Register for email alerts and news feeds:
This journal | BMJ Group
rss
Archives of Disease in Childhood 1998;79:59-62; doi:10.1136/adc.79.1.59
Copyright © 1998 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child 1998;79:59-62 ( July )

Accuracy and reproducibility of low dose insulin administration using pen-injectors and syringes

M G Gnanalingham,a P Newland,b C P Smitha

a Department of Paediatrics, Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester M9 2AA, UK, b Department of Clinical Biochemistry, Booth Hall Children's Hospital

Correspondence to: Dr Smith.


Accepted 3 February 1998

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 15 times 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.

Key messages

  • Insulin doses of < 2 U are administered inaccurately by syringe and pen-injector devices
  • The reproducibility (coefficient of variation) of actual doses was similar (< 7%) using two pen-injector devices (NovoPen and BD-Pen), and 30 U syringes
  • Pen-injectors underdose and nurses using 30 U syringes overdose insulin
  • Transferring patients on low insulin doses from syringe to pen-injector may result in a significant dose change



Keywords: pen-injector device; insulin syringes; insulin administration; low dose insulin

© 1998 by Archives of Disease in Childhood
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Ignaut, D. A., Schwartz, S. L., Sarwat, S., Murphy, H. L. (2009). Comparative Device Assessments: Humalog KwikPen Compared With Vial and Syringe and FlexPen. The Diabetes Educator 35: 789-798 [Abstract] [Full Text]  
  • Wojciechowski, K. G., Avram, M. J., Raikoff, K., McCarthy, R. J., Wong, C. A. (2009). A Comparison of Epinephrine Concentrations in Local Anesthetic Solutions Using a "Wash" Versus Measured Technique. Anesth. Analg. 108: 1243-1245 [Abstract] [Full Text]  
  • Spollett, G. (2008). Insulin Devices: Addressing Barriers to Insulin Therapy With the Ideal Pen. The Diabetes Educator 34: 957-967 [Abstract] [Full Text]  
  • Meece, J. (2008). Effect of insulin pen devices on the management of diabetes mellitus. Am J Health Syst Pharm 65: 1076-1082 [Full Text]  
  • Erstad, A. J., Erstad, B. L., Nix, D. E. (2006). Accuracy and reproducibility of small-volume injections from various-sized syringes. Am J Health Syst Pharm 63: 748-750 [Full Text]  
  • Keith, K., Nicholson, D., Rogers, D. (2004). Accuracy and Precision of Low-Dose Insulin Administration Using Syringes, Pen Injectors, and a Pump. CLIN PEDIATR 43: 69-74 [Abstract]  
  • Robertson, K. E., Glazer, N. B., Campbell, R. K. (2000). The Latest Developments in Insulin Injection Devices. The Diabetes Educator 26: 135-152  

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Latest from ADC

 

ADC is co-owned by the RCPCH and is the official journal of the European Academy of Paediatrics

BMJ Careers - Latest Paediatrics and Paediatric Surgery Jobs

Paediatrics and Paediatric Surgery Jobs

Show me all >>