>> Hello, my name Dr. Allison Veide, a VA pharmacist and today I would like to discuss
with you the proper way to give yourself an injection of a newer class
of diabetes medications called Glucagon-like peptide- 1 agonist or GLP-1 agonists.
There are many different types of GLP-1 agonist pens on the market and over the past few years,
the VA has changed which one is the preferred option.
In this video, I will be demonstrating the same technique used
for two different specific GLP-1 agonist pens.
Although there are many different medications in this class available,
today I'll be demonstrating how to prime and use the Ozempic
or semaglutide and Victoza or liraglutide pens.
During this video, the example pen shown is Ozempic.
Though the steps are the same for the Victoza pen, keep in mind the other medications
in this drug class utilize a different technique which will not be covered in this video.
What is important for you to know is that the technique that I will show you is the same
as the patient instructions included in every box of Ozempic and Victoza pens,
so if you forget anything you see today,
you can refer to the patient instruction pamphlet inside the box or replay this video.
Here are some of the important points to remember about this class of medications.
GLP-1 agonists are not insulin, although they are injected in the body.
They do not work the same way that insulin works.
GLP-1 agonists do not come in vials like some insulins.
Most of the GLP-1 agonists come in pre-filled pen devices.
Unlike insulin, these agents are not for treating Type 1 diabetes and can be harmful
if given to someone with Type 1 diabetes.
In clinical studies, some of the GLP-1 agonists have been shown to reduce the risk
of serious heart problems such as heart attack and stroke in adults
with Type 2 diabetes and heart disease.
Additionally, GLP-1 agonists have been shown to have protective benefits for the kidneys.
Before using a GLP-1 agonist, it is very important that you discuss
with your provider your medical and family history to make sure
that it is safe for you to use this medication.
Like other injectable medications, it is important to never share this medication
with others even if the needle has been changed.
Another important thing to know is that you should remove the needle after every injection.
This can reduce the likelihood of contamination of the medication
and prevent the medication from leaking out.
Now that know this important information about this class of medication, let's get started.
Let's start by opening the box and looking at your pen,
which is prefilled with the medication.
When you open the box, you will see either the Ozempic pen or the Victoza pen.
Inside each box contains the package insert with patient instructions.
The very last section will have instructions on how to prime, meaning getting the device ready
for an injection and how to inject the dose of medication.
For both Victoza and Ozempic, each pen will contain multiple doses and be used over a period
of time, though remember you will need to use a new pen needle with each dose.
The prefilled pen has a dial so you can select the dose.
Note the pen window, dose counter and pointer, the dose selector, and the push button.
The supplies you will need for this injection include your pen,
a pen needle, and a sharps container.
If you do not have a sharps container, you can use a heavy plastic container
such as an old laundry detergent bottle.
Please make sure you write "used needles" in bold letters on the side.
Before starting the injection process,
it is important to wash your hands with soap and water.
Then double-check the drug name on the side of the pen
to make sure you have the correct medication.
The first step is to take the pen cap off then look at the medication in the pen window.
You'll want to make sure it's clear and colorless.
If it appears cloudy or if it appears to have any particles in it or floating around,
do not use that pen and contact your provider or pharmacy right away.
Next step will be to pick up one pen needle.
You will need to pull away the paper tab.
Push the needle straight onto the end of the pen and twist until it is hand-tightened and secure.
Make sure you have not over-tightened as the plastic may crack
or break nor push the pen needle onto the pen at any angle either.
Now pull off the outer cap and place it
to the side then pull the inside needle cap off and throw away.
Just as a reminder again, you will need to make sure you use a new needle with each injection.
It is also important to make sure you never use a bent or damaged needle.
The next step will be to check the flow before the first injection.
You will need to complete this step with each new pen you use.
Turn the dose selector slightly until the flow check symbol dots or dashes appear.
Now hold the pen with the needle pointing straight up then press and hold the dose button
until the dose counter moves slightly and shows zero.
The zero should be lined up with the dose pointer.
A drop of the medication should appear at the needle tip.
This will let you know that the pen is working correctly.
If you do not see a drop appear at the end of the needle, you will need to repeat this step.
You can repeat this step up to six times then if after six attempts there's still no drop
at the tip of the needle, you can change the pen needle and try one more time.
If there's still no drop at the end of the needle, do not use the pen
and contact your provider or pharmacy.
Please note while not occurring very often, if you do not see a drop appear at the end
of the needle when the dose counter moves, it could mean that the pen is not working properly
or may mean you have a blocked or damaged needle.
Next, you will need to turn the dose selector until it shows your dose prescribed.
Make sure the dose lines up exactly with the dose pointer.
If you pass the dose you're supposed to take, it is okay to move the selector backwards
or forwards to find your correct dose.
You will hear a click with each turn of the dose selector, however, it is very important
that you never try to choose your dose by hearing and counting the clicks
as this may result in the wrong dose.
Please note, once your pen is nearing the end of its supply, the dose counter will only allow you
to turn it to the highest dose remaining in the pen.
You will not be able to turn it further than that.
If the pen does not have enough medication left
for a full dose then do not use it and start a new pen.
Now it's time to give yourself the medication.
Before injecting, you should clean your skin with isopropyl alcohol making sure to allow time
for the skin to air dry before your injection though if you have just bathed
and your skin is very clean, you do not need to clean your skin again.
Your choice of body sites for the subcutaneous injection are the upper arm, abdomen, and thigh.
Insert the needle straight into your sign.
It is important to avoid injecting at an angle.
Be sure you do not cover the dose counter with your finger
as this could stop the pen from working correctly.
Press the dose button down and then hold it
until you see the dose counter move back to zero.
You will then need to keep the needle in your skin with button held down for six seconds,
counting slowly, one one thousand, two one thousand, and so on.
By doing this, you will make sure the entire dose is delivered.
If the needle is removed too quickly and you see liquid come out,
this may indicate the full dose was not given.
Once the six seconds are over, you can pull the needle out of your skin.
Do not rub the injection area.
If you see a small spot of blood, lightly dab the injection area with gauze or a cotton ball.
If after six seconds, the dose counter does not move and the zero does not appear
in the dosing window, you may have a blocked or damaged needle.
This may also mean you do not receive any medication.
Just replace the needle, keep the dosing counter at the same spot and then try again.
After you've completed your injection, carefully unscrew the needle from the pen.
You can do this by pointing the needle up and unscrewing the needle from the bottom
to make sure you will not accidentally prick your finger.
It is important you do not try to recap the needle
so you do not accidentally stick your finger.
Place the needle in the sharps container and put the cap back
on the pen to protect it from light.
Remember, after you've primed your pen and completed your first injection,
the pen does not need to be primed again.
Try to never drop your pen or knock it against a hard surface.
If your pen is not working right, do not try to pull your pen apart to fix it.
Please try to keep your pen away from dust, dirt, and liquid.
It is not recommended to try to wash, soak, or lubricate your pen.
If you need to clean your pen, do so with mild detergent on a damp cloth.
You should store new and unused pens in the refrigerator,
though it is okay to keep the pen you are using at room temperature.
It is important to avoid freezing your pen.
Make sure you keep the pen away from the cooling element in the refrigerator.
You have now successfully given yourself a dose of your GLP-1 agonist using the pen device.
Great job.
Thank you for watching this video and thank you for your service to our country.
I am honored to be of service to you this day.