"Diabetes for Beginners"

[ppp]

Overall, I found this very helpful, but 2 things contradict what I have often read elsewhere, which I would appreciate anybody weighing in on.
1) This does recommend manipulating the insulin container to 'mix' it. With Lantus, at least, I have read elsewhere that it does not need, and should not be manipulated... it is a clear solution.
2) on filling a syringe, it advises putting the syringe (already raised to the dosage level) into the liquid (upside down vial) and pushing the air into it, prior to filling. Elsewhere, I have read putting air into the insulin will hasten its degradation... better to dispense the air into the air in the bottle while it is upright; then turn the bottle upside down to fill.
???

 

[Tanya and Ducia]

Hi there,

This does recommend manipulating the insulin container to 'mix' it. With Lantus, at least, I have read elsewhere that it does not need, and should not be manipulated... it is a clear solution.

it is best not to manipulate the Lantus at all - keep it refrigerated on the back of a shelf , not in the door and best if you can store inside a container - I use glass - this way you'll minimize shacking/dropping.

on filling a syringe, it advises putting the syringe (already raised to the dosage level) into the liquid (upside down vial) and pushing the air into it, prior to filling.

wrong. Do not push air into the vial or a pen of Lantus.
Best thing to do is to open a syringe, run the plunger up and down several times, then press firmly to get all of the air out of it and in this "air out position" with your finger still firmly on the plunger - to insert the needle in to the liquid, release the plunger and then draw insulin in.
Take the syringe out and adjust your dose - it is good to draw a little bit more than you need so you can fine tune the dose.
Does it make any sense?
There ought to be many sites on the subject, I guess, but I trust no one as I do FDMB - the best knowledge ever.

 

[FurBabiesMama]

This does recommend manipulating the insulin container to 'mix' it. With Lantus, at least, I have read elsewhere that it does not need, and should not be manipulated... it is a clear solution.

It depends on the insulin. A vial of Prozinc is supposed to be gently rolled.

on filling a syringe, it advises putting the syringe (already raised to the dosage level) into the liquid (upside down vial) and pushing the air into it, prior to filling. Elsewhere, I have read putting air into the insulin will hasten its degradation... better to dispense the air into the air in the bottle while it is upright; then turn the bottle upside down to fill.

Every 'official' source I have found says that you should draw air into the syringe that is equal to the dose you will be giving. Then, with the vial still upright, stick the needle into the vial and push the air out, into the vial. Then, with the needle still in the vial, turn it upside down and pull your dose. (The reason is so as not to create a vacuum. Here is how one site put it: "The rubber stopper on the top of the vial does not let air through. When you're taking insulin out of the bottle, you need to put air into the vial to replace the insulin. If you don't do this, each time you draw out some insulin, you are building up a little bit of vacuum in the vial. After a while, it actually gets hard to pull the insulin out. And if you let go of the plunger, the vacuum in the bottle pulls the plunger back in.")

You mentioned you are using Lantus, so here is a link to the Lantus official site that gives those same instructions: https://www.lantus.com/using-lantus/using-a-vial-and-syringe They say:
Draw air into the syringe that is 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.
Leave the syringe in the vial and turn both upside down. Hold the syringe and vial firmly in one hand. 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.

 

[Nan & Amber (GA)]

Quick clarification on Lantus (it's confusing!): both Tanya and FurBabiesMama are correct, for different Lantus delivery systems.

1) Vial+syringe: do push air in (to prevent a vacuum)
2) Pen + syringe: don't push air in (stopper inside pen should move to compensate as insulin is drawn out, preventing a vacuum, and air will interfere with the mechanism).

As mentioned earlier, on the mixing question it depends on the type of insulin. Mixing is not recommended for Lantus, you are correct, but it is recommended for other insulins like ProZinc and Vetsulin.

 

[ppp]

Quick clarification on Lantus (it's confusing!): both Tanya and FurBabiesMama are correct, for different Lantus delivery systems.

1) Vial+syringe: do push air in (to prevent a vacuum)
2) Pen + syringe: don't push air in (stopper inside pen should move to compensate as insulin is drawn out, preventing a vacuum, and air will interfere with the mechanism).

As mentioned earlier, on the mixing question it depends on the type of insulin. Mixing is not recommended for Lantus, you are correct, but it is recommended for other insulins like ProZinc and Vetsulin.

Thanks much to you both for the input.

 

[ppp]

Hi there,

it is best not to manipulate the Lantus at all - keep it refrigerated on the back of a shelf , not in the door and best if you can store inside a container - I use glass - this way you'll minimize shacking/dropping.

wrong. Do not push air into the vial or a pen of Lantus.
Best thing to do is to open a syringe, run the plunger up and down several times, then press firmly to get all of the air out of it and in this "air out position" with your finger still firmly on the plunger - to insert the needle in to the liquid, release the plunger and then draw insulin in.
Take the syringe out and adjust your dose - it is good to draw a little bit more than you need so you can fine tune the dose.
Does it make any sense?
There ought to be many sites on the subject, I guess, but I trust no one as I do FDMB - the best knowledge ever.

Thanks for the reply, but you can see this does not agree with other, later, replies. (?)

 

[Squeaky and KT (GA)]

There are different types of insulin AND different 'containers' holding it. That can be confusing when learning.

INSULINS:

Vetsulin, NPH and ProZinc/PZI are all suspension insulins - they must be 'mixed' together by rolling it before drawing a dose

Lantus and Levemire are a different base - they don't need mixed.

CONTAINERS:

Vial - glass bottle with rubber seal in the cap where syringe is inserted. Standard 'chemistry' says equalize pressure inside and outside glass bottle thus the inserting equivalent air in before withdrawing the dose.

Pens - Lantus and Levemire both come in pen form. We don't use the pen needles, the same little rubber seal as the vial is on the end when the cap is removed. Pens work on negative pressure so equivalent air is not inserted.

Hopefully this helped a bit...

HUGS

 

[ppp]

This would be so good to be added to the "Diabetes for Beginners" section. I tried to go to the "webmaster" initially to ask about this, but my computer is not set up to get there (just don't have time to take care of everything right now).