. When your BG and health is well-managed and stable, convenience devices are great for health maintenance. When your BG isn’t well managed and your health isn’t stable, convenience has to take a back seat to accuracy and control. With either pen or syringe, technique is an important factor.

If you have good technique, a 30 unit syringe with 1/2U markings could be easier to use than a pen with 1/2U adjustments. With care, the syringe could let you make adjustments smaller than a 1/2U. In either case, the smaller the total dosage amount, the less accurate the dose delivered.

If you are “covering” a very small amount of carbs with Novolog, a 1/2U dosage error can cause a big fluctuation in BG. If you cover a larger amount of carbs with insulin, it becomes less critical. You also have more room to fine-tune your correction factor based on experience. So start raising your carb intake by 10G every week until you stop losing weight.

As you increase your food intake, keep careful records of your food intake and your insulin doses and ask your doctor about what changes you need to make in your basal insulin dose.

  • Note - I’m a little older than you. My carb intake is about 45% of my diet, but its mostly whole grains, which helps dampen post meal swings. I got a 25# weight loss over the last year plus an A1C reduction from 6.8 to 5.3 by just raising my fiber intake and just letting my appetite control my total food intake.

This is a good site, but there is another site you might want to investigate, devoted to just type 1 diabetes - .

If I can throw my 2 cents in. The pen is much more convienent as people have stated. However, on both my novolog and lantus pens even though it said 1 unit, nothing would come out. I tried on maybe 3 different pens about 10 times each doing 1 unit in the sink and NOTHING. 2 units and up worked fine. But 1 unit was nothing. So I used a syringe for 1 unit corrections.

That is odd. One unit should always come out. Do you follow the instructions and prime the pen after changing the needle (priming is to push units until a drop is coming out of the needle)? If one unit is not delivered it may be that there is a bubble of air in the insulin vial.

Yes I do prime it, but still nothing ever comes up. I’ll prime out 3 units no problem in the sink, then I try to do one unit and nothing. And this is on all pens I have.

Yes, and with a syringe, you don’t change the needle; you prime the vial with air to match each dose as you draw the insulin you need.

In either case, you have to keep insulin below 80F, whether in a pen’s internal vial or a 10 ml vial, have to carry sharps and deal with sharps disposal, and still need your BG meter and strips. Done carefully, using pens or syringes can be equally accurate, with approximately the same effort.

I started out on the pen for both Novolog and Levemir, but switched back to the syringe. I am on a low carb diet (most of the time) and would also experience irregularites between the amount I dialed up and the amount delivered. I need 3 to 5 units to cover most meals. Because the dose is so small, not getting one unit could mean a 20% inaccuracy in delivered dose This made it very difficult to control my numbers.

I did love, love, love the convenience of the pens and sort of miss that, but its a trade off for better control.

I’ve been leaving the pen in for at least 10 secs and this seems to help with the drip problem. I think they say this on their website. I also use the longest needle, it hurts less.