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If you happen to use an insulin pen or are thinking of starting on one, don’t forget to pay attention to your choice of tiny needles that are screwed on to the top of the pen device.

These small sharp needles in plastic casing, designed specifically for insulin pens, tend to be of the most overlooked and least-discussed diabetes supplies — although they’re critical for pen users.

Here’s a guide to the different types of pen needles available, how they are sized and why that matters, and details including pricing for some of the most popular brands.

For the newly diagnosed, thinking about having to inject yourself with insulin multiple times a day can be daunting. But keep in mind that insulin needle sizes today are a fraction of the size they once were — especially the tiny needles made to twist onto the top of insulin pens.

Insulin pen needles range from 4 millimeters (mm) to 12 mm in length, and 29 to 32 gauge in diameter.

Remember that in this case, the lower the number of millimeter “gauge,” the shorter the needle. And the higher the gauge, the thinner the needle will be. So, these are pretty tiny needles we’re talking about. Since human skin is on average about 2 mm thick, even the shortest 4 mm pen needles will get through it to efficiently deliver insulin.

This 2015 article in the journal Diabetes Spectrum concludes that shorter 4 mm needle lengths should be the standard, but there can be benefits of longer pen needle lengths for some patients for various reasons, so it’s best to discuss your selection with your diabetes care professionals. The article points to several studies showing that a person’s body weight does not affect efficacy or insulin leakage with the shorter 4 or 5 mm pen needles. It also cites an international scientific advisory board that released recommendations in 2010 on best practices for injection techniques for patients with diabetes, which notes that 4 mm pen needles were efficacious in all patients regardless of body mass index.

You do not need a prescription to buy insulin pen needles, but a prescription is required to get insurance coverage if you’re going that route.

These needles are typically available at the local pharmacy or your mail order supply company. Some are also sold on Amazon or through third-party pharmacy distributors that offer diabetes supplies for home delivery. You can’t typically buy these directly through the manufacturer, although one of the brands listed below does offer a special promotion for a free box of pen needles to try.

Prices vary based on the quantity purchased — ranging from 30-count to 50, 90, and most commonly 100-count. You can find them online for as low as $4 for a small box for some of the generic off-brand versions, to $14 for the name brand versions with higher amounts inside.

There are a plethora of options, but the devil’s in the details as far as what might work best for you.

Most of the insulin pen needles can be used on all of the different insulin pens available, regardless of the manufacturer. And all of the pen needles are FDA-approved to be used only once and then disposed of (although many people reuse them).

Here’s a look at some of the most popular pen needle choices.

BD Ultra-Fine, Nano and AutoShield

BD (formerly known as Becton Dickinson and Company), is the most well-known manufacturer of insulin pen needles. It has been making insulin syringes dating back to the early days of insulin the 1920s, and produced its first pen needle in 1991. Today, there are a few popular versions available with very small needles to deliver insulin.

Ultra-Fine. There is their traditional line of pen needles that come in 4, 5, 6, 8, and 12.7 mm lengths and different gauges. They also offer Ultra-Fine Micro needles that are described as being ultra-thin with a 6 mm length.

Nano 4 mm pen needle. This is the smallest and thinnest pen needle, which BD promotes as using its proprietary “EasyFlow technology” to improve insulin flow through the needle. It can help those with hand-strength challenges, who might not otherwise get their full dose of insulin. This pen needle also incorporates a five-bevel needle tip — meaning it has a larger number of different flat angles on the tip of the needle — to “provide a more comfortable and easier injection” compared to the lesser-beveled versions.

Nano 2nd Gen Pen Needles. These pen needles also have a 4 mm length and are a newer version, aimed at helping reduce the pain users can experience when injecting insulin and possibly hitting muscle tissue. They also have a new ergonomic design that BD says is proven through clinical studies to “provide an easier and more comfortable injection experience.”

AutoShield Duo pen needle. This a specially-designed safety pen needle where the needle is enclosed in a dual-protection shield on both ends of the needle, to prevent needle stick exposure and reduce injury during injection and disposal. It comes in a 5 mm length only.

Unifine pen needles by Owen Mumford

British medical device maker Owen Mumford is the other big name in pen needles, though not as well-known in the United States as BD. Their products currently on offer include:

Unifine Pentips. The most common brand name from Owen Mumford, which has been around since the late 1990s. The company says they’re designed to “lower penetration force to support patient comfort and reduce the sensation of trauma,” with a thin needle wall technology that limits how much thumb force is needed to inject insulin through the pen. This feature is designed to help reduce thumb arthritis. These are available in 4, 5, 6, 8, and 12 mm sizes and each has various gauges to choose from.

Pentips Plus. This variety of Unifine pen needles offers an extra integrated needle removal safety feature. Using what’s called “Safe Click Technology,” the pen needle has an extra chamber so you can more easily dispose of the needle after use. This can be especially helpful when you’re on-the-go and not able to immediately put the used needle into a medical sharps container. This pen needle also comes in 4, 5, 6, 8, and 12 mm lengths and gauge options of 32 to 29 mm.

SafeControl. The Unifine SafeControl pen needles are one of the latest innovations from Owen Mumford, introduced in 2020 as a protective safety pen needle similar in concept to BD’s AutoShield to offer more protection from accidental needle sticks and better dosing accuracy. Like other pen needles, you twist it onto the insulin pen and then remove the cap to expose the needle. But this one features a push tab on the pen needle, allowing one-handed control after the injection to remove the pen needle and cover up the sharp portion. There is also visual orange safety indicator and an audible click, signaling the needle is contained and no longer dangerous. These are available in 5 and 8 mm lengths with various gauges.

Novo Nordisk NovoFine pen needles

Insulin manufacturer Novo Nordisk has been making insulin pens since it introduced the very first insulin pen, the NovoPen, in 1985. They’ve launched various pens since, and make needles to go along with these products. Fortunately, most of them are universally compatible with other brands of insulin pens. Their needles use their special “SuperFlow Technology” to improve the flow of insulin through the thin needle and reduce the force of insulin going into your body.

NovoFine. These are the most commonly-known pen needles from Novo Nordisk, along with the NovoFine Plus versions, that come in 6 mm and 4 mm sizes with different gauges. The company also offered other sizes in the past, but those have been discontinued.

NovoTwist. These are exclusively designed for use with Novo’s insulin pens and don’t work with other brands of pens. They’re designed to allow users to change the needle with a quick twist and a click. To attach or detach a NovoTwist pen needle, you just give it a slight or small twist and listen for the click signaling it’s properly attached. This pen needle only comes in the 5 mm, 32 gauge size, and compared to other pen needles it has a flat base to provide better contact and comfort with your skin when injecting.

NovoFine Autocover. Like the other big name pen needle companies, Novo also has its own protective case feature called “NovoFine Autocover” to help prevent accidental needle sticks and needle reuse. The protective shield retracts during injection, and then afterward it automatically re-covers the needle and locks back into place. This only comes in the 8 mm, 30 gauge size and it works with all available insulin pens, as well as some GLP-1 receptor agonist pens.

Novo Nordisk offers a discount and savings program, where you can receive up to $60 off a single box of pen needles. There are eligibility requirements and a prescription is required for this program.

There are also a number of lesser-known brands available in pharmacies as well as on Amazon. Some of the more common off-brand products include: TruePLUS, MedTfine, Easy Touch, Care Touch, DiaThrive, and ComfortEZ. These come in 4 to 8 mm options with different gauges, and they are all pretty similar in design and function.

These can be less expensive options for those who are trying to manage costs and save money on diabetes supplies, but the downside can be compromising quality and customer service support.

There are a number of tips that insulin pen users typically pick up on pretty quickly once they’ve started use:

  • Quick stab. Many of us think that slowly easing the needle into the skin can make it hurt less, but that’s not the case. It tends to hurt or at least be a bit more uncomfortable doing that. Just jab it into your skin, like you’d rip a Band-Aid off quickly.
  • Straight in, out. 90-degree angles are best. When inserting and removing from skin, don’t twist the needle to any angle other than that, or you’ll find that it hurts.
  • Room temp insulin. Most insulins, especially the long-acting basal (background) insulins, can burn a bit upon injection if the liquid is cold, like when just removed from a refrigerator. If you can, let your insulin pen warm up a bit to room temperature before injecting.
  • Relax. An instinct that many of us have when injecting is to clench or hold our breath, but healthcare professionals often point out how important it is to not tense up. Rather, take a deep breath or two before injecting. The more relaxed you are, the less you’ll feel the needle.
  • Rotating sites. If we use the same spot on the skin too much, scar tissue can develop. So, keep track of where you inject insulin and rotate the sites accordingly. You can even find accessories like injection site temporary tattoos to help keep track of those spots.

These needles may be tiny, but they’re still considered hazardous medical waste and should be disposed of in official sharps containers. Local communities and states have varying disposal rules, sometimes allowing you to include these in sharps containers to put out for recycling just like insulin syringes.

You can read our DiabetesMine guide to disposing of used diabetes supplies, which includes these important tips:

  • Never throw loose pen needles into the trash or directly into a recycling container.
  • Put the used pen needle into a home sharps container, or something similar that follows your local rules on properly disposing of used sharps objects.
  • You can clip the needle with a special needle-clipping device, such as the BD Safe-Clip. Those can be picked up your local pharmacy or ordered online.
  • If you inject someone else or dispose of their pen needle, use extreme caution to avoid getting pricked, which can transmit infections.

Insulin pen needles are far less intimidating than traditional syringes for injecting insulin. They can be quick and easy to attach to a pen for delivery, and are easy to carry on-the-go or when traveling.

They can be found in different lengths and widths that might best suit particular skin and body types. So, if you’re using an insulin pen or plan to, it’s best to explore your options before purchasing large quantities.