Agarwal A, Yadav A, Gutch M Prognostic factors in patients hospitalized with diabetic ketoacidosis. Endocrinol Metab (Seoul). 2016; 31:(3)424-432

Dhatariya KK, Skedgel C, Fordham R The cost of treating diabetic ketoacidosis in the UK: a national survey of hospital resource use. Diabet Med. 2017; 34:(10)1361-1366

European Agency for Health and Safety at Work. Directive 2010/32/EU - prevention from sharp injuries in the hospital and healthcare sector. http// (accessed 26 February 2024)

Health and Safety Executive. The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. UK Statutory Instrument No. 645. 2013. https// (accessed 26 February 2024)

For healthcare professionals. Correct injection technique in diabetes care Best practice guideline. 2023. http// (accessed 26 February 2024)

NHS England National Patient Safety Team. PSI 115.2022. Summary for NAMDET: Insulin pen safety needles. NAMDET conference 2023 programme. 2023. https// (accessed 26 February 2024)

Maffettone A, Rinaldi M, Ussano L, Fontanella A Insulin therapy in the hospital setting: a time for a change?. Italian Journal of Medicine. 2016; 10:(1)

Royal College of Nursing. Blood and body fluid exposures in 2020. Results from a survey of RCN members. 2021. http// (accessed 26 February 2024)

Vellanki P, Umpierrez GE Increasing hospitalizations for DKA: a need for prevention programs. Diabetes Care. 2018; 41:(9)1839-1841

Yu CHY ‘Safety’ technology: a hidden cause of diabetic ketoacidosis. Canadian Medical Association Journal. 2012; 184:(5)557-558

Zhong VW, Juhaeri J, Mayer-Davis EJ Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998-2013: a retrospective cohort study. Diabetes Care. 2018; 41:(9)1870-1877

The critical role of pen needles and training in insulin delivery

07 March 2024
Volume 33 · Issue 5

Following the EU Directive 2010/32/EU, Prevention from sharps injuries in the hospital and healthcare sector, which came into force in 2010, legislation was rolled out relating to the use of safety sharps when administering insulin to patients with diabetes (European Agency for Health and Safety at Work, 2010). Safety devices use a mechanism with either a passive or active activation that covers the needle and helps reduce the risk of needlestick injuries (NSIs). However, the EU Directive did not state a preference for which type of safety pen needle to use in the clinical space. Thus, the choice is left to medical institutions.

Both active and passive devices are designed to help improve the patient experience and be intuitive to use. However, the two devices have some fundamental differences and benefits.

The key difference is that, along with an automated safety mechanism, passive devices typically cover the needle before and after the injection process, which protects against NSIs but can make it difficult to see the needle and requires the user to use a different injection technique from standard pen needles. Crucially, the passive mechanism requires consistent pressure on the skin to function properly and, if this pressure is lost, the safety feature activates. If this happens prematurely, the administration is interrupted, and medication can remain undelivered – often confirmed with visible pooling of the insulin on the patient's skin and undelivered medication remaining in the passive device.

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