Novo Nordisk Echo Pens

On Friday morning the boys took me to work. Carter was having a small DP and required an additional correction in the car so he would be ready for his breakfast bolus when he got home.

Carter opened his kit to draw up his insulin and OH NO … there were no syringes in it!

That’s never happened before, it was a combination of rushing (for work) and mis communication..

What a tricky situation (and potentially bad) and something we have learnt from..

Luckily, I keep a spare T1 Kit in the car for such situations (and have done for some time now)… I think it’s essential to have permanent emergency supplies in places where Carter is regularly..

Carter has spare emergency kits in my car, at school, on his bike, at the side of his bed and in his bag (for daily use)..

The kit in the car is as follows:

▪️ 1 novo nordisk echo pen with Novarapid and 5 needle tips.
▪️ 1 blood glucose meter with a fastclix and 10 test strips.
▪️ cotton wool pads.
▪️ 1 tube of glucose tabs.
▪️ 1 bottle of Lucozade.
▪️ 1 glucagon hypo pen.
▪️ 1 mini sharps box.

The Insulin in the echo pen had expired (whoops) BUT Carter has his insulin in his kit, so I quickly put the expired insulin vial in the sharps box (and made a mental note to change this monthly in future) and inserted the Novarapid vial from his kit into his pen and Carter screwed a needle tip onto the end, primed the pen and injected 1/2u into the air to check it was administering insulin OK before giving himself a 1/2u correction.

Many things happened to Carter on that journey as a consequence of this:

▪️Initially he panicked because he didn’t feel the injection at all and he was fearful the insulin hadn’t gone in (but it had).
▪️Then he realised the different from 4mm needles to 8mm needles.
▪️Then he realised how much easier the Novo Pens are to use a) in and rush and b) in a moving vehicle.
▪️Then he realised that maybe an echo pen would be a fab idea for drawing up 1/2u for corrections at school.

You see, Carter manages his diabetes 100% independently at school. He does an incredible job with that. BUT, he struggles at times when he’s distracted and kids are rushing around him, or he’s rushing to get back in to class. He struggles to draw up 1/2u on the syringe and avoid air bubbles and can sometimes draw and redraw a few times to ensure he has 1/2u and no air bubble in the syringe for injecting..

1/2u of insulin is such a minute amount! 1/2u can be lethal at the wrong time but it is still a very tiny amount..

He does fine with Actrapid in a syringe because he only ever takes 2 or 3 units (for lunch) and that is clearer and easier to draw with it being a larger dose..

But the tiny 1/2u of Novarapid can be tricky for him.. AND he only ever takes 1/2u rapid at a time for corrections so it would never get easier (until he’s older/larger when his insulin needs will increase)..

Maybe the Echo Pen simply for corrections of Novarapid at school is the answer?

Also, Carter was flabbergasted at the smaller needle and how he didn’t even feel it..

The insulin worked just as fast and corrected his blood sugars fine as it would with the 8mm needle in the same way..

So, he decided maybe he would like to use an Echo Pen for Novarapid at school for now, just so he had less hassle and trickery drawing up the insulin – and it would be quicker?..

Personally I don’t like trusting the Echo Pens, I’ve questioned their accuracy in the past and also questioned their mechanics at small doses, we have no guarantee once the needle is in the skin that it actually gives insulin – we only know that when blood sugars don’t respond the way they are expected.

This was why I switched him to syringes last year and we’ve never had an issue..

I don’t like leaving things to chance and I don’t relish the idea of bringing back variability or unpredictability..

But: I am 100% committed to supporting Carter in managing his disease.

Regarding him being in charge of his own fate and encouraging him to advocate for himself based on him making informed and evidence based decisions from looking at data or having reasonable argument to support his decision; I believe is important for building his confidence and good practice and I work with him, reviewing his profiles that we map out and I will quiz him and chat to him about how he would treat certain numbers and handle certain situations (and he does a fabulous job – he’s 10 remember)..

I believe this is important at his age and living with a life-long chronic disease such as T1, I work continuously to make sure he’s capable and confident and hope that this will continue to grow (which he will need for the long haul) now as a child, whilst he’s young enough for it to become a learned behaviour and therefore; it should just become normal daily practice for him..

Install good behaviours and disease management now for the future!

It’s important that he feels autonomous, supported, capable and confident..

After all: this is Carters disease, Carters body and Carters decision!

So, on Monday I ordered him a new Novo Echo Pen for school and he’s happily used it today for a small 1/2u correction at lunch – and had positive things to say:

He found it easier and was happy that something he decided on was implemented and he thanked me for doing this for him, he said it was easier and quicker and he was happy and I could see that sense of pride and achievement in him as he was talking..

That’s good enough for me!!

We continue to draw Actrapid and Tresiba from the vial into syringes. In Australia, Actrapid comes in pen vials but not in the UK. I can’t work out why, maybe if it did he would want to use the pen for that too? And maybe he would? I don’t know because right now, that’s not an option..

I also still use the larger syringes for any IM corrections he needs but luckily he hasn’t needed one for a while and I’ve recently found confidence in using Actrapid for corrections at lower numbers because I know his profile and I can predict when the rise is coming … except in a morning.. DP truly has a mind of its own in a morning – thanks Diabetes!!

I’ve attached photos of the syringes and pens and needle tips so you can see the difference
and understand what I’m talking about…

Note: Whilst I believe the 8mm needle to be better all round for many reasons:

▪️ deeper in the skin past the layer of nerves and capillaries that supplies the skin its blood supply so less chance of pain and bleeding.
▪️ administers Insulin deeper into the tissue to avoid leakage
▪️ less bruising
▪️ less lumps
▪️ easy for IM rapid corrections opposed to subcutaneous

I believe that right now, the 4mm needle for rare corrections at school is fine and until there is a problem, Carter will go ahead with what he decided and wants to do, because him having the say and being in charge in this way and the benefit that has to his confidence and eagernes to manage his own disease like he does, the benefits that has – far outweighs any small negative that the smaller needle could have – for now.. and that’s fine!!

He’s happy and He’s ok!
And that’s good enough for me..
It’s why we do what we do – for him!!

 

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