Avoiding problems

	Problem	Possible cause	Recommended action
.	Painful injection	Re-using the pen needle several times Injecting into a muscle Too superficial, hit a nerve in the skin	Change the pen needle after every injection. Make a skin fold or use a shorter pen needle. Use a longer pen needle.
	Insulin leaks from the injection site	Pen needle too short Pen needle removed too quickly after injecting (incomplete insulin delivery) Injected too quickly, insulin could not be distributed correctly	Use a longer pen needle. Inject slowly and do not remove the pen needle immediately (count to 10). Inject slowly and do not remove the pen needle immediately (count to 10).
	Insufficient insulin action	Unsuitable injection site (lipohypertrophy, scar tissue, skin hardening) Pen needle removed too quickly after injecting (incomplete insulin delivery) Incomplete mixing of insulin in the ampoule (only relevant for cloudy insulin) Pen needle blocked	Avoid unsuitable sites. Inject slowly and do not remove the pen needle immediately (count to 10). Tip the pen gently back and forth a number of times before each injection. Use a new pen needle.
	Unable to press down the dose button on the pen	Rubber membrane of the ampoule not pierced Pen needle too loose Pen needle blocked	Use a new pen needle. Ensure a firmer fit. Use a new pen needle.

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