Sticky SYRINGE & INSULIN INFO: HANDLING, DRAWING, & FINE DOSES

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jill & Alex (GA), Dec 29, 2009.

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  1. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    LANTUS and LEVEMIR: What's the Difference?

    Lantus is available in:

    • a 10 mL vial
    • a box of five 3 mL refill cartridges (no longer available in the USA)
    • a box of five 3 mL prefilled SoloStar Pens

    Basaglar is available in:

    • a box of five 3 mL prefilled KwikPens
    • a box of five 3 mL refill cartridges (not available in the USA)
    Note: Basaglar is not available in a 10 mL vial

    Levemir is available in:

    • a 10 mL vial
    • a box of five 3 mL FlexTouch® pens
    • a box of five 3 mL refill cartridges (no longer available in the USA)
    Some pharmacies *may* sell single cartridges or pens. Check with the individual pharmacy. Prices will vary. Many of our members purchase insulin from Marks Marine Pharmacy in Canada. See THIS post for more information. When shopping locally, shop around for the best price!

    Lantus, Basaglar, and Levemir should NOT be repackaged and sold by the vet. If you are buying repackaged insulin from your vet, even if it was transferred into a sterile container, its efficacy and longevity may be questionable.

    Repackaged insulin will often look like the vial on the left.
    Vials should come packaged in a sealed box from the manufacturer (like the picture on the right).

    [​IMG] [​IMG]

    Proper handling of Lantus, Basaglar, and Levemir:

    • Lantus, Basaglar, and Levemir should be visually inspected prior to administration. Use only if the insulin appears clear and colorless.
    • Never shake or roll your vial, cartridge, or pen.
    • In-use and unopened Lantus, Basaglar, and Levemir should be stored in the refrigerator between 36 to 46 degrees F (2 to 8 degrees C).
    • Do NOT use Lantus, Basaglar, or Levemir if it has been frozen.
    • Do not inject air into cartridges or pens. Cartridges and pens are designed to work on a negative pressure principle.
    • If you draw up too much insulin in the syringe... squirt excess either into the air dramatically like they do on TV or into a paper towel... anywhere but back into vial/cartridge/pen. There is a silicon coating inside the syringe. It may contaminate the insulin vial with silicon.
    • Lantus, Basaglar, and Levemir should not be diluted or mixed with any other insulins or liquids. The manufacturers do not recommend diluting Lantus and Levemir. However, some human diabetics and caregivers of diabetic cats have diluted Lantus or Levemir without any apparent problems. See the section "Administration of small doses of glargine and detemir: dilution and insulin dosing pens" in the attached file, "Management of Diabetic Cats with Long-acting Insulin": management of diabetic cats.pdf
    • [​IMG][​IMG]
      Some additional although somewhat outdated information/help from the Pet Diabetes Wiki: Diluting Insulin. If you want to explore the possibility of diluting Lantus, Basaglar, or Levemir, we strongly urge you to seek help and advice from your vet.
    How do you know when your insulin is no longer good?
    • When you lose regulation for no reason.
    • If you see any hint of "floaties"/"tiny particles"... discard the insulin.
    • If insulin is cloudy or discolored, or if rubber stopper is cracked... replace insulin immediately.
    • If the insulin has frozen, it's no longer good.
    How long will my insulin last?
    • The manufacturer of Lantus recommends discarding the insulin after 28 days of use. However, with proper handling and refrigeration, many Lantus users have been able to use a vial/cartridge/pen for six months and longer. Some use pens and vials to the last drop.
    • The manufacturer of Basaglar recommends discarding after 28 days of use. It's too new to know for sure, but we anticipate Basaglar to last as long as Lantus with proper handling and refrigeration.
    • The manufacturer of Levemir recommends discarding the insulin after 42 days of use. However, with proper handling and refrigeration, many Levemir users have been able to use a vial/pen for six months and longer. Some have used pens and vials to the last drop.
    • Unopened Lantus, Basaglar, or Levemir are good until the expiration date stamped on the box if refrigerated and handled properly.
    Using pen needles with an insulin pen:
    • When dosing cats, there can be more negatives to using pen needles with an insulin pen than positives:
      • Inability to administer doses in increments of 0.25 - 0.50 units with pens.
      • Forgetting to "prime" the pen prior to each use will result in a smaller dose than intended. Priming the pen involves wasting 2 units of insulin for every shot.
      • One must keep the pen needle in for 5 - 10 seconds after the shot or you'll run the risk of not administering a full dose (can be tough with some cats).
      • Manufacturers do not recommend refrigerating an in-use pen. Therefore, shelf life may be shortened to 28 days (Lantus & Basaglar) and 42 days (Levemir).
      • Some FDMB members have reported shots administered from insulin pens are more uncomfortable than from a syringe (?)
    Using syringes with a pen, cartridge, or vial:
    • U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Basaglar, or Levemir from vials, cartridges, and pens.
    • BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
    • Syringes come in ½ inch or 5/16 inch needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)
    • Full and half-unit syringe scales:
    SYRINGE SCALES1.jpg
    • Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:
    [​IMG]
    Using a syringe to draw insulin from a pen or cartridge:

    [​IMG] [​IMG] basaglar insulin sticky.png
    (L - R) Levemir FlexTouch Pen, Lantus Cartridge Refill (refill not available in US), Basaglar KwikPen



    Fine Dose Pictorial Guide

    Fine dose gradations:

    • 0.5U = exactly half a unit
    • 0.4U = skinny 0.5 touching the line
    • 0.3U = skinny 0.5 with daylight under the line
    • 0.2U = fat zero with daylight over the line
    • 0.1U = fat zero barely touching the line
    Pictorial guide using a U-100 syringe marked with half units:

    [​IMG] [​IMG]
    [​IMG] [​IMG]



    Shot Placement & Overlap: Flank vs Scruff

    [​IMG]
    [​IMG]



    Please note: Lantus is NOT as fragile as we once thought. Human diabetics will carry around an unrefrigerated pen in their purse, briefcase, backpack, or stuck in their pocket. The pens will be subject to motion, bumps and bangs... it still works! Refrigeration and minimizing movement will help your insulin last longer, but don't freak out if you drop your insulin or accidentally leave it out on the counter over night. Chances are the insulin is just fine!


    ====================
    This document was written by FDMB members jojo and bunny and Jill & Alex (GA) with contributions from Amanda and a Loudogg, Ann & Tess (GA), CD and BigMac, Chris & China, D and Shadow, Greg and Carmelita, julie & punkin (ga), and Steve & Jock.
    =====================

     

    Attached Files:

    Last edited: Sep 20, 2018 at 7:20 PM
    Reason for edit: added Basaglar info
  2. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
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