Another question about Lantus Pens

I was looking for a video to show someone on how to pull up Lantus from the pens and I found one from an exclusive feline hospital in Michigan. It was done on Jan 6, 2014. The vet actually says you can pull up the amount you need in the syringe first, then put the syringe in the pen and push in the air and the pressure of the pen will push that amount back into the syringe. Is it possible that the pens arent as fragile or less change to be contaminated as the vial???? I really think this is a cool method especially for newbies it would be great. Thoughts?????

Here is the video:

[youtube]nkm3PPlrkRc[/youtube]

 

This is the video we refer to.

[youtube]watch?v=u4KtK_skpmQ[/youtube]

 

I know that....I have posted it many times. But I went to go find that one again and saw that one. I am just curious as to why he does it that way.

 

Because he doesn't understand that the pressure mechanism in the pens removes the need to inject the air.
With vials, you inject the air to raise the pressure inside the vial. This makes drawing the insulin out easier.

 

I've never openly admitted it, but I've always completely ignored the rule to "squirt excess insulin into a paper towel" and simply squirt it back into the vial/pen. I'd rather only poke the vial once, keep the needle in the vial and adjust the dose from there. I'll probably get flak for admitting that, but I've been through 1 vial in 5 months and have used up 5 pens to the very last drop. For me, not wasting insulin on a paper towel and degrading the needle tip by poking it back into the vial again and again and again (yes, my ability to line up the dose is that terrible) is worth the very slim chance of insulin damage/loss of potency.

As to pushing air into the pen to force the pressurization to do the work...I definitely want to try this out! Being able to set the dose first would be a life-saver because I've always had issues lining up the dose properly on the syringe (hence the reason I leave the needle in the vial and adjust up/down/up/down till I get it where it's supposed to be precisely). I've got about 60u (~15 days) left in my current pen and am planning on getting Mikey a prescription for Levemir in the next couple of weeks, so I think I'll play the part of the guinea pig and try this method out till either it kills my Lantus (meaning this method doesn't work) or till I finish off this pen.

 

It won't hurt it to inject air into the pen - the properties for the glargine in both vial and pen are the same.

The concern about injecting insulin back into the vial or pen is the lubricant in the syringes may then contaminate the insulin. This lubricant could affect the potency or when injected into the cat, possibly affect the cat adversely, or both.

 

Yeah, I know that's the concern, but I haven't seen it yet either with my own vial/pens or any first-hand accounts of where it happened. And the lubricant affecting the cat adversely just doesn't make sense since it's already in the syringe to begin with. :?

 

The insulin isn't in sustained contact with the lubricant when you draw up a dose and give it right away.
If you inject it back into the vial or pen, it would be.
Up to you.

 

I tried the pushing the air back into the pen trick shown on the first video the other night. Complete failure and no auto-fill of the syringe. :sad: Maybe it only works on new pens and eventually stops working after a while? Maybe I didn't do it exactly as he did in the video and I missed a step somewhere? Either way, I now have a 2u sized air bubble in my pen. :lol: ohmygod_smile

 

Once you get air into the pen it messes up dosing via the button and knob on the pen. That is because the air gets compressed a little when you depress the button resulting in a reduced amount (less than the amount dosed via knob) of insulin being injected into the syringe or into a person.

 

I think I figured out what I did wrong. I never touch the dial-a-dose feature on the pen, so it was still cocked as if the pen was fully loaded with insulin. I'm going to have to try this again on tonight's dose and see if it works better. There was also this awesome tip from Mel about how to get rid of air in the pen which clued me in on the need to get the little plastic screw thingy to the base of the plunger part in the pen (how do you like my technical jargon? :lol: ).

I only have about 30u of insulin left in this pen (about a week's worth) and am planning on switching Mikey to Levemir next week anyway, so at this point I'm not too worried that any experimenting might ruin my insulin. ;-)

 

omg i hope/wish this were true! what a lifesaver.
KP, u have me LOLing. quite a feat. a 2u size bubble. holy crap. i am so glad i didnt try it. i wish it was real tho. let me know! getting correct dosage is hard.
i was a seesaw pro on N.

 

I actually got back a response from the vet clinic that video was done at. It was really great they responded to me.

Donna -

Thank you so much for your inquiry! It's a great question.

We instruct our clients and patients based on the official Material Safety and Data Sheet information sheet (MSDS) that comes with the product (http://products.sanofi.us/lantus/lantus ... ction-17.2 This is a link to the FDA approved patient labeling information). It specifically talks about injecting a volume of air into the multi-use vial. (these were steps 6, 7 and 8 on the sheet, but they changed to steps 1-3 when I copied and pasted them over!)
1. Draw air into the syringe equal to your insulin dose. Put the needle through the rubber top of the vial and push the plunger to inject the air into the vial.

2. Leave the syringe in the vial and turn both upside down. Hold the syringe and vial firmly in one hand.
3. Make sure the tip of the needle is in the insulin. With your free hand, pull the plunger to withdraw the correct dose into the syringe.



We treat the pens as a vial - you inject the same volume of air into the pen as the volume of insulin you remove, so the balance of pressure will remain the same. It may be that if you are using the pen as the actual pen, the pressure will be affected, but for cats, the pen is used as a multi-dose vial. Air will not degrade the insulin - there is a small volume of air present in the pen initially, and if you are using a sterile syringe and needle, introducing new air into the pen is unlikely to contaminate the insulin.

I hope that answers your question!

Have a great weekend, and let us know if you have any further questions. Diabetes can be a very difficult disease to manage in cats, so hang in there!

Jennifer Osterman, LVT and Steven J. Bailey, DVM, DABVP (Feline)
Exclusively Cats Veterinary Hospital
Waterford, MI
248-666-5287
ecats@exclusivelycats.com

 

wow. how impressive and a possible breakthrough for ppl like me! nice going with the info. dosing has been so challenging this last wk. whew :YMSIGH: nailbite_smile
i almost had tears from KP and her bubble. yay her and not me. i shall let kp perfect the art and let us know!

 

It worked!

...Sorta. It auto-filled the pen about halfway to the dose. I think it's because it still had too much air in it from before. Either way, I call this a success and will try it from the start with the Levemir so it'll work better. I took some pictures of the process I did to "re-pressurize" the pen (thanks, Mel!) and to draw the dose as shown in the first video.

I'm too lazy tonight to put them into a google doc with step-by-step instructions but the captions on the pics should help.

ETA: Updated link to photo album. Should hopefully be viewable now.

 

cool. i hope u can perfect it.

 

a few comments on some points made in this thread:

sanofi adventis offers instructions for human use on their website (the site where that vet got his information). the instructions for human use are based on the assumption you'll also follow their instructions to discard lantus after 28 days. i don't know about you, but discarding insulin after 28 days is not an affordable option for me... heck, most of us. that's why we take extra measures to prolong the life of our insulin.

the suggestions for handling lantus and levemir presented in the STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE are just that... suggestions. Suggestions based on common sense and anecdotal evidence. however, individual caregivers can opt to handle their insulin however they want. :mrgreen:

as far as the possibility of the lubricant contaminating your insulin if repeatedly pushed back into the vial or pen...
it could. and it might not. i prefer not to chance it, but it's up to you whether you want to take that chance of shortening the life of insulin in your pen or vial.

as far as the lubricant adversely affecting the cat...
over time, human diabetics are known to form deposits of silicone under their skin from the lubricant in the syringes. personally, i'd like to minimize the amount of silicone which just happens to get injected into my cat (and appears to stay there) by taking care not to see-saw the insulin between the syringe and the pen/vial when drawing a dose, but that's just me. my cat, alex, has been receiving insulin injections on and off since 2006. are those deposits of silicone from all the shots she's received over the years affecting her adversely? i don't know. why chance what happens to a fully grown adult body with that of a 12 pound cat? i don't believe in exposing any animal to anything unnecessarily... especially something injected under their skin. :?


when a member is new to the board and finds themselves in a situation where they're receiving contradictory advice, i suggest weighing the advice given. look at the spreadsheet of the member offering advice. when possible, check to see if whatever suggestions they're giving you are working for their own kitty.


bottom line...
we ALL do the best we can... each and everyone of us.
there are guidelines and suggestions made all over this board. take from them whatever works for you and your precious kitty.

TGIF... have a great weekend!

 

well i hate to hear that jill didnt know the silicone was harmful also.
it is a tough decision. keep wasting at least 2 U a day. i have to draw an extra 1 each shot, and shoot out to get rid of bubble, then dose is not always exact, plus left with a small bubble that effects dose usually. or...take all these risks for an exact dosage and no waste but possible danger to the cat. not good either way. for now i am obeying the rules most every1 follows. i guess only time will tell.
thanks for the input

 

All I knew about insulin, syringes, and lancets before coming here were from diabetic friends and relatives. They set doses by leaving syringes in the pen, they change out lancets only a few times a year , they sometimes get air into their pens/vials, they sometimes purposefully shoot air into their pens/vials. Three of them even use or have used Lantus specifically, so this is not based on "other, more tolerant insulin."

It wasn't till a month or two in on this site that I discovered you weren't supposed to get air in the insulin nor were you supposed to roll your vial. I remember crying for hours that I was now going to have to toss out my $180 vial because of air bubbles and rolling it. My scientific mind finally overruled my emotional upset and I decided to keep quiet about how I'd "ruined" it and to keep using it and see if it would still work. Even after getting an additional four months out of it, I was still so nervous I had somehow ruined my vial in a way I couldn't visibly see that I switched it out for a pen earlier than need be because I feared it had lost potency from my bad treatment of it or that it would cause some sort of adverse reaction in Michelangelo or that it would blow up in my face because I should have replaced it that first month but I held onto it instead. (In actuality, I used the vial again a few months later for a week just to see if it would still work and it was perfectly fine; no difference between the used-and-abused vial and the brand new pen I had just gotten.)

Then, with the pens, it wasn't till I was on my third pen that I learned I was supposed to refrigerate it on a shelf and not in the door and I should be removing the syringe and squirting the excess out and re-inserting the syringe over and over and over again till I could get the right dose. After wasting about 5u of insulin and going a half hour past Mikey's shot time trying this method, I just rolled my eyes :roll: and threw in the towel. My method had worked fine on the other two pens and I wasn't going to waste any more insulin because someone somewhere had a friend of a friend whose cousin's cat's granddaughter ended up with a lump from the shots...but it might have actually been a vaccine shot and not insulin shots.

My biggest problem is that it scares off people. Several times in the past, I have been approached by others either here or on fb about how they can't afford the insulin because they have to replace it so often. When I tell them that the expiration date is for if it's unrefrigerated, they explain, "no, it's because I got an air bubble in it," or "no, it's because I shot insulin back in," or simply because they left it out overnight. ohmygod_smile There is even at least one or two posts a month on the Main Health Board with people asking if they've "ruined" their insulin because they did this.

I'm just not a fan of fear-mongering and when it causes people to feel like they can no longer afford to care for their pet or causes them undue stress because they can't be perfect at drawing a dose, I feel for them because I remember all too well my own crying jag from when I thought I'd ruined my vial. Statistically, the majority of people who join this site will end up with a kitty in remission probably before they even use up their first vial/pen. Are they really going to need to worry about long-term silicon build-up? There are more important things to be focusing on, like learning how to home-test and being able to find a low carb food that fits your budget, than on whether or not you can draw a perfect dose without wasting any insulin. I know I'm probably in this for the long haul with Mikey, from when he was diagnosed at 6 months old till he's 25 years old (or hopefully older). I'd rather be the guinea pig and show people that it's okay to be imperfect with your insulin; it's not going to ruin it nor is it going to kill your cat any more so than the dry food you've been feeding him all his life.

ETA: Maybe we should "Think Tank" this post? :lol:

 

pam, i wouldn't say silicone is "harmful" nor would i say your cat is in danger. all i know is over time silicone oil deposits form in human diabetics. it's just not something I want for my cat if it can mostly be avoided by simply not see-sawing the insulin in and out of the vial/pen. however, it's not totally unavoidable because of the very nature of a disposable syringe itself. personally, when it comes to exposing my cat i like to minimize stuff like this. it's your decision.

as far as worrying about "wasting" insulin...
an argument could be made that one would waste a whole lot more insulin if one's insulin went bad or kitty's numbers were wonky before reaching the six months many users have been able to use their pen or vial. besides, you're new at this. with time, you'll get better with all facets of larry's care. treating larry's diabetes WILL become much easier.

the tips in the sticky i linked in my post above above are to help you get the most bang out of your buck when it comes to insulin. all any of us can do is pass along what we've learned... information which has been found to work amongst caregivers using lantus for their diabetic cats here and in other parts of the world.

 

kay, i do not condone nor believe in "fearmongering" either.

however, i do believe in giving members all the information we have as well as updating information as it becomes available.
i stand behind everything i've written in this thread as well as the information contained in the "STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE" as it's written today. as you can see from the number of times each sticky has been edited... we try to update as soon as anything new or contradictory comes our way.

~ jill

 

Sorry, I in no way meant anything specific against you or the Sticky. They're fantastic and very well-written and I really appreciate all the effort and time you put into writing them.

I was trying to explain where I personally was coming from after having been there, done that as a newbie with all of the information from everywhere (not just here, but other forums and websites) and thinking it was the end of the world that I had accidentally dropped my lantus bottle and it got shaken up or that I had been storing it in the door of the fridge instead or that I had been sucking air out if it with a syringe or pushing air back into it or left it out all day or a million other No-No's and rules. Yes, there is a proper way to treat your insulin for optimal results (like the Sticky explains), but if you mess up or need to do things a little differently so it works for you, it's helpful to know it's not going to ruin it.

 

then you probably appreciate the following part of that same sticky:

it's copied and pasted from that sticky... right down to the red font. can't remember when i added it. for the most part individual edits are not dated.


P.S. - i wasn't taking this personally. no apology necessary. :mrgreen:

 

Hahahaha! I was just coming back here to post that exact same section to say how much I appreciated that! :thumbup I've actually shared it with a few folks in the past (I know it was there a couple of weeks ago when I made a print-out for my vet).

 

From the Midwest Veterinary Conference this past weekend, the meta-cresol to retard bacteria is the problem with using it longer than the tested 28 days, as it becomes less effective with time ... and less effective with refrigeration.

To me, that suggests that you want to avoid doing anything that could contaminate the contents of your pen or vial.

 

arent we supposed to refrigerate? and ur saying we can inject air? if def. so, i want to try that autofill method. just once getting the right dose, not wasting it, and no bubble, would be fantastic!

 

Refrigeration also retards growth of any bacteria, so there may be a trade off.

Air shouldn't be a problem.

 

This does not work at all on the Levemir pens, but in the last couple of days with my Lantus pen, it was working fairly well. I'm sure if I had done this from the beginning with a brand new Lantus pen, it would have worked perfectly. I'm going to keep trying with the Levemir and see about maybe "injecting air" instead of just setting the dose and letting it autofill (which is what worked with the Lantus pen).