Recommended Needle for Lantus and Levemir Insulin Pens
For both Lantus (insulin glargine) and Levemir (insulin detemir) pens, a 4-mm pen needle is recommended as the safest and most effective option for all patients regardless of age, BMI, or other factors. 1
Optimal Needle Selection
Primary Recommendation
- 4-mm pen needle is the safest choice for all patients using insulin pens 1
- Should be inserted perpendicularly (90° angle) to the skin surface
- Provides sufficient length to reach subcutaneous tissue while minimizing risk of intramuscular injection
Alternative Options
- 5-mm needle may be acceptable for obese patients, but 4-mm is still preferred 1
- For patients using syringes instead of pens, the safest available needle length is 6-mm 1
Proper Injection Technique
Insertion Method
- Insert the 4-mm needle perpendicularly (90°) to the skin surface
- For very young children (≤6 years) or very thin adults: use a lifted skinfold technique
- For most adults: no need to lift skinfold when using 4-mm needles 1
Injection Process
- Prime the pen before injection to ensure free flow
- Insert needle fully before touching the thumb button
- Press button along the axis of the pen (not at an angle)
- Keep pressure on button until needle is completely withdrawn
- Count to 10 after fully depressing the plunger before removing the needle 1
Important Considerations
Needle Usage
- Pen needles should be used only once - they are no longer sterile after use 1
- Never leave needles attached to pens after use 1
- Needle reuse may increase risk of infection and lipodystrophy 1
Injection Sites
- Recommended sites: abdomen (2 fingerbreadths from umbilicus), upper thigh, buttocks, upper arm 1
- For long-acting insulins like Lantus and Levemir, any of these sites can be used 1
- Avoid injecting into lipohypertrophy, inflammation, edema, or infection 1
Common Pitfalls to Avoid
- Intramuscular injection risk: Particularly important with long-acting insulins like Lantus and Levemir as this can lead to profound hypoglycemia 1
- Improper pen handling: Pushing the button before needle insertion or releasing it while needle is still in skin can contaminate the cartridge 1
- Angled button pressing: Especially problematic for elderly or frail patients who may not deliver full dose 1
- Mixing incompatible insulins: Lantus should not be mixed with other insulins due to its low pH 1
Device Considerations
- Both Lantus and Levemir pens are designed for ease of use, but studies show patients generally find the Levemir FlexPen more intuitive and easier to use than the Lantus OptiClik pen 2
- Insulin pens are often preferred over vial-and-syringe methods due to greater convenience, less pain, and improved social acceptability 3, 4
By following these recommendations, patients can optimize their insulin delivery while minimizing risks of complications such as hypoglycemia, pain, or inconsistent absorption.