A comparison of insulin injection needles on patients' perceptions of pain, handling, and acceptability: a randomized, open-label, crossover study in subjects with diabetes

Diabetes Technol Ther. 2009 Mar;11(3):195-201. doi: 10.1089/dia.2008.0054.


Background: For some diabetes patients, subcutaneous injections are associated with pain, discomfort, and anxiety. We compared overall preferences of two needle types: NovoFine((R)) 32-gauge tip x 6 mm and NovoFine 30-gauge x 8 mm, when used with the FlexPen((R)) injection device (all from Novo Nordisk A/S [Copenhagen, Denmark] and Novo Nordisk Ltd. [Crawley, UK]).

Methods: In this randomized, open-label, two-period, crossover trial in 119 insulin-treated patients with type 1 (22%) or 2 diabetes, patients injected their usual insulin with one needle type followed by the alternative, each for 7-14 days. Needle preference and perceptions of pain, handling, and acceptance were assessed using a questionnaire after use of each needle.

Results: Overall, 58% preferred the NovoFine 32-gauge tip, 26% preferred NovoFine 30-gauge tip, while 16% had no preference (P < 0.001 between needles). Subjects injecting </=40 or >40 (I)U/day and two or fewer or more than two injections/day all preferred NovoFine 32-gauge tip over NovoFine 30-gauge tip (all P < 0.05). Little or no pain (<5 mm on a 100-mm Visual Analog Scale) was experienced by 57% of subjects when using NovoFine 32-gauge tip and by 40% when using NovoFine 30-gauge tip. More subjects found the injection button easier to press with NovoFine 30-gauge tip (P < 0.01). Responses for ease of insertion, needle sharpness, and performance favored the NovoFine 32-gauge tip; ease of pushing insulin out through the needle favored NovoFine 30-gauge tip. One person for each needle type reported bleeding/bruising at the injection site.

Conclusions: NovoFine 32-gauge tip x 6 mm needles are a viable alternative to NovoFine 30-gauge tip x 8 mm needles for people administering daily insulin injections.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen
  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Cross-Over Studies
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Female
  • Humans
  • Injections, Subcutaneous / adverse effects*
  • Injections, Subcutaneous / methods
  • Insulin / administration & dosage*
  • Insulin / therapeutic use
  • Male
  • Middle Aged
  • Needles / adverse effects*
  • Pain / etiology*
  • Pain / psychology
  • Perception
  • Surveys and Questionnaires
  • Thigh
  • United Kingdom


  • Insulin