Abstract
Many children with diabetes require small doses of insulin administered with syringes or pen-injector devices (at the Booth Hall Paediatric Diabetic Clinic, 20% of children aged 0-5 years receive 1-2 U insulin doses). To determine how accurately and reproducibly small doses are delivered, 1, 2, 5, and 10 U doses of soluble insulin (100 U/ml) were dispensed in random order 15times from five new NovoPens (1.5 ml), five BD-Pens (1.5 ml), and by five nurses using 30 U syringes. Each dose was weighed, and intended and actual doses compared. The two pen-injectors delivered less insulin than syringes, differences being inversely proportional to dose. For 1 U (mean (SD)): 0.89 (0.04) U (NovoPen), 0.92 (0.03) U (BD-Pen), 1.23 (0.09) U (syringe); and for 10 U: 9.8 (0.1) U (NovoPen), 9.9 (0.1) U (BD-Pen), 10.1 (0.1) U (syringe). The accuracy (percentage errors) of the pen-injectors was similar and more accurate than syringes delivering 1, 2, and 5 U of insulin. Errors for 1 U: 11(4)% (NovoPen), 8(3)% (BD-Pen), 23(9)% (syringe). The reproducibility (coefficient of variation) of actual doses was similar (< 7%) for all three devices, which were equally consistent at underdosing (pen-injectors) or overdosing (syringes) insulin. All three devices, especially syringes, are unacceptably inaccurate when delivering 1 U doses of insulin. Patients on low doses need to be educated that their dose may alter when they transfer from one device to another.
Full Text
The Full Text of this article is available as a PDF (103.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bell D. S., Clements R. S., Jr, Perentesis G., Roddam R., Wagenknecht L. Dosage accuracy of self-mixed vs premixed insulin. Arch Intern Med. 1991 Nov;151(11):2265–2269. [PubMed] [Google Scholar]
- Casella S. J., Mongilio M. K., Plotnick L. P., Hesterberg M. P., Long C. A. Accuracy and precision of low-dose insulin administration. Pediatrics. 1993 Jun;91(6):1155–1157. [PubMed] [Google Scholar]
- Frid A., Gunnarsson R., Güntner P., Linde B. Effects of accidental intramuscular injection on insulin absorption in IDDM. Diabetes Care. 1988 Jan;11(1):41–45. doi: 10.2337/diacare.11.1.41. [DOI] [PubMed] [Google Scholar]
- Galloway J. A., Spradlin C. T., Nelson R. L., Wentworth S. M., Davidson J. A., Swarner J. L. Factors influencing the absorption, serum insulin concentration, and blood glucose responses after injections of regular insulin and various insulin mixtures. Diabetes Care. 1981 May-Jun;4(3):366–376. doi: 10.2337/diacare.4.3.366. [DOI] [PubMed] [Google Scholar]
- Gardner S. G., Bingley P. J., Sawtell P. A., Weeks S., Gale E. A. Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis. The Bart's-Oxford Study Group. BMJ. 1997 Sep 20;315(7110):713–717. doi: 10.1136/bmj.315.7110.713. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ginsberg B. H., Parkes J. L., Sparacino C. The kinetics of insulin administration by insulin pens. Horm Metab Res. 1994 Dec;26(12):584–587. doi: 10.1055/s-2007-1001764. [DOI] [PubMed] [Google Scholar]
- Gordon D., Wilson M., Paterson K. R., Semple C. G. An assessment of the accuracy of NovoPen 1 delivery after prolonged use. Diabet Med. 1990 May;7(4):364–366. doi: 10.1111/j.1464-5491.1990.tb01407.x. [DOI] [PubMed] [Google Scholar]
- Kølendorf K., Aaby P., Westergaard S., Deckert T. Absorption, effectiveness and side effects of highly purified porcine NPH-insulin preparations (Leo). Eur J Clin Pharmacol. 1978 Nov 16;14(2):117–124. doi: 10.1007/BF00607442. [DOI] [PubMed] [Google Scholar]
- Polak M., Beregszaszi M., Belarbi N., Benali K., Hassan M., Czernichow P., Tubiana-Rufi N. Subcutaneous or intramuscular injections of insulin in children. Are we injecting where we think we are? Diabetes Care. 1996 Dec;19(12):1434–1436. doi: 10.2337/diacare.19.12.1434. [DOI] [PubMed] [Google Scholar]
- Smith C. P., Sargent M. A., Wilson B. P., Price D. A. Subcutaneous or intramuscular insulin injections. Arch Dis Child. 1991 Jul;66(7):879–882. doi: 10.1136/adc.66.7.879. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spraul M., Chantelau E., Koumoulidou J., Berger M. Subcutaneous or nonsubcutaneous injection of insulin. Diabetes Care. 1988 Oct;11(9):733–736. doi: 10.2337/diacare.11.9.733. [DOI] [PubMed] [Google Scholar]