Novo Nordisk NovoPen Echo Plus User manual

User guide
Read this user guide carefully before you use your
NovoPen Echo® Plus for insulin delivery the first time
Find a quick guide at the back of this manual

Prepare the pen for an injection
Inject your dose 12
After your injection 14
What is the dose memory? 16
How to check your last dose 18
How to keep a personal injection log 20
How to check how much insulin is left 22
How to use the dose memory
If you need more insulin than
what is left in the cartridge 24
Special display messages 28
How to replace a used insulin
cartridge 26
How to care for your pen 30
Care 30
Cleaning 30
Storage 31
Disposal 31
Warranty 32
Technical information 32
Contents
Overview of pen parts Inside cover
Introduction Inside cover
Important notes 1
Insert an insulin cartridge 2
If you use white and cloudy insulin 5
Attach a new needle 6
ALWAYS test the insulin flow before you inject 8
Select your dose 10

Cartridge
holder
Insulin
scale
Pen
Time passed since last injection (hh:mm:ss)
Number of units last injected
Dose memory
Pen cap
Insulin
window
Dose
memory
Pen IDDose
counter
Piston
rod
Piston rod
head
Dose
button
Dose
pointer
Outer
needle
cap
Inner
needle
cap
Needle Paper
tab
Single-use needle
(example)
Threaded end
(for needle
attachment)
Coloured
band
Piston
Insulin cartridge
(Penfill® cartridge 3 ml)
Glass ball
(in white and
cloudy insulin only)
LOT number
(on reverse side)

Introduction
Thank you for choosing NovoPen Echo® Plus.
NovoPen Echo® Plus is a re-usable insulin pen
with a dose memory function.
Your NovoPen Echo® Plus package contains one
pen, a soft case for storage and this user guide.
You should read this guide carefully before
you use your pen – even if you have used
NovoPen Echo® Plus or similar Novo Nordisk
delivery systems before. It will tell you all you need
to know about your pen and how to use it.
NovoPen Echo® Plus is a re-usable pen injector
designed for single patient use by diabetes patients
for the self-injection of insulin in a home healthcare
environment. The NovoPen Echo® Plus pen injector
should only be used with compatible products that
allow it to function accurately and safely. The pen
injector uses Penfill® 3 ml cartridges of
Novo Nordisk insulin and single-use disposable
needles (supplied separately). The pen injector
allows the user to dial required doses from 0.5 to
30 units in 0.5-unit increments.
The pen has a dose memory that helps you
remember the number of units you last injected
and the time passed since that injection. The dose
memory also saves your injection history for the
past three months. See pages 20-21 in the user
guide for more information on how to use this to
keep a personal injection log. You can transfer this
to, for example, your smartphone to keep
a personal injection log.
The pen is durable, which means that you can
reuse it. When you have used all the insulin in
a cartridge, you simply replace it with a new one. If
you use more than one type of insulin, it is highly
recommended that you use a different
NovoPen Echo® Plus for each insulin type.
You can get the pen in red or blue.
Always remember to check the name and colour of
the cartridge to make sure it contains the correct
type of insulin before every injection.
Mixing up your insulin can have serious
medical consequences. It is therefore
recommended that if you use two types of insulin,
to discuss with your Healthcare Professional how to
avoid mix ups.
About this user guide:
Throughout this guide, instructions on how to
use your pen are presented step by step.
Important information and additional
information are clearly marked by the symbols
you see below:
Important information
Pay special attention to these notes as they
are important for safe use of the pen. If
you do not follow the instructions
carefully, you may get too little or too
much insulin, or no insulin at all.
Additional information

Important notes
•Do not use NovoPen Echo® Plus without
proper training from your doctor or nurse.
Make sure you are confident in making an
injection with the pen before you start your
treatment with it.
• If you are blind or have severe visual
problems, do not use NovoPen Echo® Plus
without help. Get help from a person with
good eyesight who is trained to use
NovoPen Echo® Plus.
• ALWAYS test the insulin flow before each
injection. Do not use the pen if insulin does not
squirt from the needle tip when you test the
flow. If you do not test the insulin flow, you may
get too little insulin, or no insulin at all.
• If you drop your pen, check the insulin
cartridge for damages, for example cracks.
Replace the cartridge with a new one if
necessary.
• If you accidentally twist your pen apart
between injections, it is important to test the
flow of insulin before your next injection. You
may need to do it several times before insulin
squirts from the needle tip. If insulin does not
appear, you may get no insulin at all.
• NovoPen Echo® Plus is designed to be used
with Penfill® cartridge 3 ml and
NovoFine® Plus, NovoFine® or NovoTwist®
single-use disposable needles up to a length of
8 mm.
• Novo Nordisk is not responsible for harm
due to using NovoPen Echo® Plus with products
other than these.
• Always check the name and colour of the
cartridge to make sure that it contains the
type of insulin you need. If you take a wrong
type of insulin, your blood sugar level may get
too high or too low.
• Always carry a spare pen, extra insulin of the
same type(s) you use, and new needles with
you in case of loss or damage.
• Never share your pen, insulin cartridges and
needles with other people. They are for your
use, only.
• Always keep your pen, insulin cartridges and
needles out of sight and reach of others,
especially children.
• Always keep your pen with you. Do not
leave it in a car or other place where it can get
too hot or too cold.
• Caregivers must be very careful when
handling used needles to reduce the risk of
needle sticks and cross-infection.
1

1
3
2
• Pull off the pen cap.
• Twist off the cartridge holder. Put it to one side for later use.
• The piston rod may stick out of your pen. If so, push it
completely in until it stops.
Insert an insulin cartridge
2
The piston rod and the piston rod head may be loose and
move on their own. This is natural and does not affect the
function of the pen.

• Take a new insulin cartridge. Hold the cartridge holder and let
the cartridge slide in with the threaded end first as illustrated.
The colour of your cartridge may differ from the one shown in
the illustration. It depends on the type of insulin you use.
4
3
Check the name and colour of the cartridge to make sure
that it contains the type of insulin you need. If you take
a wrong type of insulin, your blood sugar level may get too
high or too low.
Check that the cartridge is not damaged, for example by
cracks. See how to do this in the Penfill® cartridge 3 ml
leaflet that comes with the Penfill® cartridge 3 ml
package.
Check that the insulin looks the way it should. The
Penfill® cartridge 3 ml leaflet will tell you how your type of
insulin should look.
NovoPen Echo® Plus is designed to be used with
Penfill® cartridge 3 ml and NovoFine® Plus, NovoFine®
or NovoTwist® single-use disposable needles up to a length
of 8 mm.

• Twist the cartridge holder back on, as illustrated, until you hear
or feel a click.
4
5

If you use an insulin cartridge with cloudy-looking insulin (white
insulin suspension), always resuspend this right before
injection. See the Penfill® cartridge 3 ml leaflet on how to
resuspend your type of insulin.
Make sure there is enough space in the cartridge before you
resuspend the insulin:
The piston must be above the white line on the cartridge
holder when you hold the pen as illustrated. This is necessary to
allow the glass ball inside the cartridge to move freely to
resuspend the insulin.
If the piston is below the white line, replace the insulin cartridge
with a new one, see pages 26-27.
5
If you use white and cloudy insulin
White line

• Take a new needle, and tear off the paper tab.
• Push the needle straight onto the pen. Turn until it is on
tight.
• Pull off the outer needle cap and save it. You will need it after
the injection, to safely remove the needle from the pen.
Always use a new needle for each injection. This
reduces the risk of blocked needles, contamination,
infection and inaccurate dosing.
Never use a bent or damaged needle.
Do not attach a new needle to your pen until you are
ready for your next injection.
Attach a new needle
6
2
1

7
3
• Pull off the inner needle cap and throw it away.
A drop of insulin may appear at the needle tip. This is normal,
but you must still test the insulin flow.
NovoPen Echo® Plus is designed to be used with Penfill®
cartridge 3 ml and NovoFine® Plus, NovoFine® or NovoTwist®
single-use disposable needles up to a length of 8 mm.
The needle is covered by two caps. You must remove both
caps.
If you forget to remove both caps you will not inject any
insulin and your blood sugar level may get too high.

8ALWAYS test the insulin flow before you inject
• Pull out the dose button, if it is not already out.
• Turn the dose button to select 2 units.
1
2
Dose button
out
2 units
selected
ALWAYS test the flow before you inject.
Keep testing until insulin squirts from the needle tip.
This makes sure that any gap and air bubbles are
removed and that insulin is getting through the
needle.

9
3
3B3A
• Press the dose button until the dose counter shows “0”. The
“0” must line up with the dose pointer.
• Check that insulin squirts from the needle tip.
If no insulin appears, repeat steps 1-3 until insulin squirts from
the needle tip.
If no insulin appears after several attempts, check the insulin
window to see if there is a gap between the black piston rod
head and the piston, see illustrations 3A and 3B. If you do not see
any gap, change the needle and test the insulin flow again.
The insulin flow test is complete when you see insulin
squirt from the needle tip.
Do not try to inject if no insulin appears. You may not
receive any insulin, even though the dose counter may
move. This could lead to too high blood sugar
(hyperglycaemia).
If insulin does not appear after testing the flow
repeatedly, do not use the pen. Contact your supplier to
get a new pen.

Select your dose
1
2
10
2.5 units
selected
12 units
selected
• Pull out the dose button, if it is not already out.
• Make sure the dose counter shows “0” before you start.
• The “0” must line up with the dose pointer.
• Turn the dose button to select the dose you need. You can
turn the dose button forward or backward.
The dose button changes the number of units. Only the
dose counter and the dose pointer will show how many
units you select per dose.
You can select up to 30 units per dose.
Half units are shown as lines between the figures.

11
Always look through the insulin window to make sure that
the insulin in your pen looks the way it should. The
Penfill® cartridge 3 ml leaflet will tell you how your type of
insulin should look.
Always use the dose counter and the dose pointer to
see how many units you select.
Do not use the insulin scale on the cartridge holder. It only
shows approximately how much insulin is left in your pen.
Do not count the pen clicks.
If you select and inject a wrong dose, your blood sugar level
may get too high or too low.
If you need more than 30 units, you may choose to use
another Novo Nordisk insulin delivery device with a higher
maximum dose.
The dose button should turn easily. Do not force it to turn.
When your pen contains less than 30 units, the dose
counter stops at the number of units left. If you need more
insulin than what is left in the cartridge, see pages 24-25.

12 Inject your dose
• Check the name and colour of the cartridge to make sure that
it contains the type of insulin you need. If you take a wrong type
of insulin, your blood sugar level may get too high or too low.
• Insert the needle into your skin as your doctor or nurse has
shown you.
• Make sure you can see the dose counter.
• Press the dose button until the dose counter shows “0”. The
“0” must line up with the dose pointer. You may then hear or
feel a click.
• Keep the needle in your skin after the dose counter has
returned to “0” and count slowly to 6.
If the needle is removed earlier, you may see a squirt of insulin
coming from the needle tip. If so, the full dose will not be
delivered, and you should increase the frequency of checking your
blood sugar levels.
1
2Wait and
count slowly
1-2-3-4-5-6
ALWAYS test the flow before you inject.

13
3
• Remove the needle from your skin.
Always inject by pressing the dose button. Do not turn
it. If you turn the dose button, you will not inject insulin.
Always watch the dose counter to know how many
units you inject. Do not count the pen clicks. The dose
counter will show the exact number of units.
If the dose button stops before the dose counter shows
”0”, the needle may be blocked. Turn the dose counter
back to “0” and replace the needle with a new one. Test
the insulin flow and inject your full dose.
You may see a drop of insulin at the needle tip after
injecting. This is normal and does not affect your dose.

After your injection
1
2
3
14
• Remove the needle right away by screwing it into
a sharps container.
• If you do not have a sharps container, follow a one-handed
needle recapping method. Lead the needle tip into the
outer needle cap on a flat surface without touching the
needle.
• Do not touch the outer needle cap before it covers the needle.
• Once the needle is covered, carefully push the outer needle
cap completely on.
Never try to put the inner needle cap back on the
needle. You may stick yourself with the needle.

15
4
5
• Hold the black cartridge holder and unscrew the needle. Throw
it away carefully as your doctor or nurse has instructed you.
• Put the pen cap on your pen after each use to protect the
insulin from light.
• Store your pen carefully. The pen should be out of sight and
reach of others, especially children, see page 31 on how to
store the pen.
Always hold the black cartridge holder when you
unscrew the needle. Otherwise you may twist your pen
apart. If this happens, twist the pen together again. Replace
the needle and test the insulin flow before your next
injection to make sure you get your full dose.
Always remove and throw away the used needle
safely, for example in a sharps container, as instructed
by your doctor or nurse. This reduces the risk of blocked
needles, contamination, infection and inaccurate dosing. Do
not store your pen with a needle attached.

16 What is the dose memory?
Your pen has a dose memory that shows how much insulin you
last injected and the time passed since your last injection:
• The number at the top shows the number of units last
injected.
• The timer below counts the hours, minutes and seconds
(hh:mm:ss) that have passed since your last injection.
The example on the left shows 5.5 units injected 3 hours,
45 minutes and 10 seconds ago.
How does it work?
The dose memory records your dose when the dose counter
returns to “0” and the dose button is pressed completely in after
an injection.
Note that the dose memory only shows the details of the
last injection or insulin flow test. This means that when you
test the insulin flow before a new injection, it will overwrite the
details of your last injection.
Time passed
since last
injection
Number of units
last injected