There is much talk of contamination by syringe lubricants - are there studies to support this?

[Bob & Simon(GA) & Arthur]

I found a video posted by LizzieInTexas in the thread at http://www.felinediabetes.com/FDMB/threads/purchasing-lantus-best-prices.176546/ which shows how to load a syringe with insulin.

Is it correct, are the explanations given for various actions considered correct?

Among several items which really caught my attention on is when see says that the pen she is using for the demo has a bubble in it and so "it is no good." She says she's not sure why she kept it but that she is using it for the video because the bubble has made the insulin "no good" and thus an be used for the video, I assume so that insulin is not waste from a pen without a bubble. Is that considered correct?

Another - she does not inject air equal to the dose to be withdrawn when using a pen but does so when using a vial. She says that she does it to a vial to prevent a "negative vacuum" in the vial.

She says not to inject anything into the "liquid.

Are all of these things considered correct and are the way things should be done or is this video an exception and there are other instructions, whether on video or not, that give the methods in a different way with explanations provided as needed?

Does this video represent the current "wisdom" regarding preparing an insulin dose in a syringe?

Bob & Simon(GA) & Arthur

 

[Bron and Sheba (GA)]

@LizzieInTexas is an experienced member so I am sure she will be happy to explain it to you.
Are you using lantus? here is a link to drawing up Lantus. I suggest reading all the yellow stickies at the top of this page if you are using Lantus...... there is a lot of information here
www.felinediabetes.com/FDMB/threads/insulin-care-syringe-info-proper-handling-drawing-fine-dosing.151/

 

[Erin & Scott]

From what I have read, it is correct that you need to inject air into a vial, but not into a pen. I didn’t know anything about a bubble in the pen rendering it “no good”; if that’s the case, I’ve been injecting bad insulin from the start. There’s actually a large bubble in my Lantus pen. I think that may be a concern if you use the needles made to work with the pens, but not so much when you’re drawing the insulin out with a syringe.

 

[JoyBee&Ravan]

not to inject anything into the "liquid.

I've been here a year now. I cannot afford to squirt insulin out into a napkin if I draw too much. I follow the advice of the Experienced people here 99% of the time,but when it comes to wasting "Anything" I cannot comply.
If I do draw too much insulin into the syringe I squirt it back into the pen. & yes there are bubbles in the insulin.( if the bubbles bother you,you can draw them out with the syringe & squirt the insulin & bubbles into a napkin.
I just deal with it. So far it hasn't affected the insulin. I use it to the last drop. My vet told me from the start to use it to the last drop.
My Ravan uses Levemir & gets about 1 unit or a bit more if he starts going up.The pen will last me nearly 4 months. I see no difference in my cats BG when I start a new pen So I have to assume the insulin is still working just fine.

I do what I can to take care of Ravan. You need to decide for yourself what you feel comfortable doing. Over a year I've gotten pretty good at drawing the correct amount

I also do a lot of reading & research on veterinary web sites. And I ask a LOT of questions.

Good Luck to you on your journey! There's a lot to learn but the more you know the easier it will be.

 

[MrWorfMen's Mom]

the pen she is using for the demo has a bubble in it and so "it is no good."

The comment that the pen is "no good" could be referring to 2 situations. First if you get enough air into the cartridge it will eventually become difficult if not impossible to draw insulin out of the pen. Second, if you were using the pen with the pen needles, it would have an effect of the accuracy of the doses being dispensed according to the pen setting. The insulin itself is not damaged by the air......otherwise the larger vials would be rendered less effective because air must be injected into the vial to avoid creating a vacuum (not a negative one) which would likewise cause difficulty drawing the insulin.

It is not recommended to be drawing insulin and injecting it back into the vial/pen as there could potentially be some cross contamination that might render the insulin less effective or to not last as long as possible but the chances of that as long as a clean technique is used are probably slim.

Generally speaking, that video does represent proper technique for both the pen and vial but admittedly, some of the commentary might be lacking in some detail/explanation.

 

[flyingduster]

#1: pens often have a bubble in them from my experience. This has never been a bad thing that I know of and IMO would be no difference to a vial that has a bubble of air at the top too???? It COULD be an issue if using the pen device perhaps, but with syringes I wouldn’t even think twice about a bubble in my pen cartridge.

#2 this is totally correct. You do not need to add air to the pen cartridge but you do need to for the vial. The reason being that pens have a large plunger/stopper that will shift down inside the cartridge as you draw out the insulin. So it will never form a total vacuum and it will just keep moving along fine. Adding air in to the pen cartridge may weaken the seals of it as it’s designed to just move down. But in a vial, it’s totally sealed without that plunger effect and so if you just suck and suck and suck the insulin out without adding air to compensate, you will create a vacuum and may weaken the seals in the opposite direction!

-#3 I have no idea why it would matter to inject the air through the insulin or direct into the air pocket though. I’ve never heard of that one?? You aren’t putting any additional contamination in there by adding it upside down or the right way up??



I have definitely heard of not injecting the liquid back in to the vial/cartridge if you draw up too much, but that makes more sense as the liquid may have taken up any contaminants from the syringe. But in saying that when I’m narrowing down my exact dose, I sometimes will shift the syringe the teeniest bit back towards the cartridge if I’ve gone too far. I’m talking less than half the width of the lines on the syringes though!

 

[LizzieInTexas]

Among several items which really caught my attention on is when see says that the pen she is using for the demo has a bubble in it and so "it is no good."

She states that drawn insulin had been pulled back into the pen and was contaminated with the lubricant and that was why it was "no good". There is no issue with bubbles in pens. It has happened to several here.

Full confession, the first vial I used (cost $300) I didn't know that you shouldn't push extra drawn insulin back into the vial/pen and so for about the first 3-4 months did so.

How much it contaminates the insulin I have no idea but Gizmo was never well regulated and had so many other complications that it would have been difficult to determine anyway.

IMO and experience, if the insulin is stored correctly and you do your best not push or allow insulin back into the vial/pen the issues with BG usually isn't insulin "gone bad." There is some other factor.

Insulin will lose potency gradually. It isn't something that happens overnight. Also, the general concession now is freezing the insulin (shipping during cold weather) can affect it more than heat.

Visually inspect the insulin when drawing. Look for small flecks and cloudiness, if seen, time to replace. I used a vial for 6 months, using about 3/4 of the vial and then replaced.

In summary/best practice, try and not do it, but if it happens, I wouldn't stress too much.

 

[LizzieInTexas]

Another - she does not inject air equal to the dose to be withdrawn when using a pen but does so when using a vial. She says that she does it to a vial to prevent a "negative vacuum" in the vial.

I never had to inject air into either the pen or vial of insulin. Gizmo got other injunctions and I did have to add air to those vials because of negative pressure but never had any issue with insulin.

 

[Sienne and Gabby (GA)]

The information on the issue with lubricants in syringes is in this post on pre-filling syringes. It's in the sticky on insulin care and syringe info.

All of the pens work on a pressure gradient. If you've been using a pen, you'll notice that there's a plunger that moves down the pen as you draw off insulin. This keeps air out of the pen and makes it easier to draw out what you need (or for humans, to inject the desired amount directly from the pen). Injecting air back into a pen can cause a problem. However, it does happen and there may be a bubble in a pen. What I always did was use a clean syringe and draw out any air. I never discarded a pen that had a bubble unless there was some other issue with the insulin.

The issue of injecting air into a vial is not a problem. As soon as you start using a vial, there is air in the container. The only concern I could see is that to some degree, if you are injecting air into vial, you are usually injecting air into the insulin and you may be agitating the insulin. While Lantus is less fragile than we once thought, I would err on the side of not mixing the pot, so to speak.