Do I need to order needles with Insulin Degludec (insulin degludec) flextouch pen injector?

Yes, You Must Order Pen Needles Separately

The insulin Degludec FlexTouch pen does not come with needles included—you must order pen needles separately for the patient to administer their insulin. 1

Why Needles Are Sold Separately

Insulin pen devices and pen needles are manufactured and distributed as separate products. The FlexTouch pen injector is designed to accept standard pen needles that attach to the pen, but these needles must be prescribed and obtained independently. 1

Recommended Needle Specifications

When ordering pen needles for your patient, follow these evidence-based recommendations:

Needle Length

• Order 4-mm pen needles as the first-line choice for all patients, including those with obesity. 1, 2
• The 4-mm needle is safe and effective regardless of BMI and should be inserted perpendicularly at 90 degrees without requiring a skinfold in most adults. 1, 2
• A 5-mm needle is an acceptable alternative but the 4-mm is preferred. 1

Needle Gauge

• Order 32-gauge needles (or 31-gauge) for optimal patient comfort and acceptance. 2, 3
• Thin-walled or extra-thin-walled needles are preferred as they provide better insulin flow while maintaining a narrow gauge. 1, 2

Special Populations

• Very young children (≤6 years) and very thin adults (BMI <19): Use 4-mm needles with a lifted skinfold and perpendicular insertion. 1
• Children and adolescents: If using 5-mm or longer needles, always inject with a lifted skinfold; switch to 4-mm needles when possible. 1

Critical Patient Education Points

When prescribing pen needles, ensure your patient understands these essential practices:

Single-Use Only

• Pen needles must be used only once and then discarded. They are no longer sterile after a single use. 1
• After each injection, remove and dispose of the needle immediately—do not leave it attached to the pen. 1
• Leaving needles attached can allow air or contaminants to enter the cartridge and cause medication leakage, both of which distort dose accuracy. 1

Proper Injection Technique

• Prime the pen before each injection to ensure free insulin flow—this means seeing at least one drop of insulin at the needle tip. 1
• Do not touch the injection button until the needle is fully inserted into the skin. 1
• After fully depressing the button, count to 10 before withdrawing the needle to ensure complete dose delivery. 1, 4
• Press the injection button vertically along the pen's axis, not at an angle, to avoid excessive resistance. 1

Site Rotation

• Rotate injection sites by at least 1 cm (approximately one finger width) from the previous injection. 1, 4
• Never inject into areas of lipohypertrophy (lumpy, firm, enlarged tissue), as this causes unpredictable insulin absorption. 1, 4

Common Pitfalls to Avoid

• Do not assume the pen comes with needles—this is the most common prescribing error and will prevent your patient from using their insulin. 1
• Do not prescribe needles longer than 6 mm for children—this creates excessive risk of intramuscular injection. 1
• Warn patients never to share pens or needles between individuals, even with a new needle, as this can transmit blood-borne infections. 1

Practical Prescription Guidance

Write a separate prescription for:

• Pen needles, 4-mm length, 32-gauge (or specify brand name if preferred)
• Quantity: Typically 100 needles per box; prescribe based on injection frequency (e.g., one injection daily = 100 needles for ~3 months supply)