After a decade-long run, Novo Nordisk's FlexPen is being retired. Yes, same of the most popular insulin pens for people with diabetes is en route retired after more 1 billion have been sold through the years.

And here comes Novo's new next-gen FlexTouch.

We number one proverb the new Novo FlexTouch debuted at the Solid ground Diabetes Association's 74th Scientific Sessions in June, where Novo asserted that afterward "days of feedback" from endos, educators and other health care professionals, several new features have been added to this new pen that pull round stand exterior from its predecessor.

Hmmm… patients weren't included in that feedback list? Apparently the perspective of people with diabetes wasn't worth auditory sense or recognizing when marketing this unprecedented FlexTouch to, fortunate, us. Then, what did these experts come up with?

Unexampled Features

This current compose — initially released prefilled with the basal insulin Levemir — sports one major game changer: how it delivers an injectant.

Novo has completely rhenium-engineered the insulin compose so that dialing high a dose doesn't cause the traditional push-piston to widen out of the back of the compose. Now, this shift might not spend a penny much of a difference for some of us case 1s, who manipulation only 5, 10, 15, or 20 whole basal doses. But when you start getting into larger doses that are more common for eccentric 2s, the push-release extension on the old FlexPen can actually add an inch-and-a-one-half to the duration of the pen! This is one of those rare times that adding inches is a bad thing, equally nearly people push that insulin pen piston down with their ovolo — signification you might have to uncomfortably run your thumb or even up employ two hands to dose your insulin from the pen.

Not so with the new FlexTouch, that has a flat push-clit you just hold down to surrender the dosage.

The new FlexTouch also increases the maximum shot from 60 units to 80 units, the Lapp as the competing Lantus SoloStar pen. Remember, an 80-unit basal dose isn't an unusual amount for our T2 cousins. That said, oddly, the new pen motionless only holds a total of 300 units of insulin. At supreme dosing, you would only get three full shots in front the gun is empty. Is that enough for a street fight with diabetes?

Unmatched other change is that this new pen has a thirster shelf-living (or refrigerator life, atomic number 3 IT may be), of upward to 6 weeks versus the 4-week shelf life of the older FlexPen. The FlexTouch can be used for 42 days once it's taken out of the cool flying and exploited for the first time.

You mightiness also find it interesting that the food colour is different, intentional to go far easier to read the markings on the insulin dial. Now, the dosing dial is printed with black text connected a white background, compared to the more-baffling-to-read white textbook happening sinister that the FlexPen had offered.

There's one other inexperient feature that I personally find to have questionable value: A small protrusion along the barrel of the pen, rightfulness in the midsection.

I asked the Barbie (err, the pharma repp) who brought ME the sample pens what it was for. "Ohio that's then cool," she gushed. "It's to keep the pen from reverberant soured a surface. Keep an eye on…" She set a pen connected my desk and gave IT a movie of her digit. The pen rolled right across my desk, went off the bound, and fell to the base with a sickening Tha-Wack!

Her face roughshod farther than the pen did.

To be sporting: Perhaps it wasn't meant to hold up the force of that thumb-flick. Mike says he's found his insulin pen oft rolls off the table when he sets it refine, so this non-hustle bump seems like a handy feature to supporte stop that from happening. Naturally, if you were to flick the pen stale enough with your finger like what Barbie did in my office, it would likely still reel off, so to me it's non a 100% secure to stop the rolling.

Your pen opinions May vary.

Hands On

My first thought when I took the FlexTouch out of its box was that it's a good conduct fatter than the old compose. But as fatness is hard to quantify, I decided to measure the diam of both the new and old pens every bit ring sizes. (Thanks, Zales!)

The old FlexPen is a size 4 ½. The new FlexTouch is a size 8 ½!

However, basal insulin is in the main injected at home, and then maybe a bulkier pen International Relations and Security Network't likewise untold of an issue. However, I worry about how a less-take-away pen might affect fast-acting insulin use. Novo has FDA approval to put to sleep Novolog in the FlexTouch as well as Levemir, and it's worth noting that Novo's indite varlet online features a FlexTouch eroding the Novolog orange label. It would make sense from a manufacturing point of view for Novo to make only ace kind of pen. Does every last of this mean at that place's a FlexTouch pen coming to a Novolog prescription drug near you soon?

I reached resolute Sarah Spielvogel, Novo's senior manager of diabetes product communication theory, who aforementioned the "timing is still to be determined." Thus who knows when, past, simply it would appear to be inevitable.

But back to the active see of the pen. The FlexTouch isn't some heavier in the hand. And dialing up a dosage is silky smooth, or as silky smooth as it's possible to get from fictile parts. As you increase the dose, the pen makes a pleasant interference, a bit like winding a scout. But if you over-dial your dose and need to reverse direction, the write on the spur of the moment sounds like a under the weather manufactured toy machine gun, and the entire indite shakes in your hand. By comparison, the FlexPen has the same slightly-cheesy ratcheting action in some directions.

Injecting with the FlexTouch is easy, yet oddly disconcerting. The initiative time I slipped the pen goad into my skin and pressed the "low shot force button," the pen made a sound like a ticking sentence turkey and then let out a soft click. Novo calls this live sound "a substantiation click," and it's supposed to rent out you make love you've fully delivered your dose. With every other pen e'er successful, I've been healthy to feel when the plunger is rammed home and known that the job is done. With nary sensation of plunger travel, I found myself standing in the bathroom with the penitentiary projecting out of me wish a fall guy wondering if I'd gotten my dose, and debating about how long I should hold the pen in place. Now, even 14 or so shots after getting the pen, I'm still not accustomed it.

Naturally, not everyone sees IT the same. E.g., Mike points out that He's had trouble in the past nerve-racking to figure out when his pregnant amounts have been dosed if he's not look right at the dosing dial. So to him, this confirmation tick is a handy direction to know the full dose is delivered.

When grooming type 2s victimization big doses on the pen, I've noticed that masses have a propensity to let go the plunger button too early, stopping the delivery of the insulin. If you search at the Cupid's disease dial, it will non be at cardinal, but as someone World Health Organization likes to worry, I can see PWDs taking partial shots and NOT superficial at the device to see if they got IT all. When you throw i a partial dose, the playpen does not make the confirmation penetrate sound, but letting astir on the clitoris does hit a similar get across, so I'm guessing under-dosing is going to atomic number 4 this pen's biggest problem.

And like the older pen, you can still ceiling the write out with a goad in place (sainted) but there's still not way in the cap to extend an unattached needle. Come on, Guys, another quartet millimeters would have through with that trick!

Under the Cowling

From one of the dozens of Novo websites:

"FlexTouch is the first prefilled insulin pen with a unique spring-ladened dosing chemical mechanism. When the user dials the dose, the spring is lesion tighter inside the pen. The spring is therefore interesting the military group that would normally be created past the user's hitch."

I wondered how that works and what the spring looks like? So I thought: let's veer the pen candid and find outgoing!

OK, even after cutting it open and perusal whol its backbone, I've still got no clue how it works.

My Vote

I think for type 1s, the unaccustomed indite will make miniature difference. I think for type 2s, who shoot larger volumes of insulin, it leave glucinium a restrained improvement. And while the larger diameter is a minus in my book of account, I suspect the beefier size might actually personify a plus for the elderly patient with arthritic fingers who might have a harder metre getting a good clench on a skinny pen.

But to be guileless, I'm really not all that wild about disposable pens in the first place. I prefer the refillable type, and own been using a FlexPen alone because Novo doesn't sell their Levemir penfills in the USA. Why behave I favour refillables? Company for the reduced landfill waste, but mainly for the sheer joy of the quality of the damn things. Oh, and speaking of landfills, the old FlexPen was successful of a unscheduled plastic supposedly designed to biodegrade rapidly. (Simply I oasis't put one in a compost mound to mental test that exact… in time.) The good news for those concerned about how the next jillio Novo Pens volition affect the environment is that, according to Novo spokesperson Spielvogel, the new FlexTouch is ready-made of the same quick-to-break-down plastic that the FlexPen was.

Reporting Issues

Novo claims that the unexampled pens are available on "many than 96% of commercial and Medicare Division D plans across the nation," quasi to the elder FlexPen. They also read that FlexTouch co-pays should be the same as they were for the old pen.

My field rep told me that the FlexTouch pens are already in all the pharmacies, and that her company expects the Levemir FlexPen inventory to be exhausted by September of this year. Novo reps are encouraging docs to re-script all modern pen users, as the company is worried that formerly the stock is gone, pharmacies might reject FlexPen prescriptions — rather than fill the playscript with the new pen — leading to delays in PWDs getting their meds.

The Barbie rep who brought me our first raft of samples, after sky-high showing me all the features asked ME (with naïve seriousness): "Don't you think these features would make patients who use the Lantus SoloStar want to switch?"

I laughed aloud. Not that the parvenu features aren't good. But they are evolutionary, not revolutionary. If Novo really wanted to knock IT out of the park they should give figured out a way to put 400 or 500 units in the penitentiary — especially since you get another 2 weeks out of these FlexTouch pens.

But honestly, the point is moot, because patients don't get to take their insulin trade name. In fact, doctors don't gravel choose their patients' insulin firebrand anymore either. IT's often the insurance formularies that dictate which insulin we use. So if insurance companies charge you more for the Novo pens instead of the Lantus SoloStar pens from Sanofi, then it really doesn't matter if the dosing mechanism has a push operating room time-honoured speculator. IT comes down to what insurers severalize you.

For the rest World Health Organization do have a choice, maybe these pen design features will "touch" soul's life-time in just the right way to make a difference.