Would it be okay to draw up the AM dose the night before as long as it is refrigerated?

Am not wanting to prefill all injections of Lantus, just have the AM dose ready before I go to bed the night before, around 6-7 hours or so. Am trying to find ways to make my early mornings easier and more accurate.

 

The makers of Lantus say not to pre-fill syringes, so it's probably not the best idea. Sorry, too, it really would make some situations easier, wouldn't it?!

 

I have read that on here, but have not found it on the manufacturers web site. It doesn't make any sense to me as the vial is not rolled or mixed in any way ant the syringe would not be either. It would be put in the same coffee cup that the vial is in also so the temp would stay the same. I may just call the makers.

 

That's a good idea, I wouldn't have thought of that! Please post their answer, I'm sure there are others who would be curious to know!

 

It seems to me that the biggest concern is the coating inside the syringe contaminating the Lantus. I think you probably wouldn't want to inject that into your kitty.

 

Am on hold with the company right now.

 

I don't think there's a problem drawing one syringe up the night before. I think the concern would be if you were drawing up doses to be used over a longer time frame. I seem to remember reading that Lantus got cloudy after about 3 days when pre-drawn and that raised questions as to its efficacy. Now that I think about it, I had to delay my girl's shot the other day due to a low pre-shot and used a syringe I had drawn up 5 hours earlier. Be interesting to hear what Sanofi-Aventis says.

 

Ok, I spoke to someone in their medical information department. First thing that they have to tell you is that their insulin is not approved for use in animals. Then I got a reading from a script with the answer that the company does not recommend prefilling a syringe for any length of time other than what it takes to draw it up, blah blah blah. She continued to say that if the consumer chooses to prefill a syringe for any length of time longer than drawing up and immediately giving the shot, the company cannot guarantee that it will work. She also said that the insulin is only effective for 28 days even if it is refrigerated and everyone here knows that is not true. After saying to her that I understood that she was reading from a script and her answers were all given in order to best protect her company from any liability that in reality it really is not wrong to prefill but don't expect the company to guarantee the effectiveness of the dose. She basically said that I was correct. The call was recorded of course so she is not going to say anything other than the company line. So my take on this is that if someone wants to do this, it is at your own risk, blah, blah, blah.

 

Thanks for getting the information and sharing it here!!!

 

Unfortunately, even if you are supposed to be talking to the medical information department, they are in reality just call centre employees with canned scripts. All the testing done with the human insulins, is done with human users in mind. It is actually common practice for insulin to be pre-drawn ahead of time in some clinical settings and while I doubt it's drawn up days in advance, it certainly is not used the second it's been drawn. Many hospitals have systems where drugs are dispensed for patients on a daily basis. So with that in mind, I'd think up to 24 hours might be safe.

 

Welcome!

 

Just so you know, I did not keep my pre-drawn syringe in the fridge but then I have a high dose cat who blows through insulin fast enough that I don't refrigerate the pen I am currently using because I use up a pen well before any 28 day unrefrigerated limitation. I use Levemir and now you got me wondering what they say about pre-drawing!

 

Actually, the person you talked to may not know it, but her "script" is based on a study which has already been done about the efficacy of insulin once opened which included testing prefilled syringes.
To view in it's entirety: http://care.diabetesjournals.org/content/26/9/2665.full.pdf

Sanofi-Adventis, the manufacturer of Lantus, concluded:

Summary
Aventis Pharmaceuticals does not recommend prefilling syringes with Lantus and storing for any period longer than needed for application. In addition BD states the following (9): "BD does not recommend that any of our syringes be prefilled more than a few minutes in advance of the injection. There are no conclusive studies to determine the safety or risks associated with this practice.”

I don't know what you're used to in Canada, but hospitals I'm familiar with here have mini-vials of insulin which are dispensed daily with other meds. I want to say they're 20 or 30 unit vials, but I can't remember. The nurse draws the insulin in the patient's room after testing blood sugar and immediately injects the patient.

It bothers me that a conclusion is being drawn and then accepted simply from an interpretation of a single phone call. We try to draw evidence based conclusions whenever possible on the FDMB... such as the document quoted above.

That said, the caregiver holds the syringe. Prefill at your own risk. Given that over time human diabetics are known to develop pockets under their skin of the lubricant used in disposable syringes... personally, I wouldn't rush to prefill a syringe unless it was absolutely necessary, but that's just me. I've never liked introducing/injecting anything into any my cats that I didn't have to...

 

They are just a phone call away.

 

Isn't that what I said Jill? I don't know what profession you are in Jill but I am in public civil service for a municipality and I do know that on the record, we are not allowed to deviate one word or phrase from a pre-approved response when asked about issues, even when we know what we are being asked about is perfectly safe. It's in order to protect the city from liability. I have no doubt that the person I spoke with was in medical information and was reading verbatim from the study results you posted. I also don't want to prefill a syringe for any longer than 6-8 hours, from the time I go to bed to the next am's shot at 5:00 am. I definitely would not hold FDMB or it's owners or moderators responsible for anything decision that I make regarding the care of my Shoes.

 

The problem is that there will be things that they read verbatim that are not needed to be followed 100%, and then there will be things that should be. There are many things on their cue cards that if not followed, could kill a person (or pet).

There is a difference between her answers on things we know to be different.
**Use of insulin in pets -> her answer is based on no one having tested or approved it
**Use past 28 days -> her answer was based on no one having tested it past 28 days
**Pre-drawing syringes -> her answer was based on someone having tested it, Now their testing doesn't show conclusive problems in short term usage, but they still concluded based on the testing to recommend not doing it. Lantus doesn't make more money off of us by saying not to prefill syringes, so their answer is likely based on best practices and not how make more $ off of us.

 

I don't think that the company's or FDMB answer is based on how to make money from me or any consumer. I think that in both the company and FDMB, it is based on the potential for liability not the money making potential. I think, however, that almost 100% of FDMB response is based on wanting the safety and best response for the cat, not money.

 

the only thing i can think of that would effect the insulin maybe is the coating inside the syringe for sitting that many hours. its explained better in this video

 

I think you completely misread my post. I didn't say that FDMB's answer were ever about money. I was talking about the response from the maker of Lantus, not about anyone on FDMB (as far as I know, no one is answering on the forums as a spokesperson for FDMB). The maker may have different motives in some of their answers - why only test their insulin for 28 days ?? Because they can sell more if you have to throw it after 28 days. My point was that the answer to that question (about predrawing syringes) doesn't seem to have any other motivation other than best practices, i.e. safety. The other answers definitely could have some other motivation, but they gain nothing by telling you to not prefill syringes. To me, that is a stronger no because they tested it vs a we-didn't-test-it-and-we-make-more-money-this-way no.

 

I probably did misread it. But I still think that Sanofi's motive is preventing potential liability, not altruistic. And I'm not against Big Pharma in any way, shape, or fashion. As a 5+ year breast cancer survivor, I can thank Big Pharma for this as well as keeping me healthy enough to work the entire time during my chemotherapy except for 3 days over 4 months.

 

What does this matter when those working independently from Sanofi found a problem with prefilling syringes?
Sanofi simply confirmed there was a problem prefilling syringes... after being invited to respond to the author's findings:

Editor’s comment:
The commentary by Dr. Grajower has such important clinical relevance that responses were invited from the three pharmaceutical companies that supply insulin in the U.S. and the American Diabetes Association, and all of these combined in this commentary. The commenting letter and individual responses were authored separately and are completely independent of each other.
http://care.diabetesjournals.org/content/26/9/2665.full.pdf


Strictly a personal thought... When there's a known issue, I can't imagine why anyone would want to take a chance prefilling a syringe (except for certain/extreme circumstances) when it takes less than 5 minutes to do it. With a little practice, many caregivers will draw insulin in less than a minute.

 

It matters to me because I am just looking for a way to do this easier and better for me because of the micro doses that I have had to measure and I am not at my best at 5:00 am, especially when I am not getting enough sleep as it is. That's why I even asked the question. Everyone else has escalated this into what it has become. I simply relayed my conversation with the person at Sanofi and said the same thing that you said and it's just morphed into this. I am so ready to end the thread.

 

I see a dose increase has already been suggested in the Lantus & Levemir ISG... that'll get you on a line. If you ask, they can also help by offering suggestions as to when it's the most beneficial to test at night... given what's happening with Shoes on any given day. Looks to me like PM preshot and before bed tests is all you need at night for the moment. An occasional +10 or +11 in either the AM or PM cycle would be nice. Seriously, with Shoes' numbers as high as they are right now, you should be able to get a good night's sleep...

 

I actually have had 2 nights with longer sleep this week. I get up daily, M - Sunday at 4:50 a.m. because I have to be at work at 7:30 a.m. and work until 4:30 p.m. M-F. I get up that early so that I can ensure that I always get a +2 before leaving my house for work given Shoes' penchant for steep and quick dives. I am increasing his dose tomorrow am and hoping that the drop doesn't start until the pm cycle. I can only get the later checks during the day on the weekends. Have not gotten any late pm checks for the reasons you mentioned and because I just couldn't wake up when the two alarms that I set went off.

 

Best information I can find is this https://www.dhs.wisconsin.gov/publications/p0/p00738.pdf which seems to indicate that Lantus MAY be OK to be pre-filled up to 2 days in advance. As you can see from the chart, most insulins appear to be fine for pre-filling if they're not a mixture of insulin but including Lantus is not (or not for long). Lantus, if I remember correctly is slightly acidic which may be the reason for this - it might be more likely to absorb the syringe lubricant because of the acidity. Ultimately, it's your choice - that chart would seem to indicate that keeping a syringe pre-filled overnight with Lantus is probably not an issue though the manufacturer recommends against it. I don't plan to get into an argument about this either way - just figured the information might be useful for you in making a decision.

 

Thank you.

 

I wouldn't be paranoid to pre-fill it for a couple of hours. Try it. If you suddenly lose control for no reason, and the only thing that has changed was that you started pre-filling the syringes, then you'll know not to do it again. That's called research.

And honestly, as someone who is mere months away from entry into the healthcare industry, someone who has family and several friends all in the healthcare industry, and someone who has dated 2 men who are in the healthcare industry...I am here to tell you that many times, insulin is indeed pre-drawn into a syringe unless it's a mixed dose. Sometimes mini-vials are used and drawn from immediately and sometimes a syringe is pulled out of the refrigerator and given. Usually only nursing homes do this or nurses in home health settings. It is highly frowned upon, but not because it interferes with the action of the insulin, but because it's SO easy to mix things up, not give a full dose, make a huge med error, etc and risk losing your license just to save a few minutes. It's considered sloppy and lazy but it is done during really busy med passes in some clinical settings. That's the reality of it. If your cat were mine and this would make a huge difference in my life, I would at least try it.

 

I am lucky enough to have a job with incredible flexibility. Sometimes I accept shifts that start at 6pm and don't let out until well into the night. I cannot give Diego his shot at 5:30, and midnight is way too late. Although my friends and family are willing to give him his shot, it doesn't mean I'm trusting of them not to make a dosage error. When it comes down to me pre-filling the syringe for an upcoming evening shot, vs a potential deadly med error from a well-meaning friend, I'm pre-filling that syringe. I'll pre-fill it every time.