withdrawing lantus from a pen/info plz

hello every1. wntd to see if i could get more feedback and some great ideas. been using the pen about 12 days now. no air is present in vial. i follow the exact instructions in the video. watched it many times. still left with a huge bubble every time. we r using 1.5u as a dose and i have to pull up at least 2.5 to get 1.5 left after bubble is expelled. today i accidentally went to 3u. as dosing is vry challenging and tedious with no leeway. evn after expelling/wasting 1.5u there was still a bubble left. i dont like wasting 2u or so a day, and i dont like not knowing the exact dose. what can i do?
thanks!

 

Hi Pam

After you draw the dose, do you draw a little air into the syringe on purpose? If there is a bit of air in there on top of the insulin, it makes the other little bubble go up to it (with the help of you tapping the syringe). Then expel the air and extra insulin. Hope this helps.

 

ohhhh
nooo, nvr thot of that. so lets say i have 2.5 and at least 1u of that is a bubble. today half my amt was air! if i am at 2.5 already, how much more do i draw in? pull it up to...?

 

I would guess 1u of air would be more than enough. It just gives the syringe space for the air to be worked up. Try it with water. Create bubbles if you need to just to try the experiment. You should be able to get it to the point where you only need to draw a small (.5u?) of extra insulin and let the air do the heavy lifting for you.

 

I should mention, I have never used the pens, but this technique works like a hot da__ with vials

 

oh, wait...do u mean put the air in first? like draw air to 1 or so, then add insulin? confused. also mine has no vacuum like they talk abt. it doesnt push insulin into my syringe on its own.

 

No...pull out your normal dose and then remove the syringe from the pen. ADD a little more air and then tap the syringe hard to get the bubble that's usually sticking down on the rubber stopper to go up to where the added air is. Then gently expel all the air.

You might also need to slow down when you're pulling out of the pen. I've noticed it takes longer to fill my syringe from the pen than it did from the vial. You can't rush it.

If you're giving 2.5 units, pull up about 3, remove the syringe from the pen, ADD air, tap syringe hard to get the bubble to go up to the added air and expel gently leaving 2.5 units of insulin.

 

ok, so no way around all the waste? within a month, we will hv wasted abt as much as we have given. that means only getting half as much out of a vial. surely it can be better?

 

are you pointing the syringe needle towards the ceiling when you're tapping to work the bubble out?

drawing the dose very slowly can help reduce bubbles.

some syringes are terrible about creating bubbles as you use them. what brand syringe are you using?

let me ask to clarify - did you say you are using a vial? the little bottle, not the pen?

and you're following the directions in the video -
....only injecting air into the air of the vial,
.........holding the plunger tightly down to keep any air from getting into the syringe,
.....then flipping it over and
.........SLOWLY drawing up the dose?

if you are doing all of that, you really shouldn't be seeing any significant amount of bubbles unless it's caused by your syringes.

 

They're using a DCIN donated Pen Julie (If I remember right)

No, you won't have to waste that much. It just takes a little practice. I know you've had some trouble, but try pulling very slowly, adding only a tiny bit more than your dose (for now), then pull the syringe out of the pen and add a little more air. Tap hard enough to get all the air up on the needle end and then slowly expel it all. You should be left with pretty close to your correct dose without wasting more than a drop or two

 

And believe me the syringes DO make a difference. We here is SK have only one choice and it was the worst!
You should only need to waste about a half unit to start and the rest of the waste should be air. It's horrible how much insulin goes down the drain, but hopefully these tips everyone is mentioning will help lessen the loss :smile:

 

using the pen, yes to everything u said. identical to the video. relion syringes. i get my supplies thru the financial aid, and vry thankful i dont think i shd be getting bubbles either but i do.
at first, going slowly seemd to help i thot. the end result is always the same tho. huge air bubble.

 

i believe u. we r using relion, however. thats what we have, and r able to do
we waste abt 1 u each time and there is still some air, so i am afraid hes nvr gttng the full 1.5 i aim for.
yes brand new donated pen

 

ok, because the technique is different for the pen and the vial.

a couple of people recently have mentioned having bubbles with the relions.

I would concentrate on getting the dose accurate even if you're wasting some. in order to adjust the dose, you need to know what you're giving - so draw up more than you need and let it be wasted in order to get the dose accurate. if you have the chance to get other syringes, these http://www.americandiabeteswholesale.com/product/terumo-thinpro-insulin-syringe_5891_112.htm are only $13.09 for 100 and they are pretty good for not creating bubbles.

 

yes i notice going slower helps some. to get 1.5 we have to pull up abt 3. however. idk if adding air will change that since thats whats left minus air, but i will try it tonight
the air takes up a big portion of our dose, as i said.
with all these folks on here, i wonder if any1 has figured out a bttr alternative. evn wasting 1U a day is a lot. lots of ppl on here. maybe sum1 knows a trick?

 

oh it's a regular topic of conversation. it often comes down to the particular syringes. i've seen lots of suggestions for what works for people and i think you've been given all of them. you're probably not wasting a full unit. if you're drawing up 3u and there is a lot of air in the syringe, you're not wasting that much insulin.

there are 300 units in your pen, so if you could use every drop (which no one can) that's 150 two unit shots, or 75 days (2.5 months). you just have to do the best you can with it.

but as i said, the most important thing is the accuracy of the dose.

 

pam, i was just looking at Larry's spreadsheet.

i want to suggest a couple of things.

----go to the 2/19 date column, move your cursor to the left of it and click there. it should highlight the entire row horizontally.
then go up to the top of the ss where you see "File....Edit....View....Insert" Click on Insert and there click on "insert a row ABOVE"

In the row that appears above 2/19 (hopefully!), type in "start Lantus." Then while it is still highlighted, drop down a row from the "Insert" row and see the capital A. To the right of that is an icon that looks like a beaker half-full pouring out. Click there and you can fill the row you just created with a background color. Use any color that's not similar to the ones that mark blood sugar numbers.

The reason i'm suggesting that is because it's very important for people to see you've just begun using Lantus when they are helping you.

Another bit of advice - you're doing a great job getting preshot tests and mid-cycle daytime tests, but it can be extremely revealing to see what happens in the evening cycle. we encourage people that it's very, very important to get an evening cycle test. just check sweet Larry before you go to bed.

One reason for that is that there is a phenomenon called the "Dawn Phenomenon" whereby our bodies release hormones in the early morning hours that increase blood sugar. Those people and cats who aren't diabetic don't have much response to it, but diabetics will often have their highest blood sugar at the amps. Because Lantus dosing is based upon the low point that any particular dose gets the body to, it is vital to see if a kitty is dipping lower at night, when the hormones are least active in the body.

Many, many cats have their lowest numbers at night - and we wouldn't want to only look at the day cycle and decide there wasn't enough insulin going in, if in fact, the truth was that at night kitty is getting into low numbers.

I really like that you're varying the times of the daytime cycles. I like to explain the spreadsheet using a jigsaw puzzle metaphor. you don't have to have every piece to see the puzzle picture, but if you only have the edges (preshots) it's pretty impossible to be able to say with any accuracy what the picture is.

Another thought is that we save fattening & skinnying doses until you are just fine-tuning on an an almost-perfect dose. until then, stick with the 0.25u increases. we like to adjust the dose regularly so that a cat doesn't get accustomed to high numbers, so we follow the protocol for adjusting every 6-10 shots most of the time. If you had any evening cycle tests i'd encourage you to increase the dose to 1.75u to see if he can get into some better numbers. If it's possible for you to get a test tonight and tomorrow evening and you're still seeing yellows and pinks, i'd increase.

take a peek at the PDF about a paragraph down from the top called "Management of Diabetic Cats" on the Tight Regulation Protocol yellow starred sticky. It has some great information.

 

thanks! i will try to figure out how to do that later. it sounds hard. only bc i hae to read each direction look at the ss and go bk n forth.
and yes, i love the jigsaw approach, thats what i am using.
now i forgot what else u said...