? 11/30 Rupert amps=242,+6=172,pmps=366,+3=473

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Lynn & Rupert

Lynn & Rupert

Member Since 2015
Not sure it is a full 3.25 dose, I think there was an air bubble. :( Really having a hard time hitting that .25 mark, have wasted several doses. I even use a magnifying glass, it's not helping, it's more my hand doesn't have enough control. I either get too much and when I try to squirt out the extra, I end up with too little. I dump that dose and try again, with the same results. Any tips on how to work that plunger better?
 
Hi I'm new too, i've had the same problem, seems some syringes stick more than others.
I don't know if this is right or not, but when I end up with too little I don't dump the dose, I just insert draw a bit more and try again. (I'm sure I'll be corrected by experienced members if that's wrong)

I've found the following to help with air bubble
1) depress plunger on empty syringe firmly to expel all air possible
2) hold pen/ vial vertically when drawing from below
4) draw more than you need, don't try and hit the exact dose, eg I need to draw 2, so typically ibdraw about 3-3.5
4) tap syringe gently whilst holding needle facing up so bubble rises to needle end
4) keeping the needle pointing up depress plunger to your required dose, squirting the excess out the top

I think there is also a gadget you can get to help with this, seem to remrmber someone mentioning in another thread, perhaps theres a link in the sticjies?? Sorry not sure what its called

Hope this helps:):cat::):cat:
 
Yes, I am pretty sure the lantus and Lev pen are the same. The only thing I read was not to is not to reinsert syringe, or dispel dose back into pen, since it might contaminate the insulin or get an air bubble in it. I hope I can do what you said and draw a little more, that way I wouldn't waste so many doses! I usually draw more than I need, but when I try to dispel some to correct dose, I get it too short. That starts the whole process over again! :banghead: lol Thanks for the helpful tips, I will use them for sure! :kiss:
 
That's right, I'd read not to re insert syringe after its been used to administer dose, I am careful not to press down on plunger so as not to squirt insulin back in.

TBH by drawing a bit more I rarely need to reinsert to top up. But would be helpful if an experienced caregiver would set us straight.

So many things to remember and take into account!!!! I'm sure we'll get the hang of it soon enough.

Gill
 
Some syringes are worse than others for bubbles and stickiness. We only have the BD's available here, so that's what I use. Make sure you work the plunger up and down a few times when you first start, to lubricate the path, before inserting into the pen. I prefer pen/cartridge to vial, so I'd stick with that. I usually draw out an extra .5 or 1 U to balance out any bubbles. After removing the syringe from the cartridge, I pull down the plunger so there is a little bit of air on top, Then I tap and try to get rid of the bubbles. It seems that bubbles seek other bubbles so they merge together. Then I push the plunger if I need to make a big change, but I twist it if I'm making small changes at a time. You should be able to twist out one drop at a time.

If you look at the Where Can I Find note, there are a couple of posts on the bottom that might help. One is Dosing With Calipers and the other is Testing and Shooting Tips. I find that the syringe markings are rather inconsistent from syringe to syringe, so I used calipers and a magnifying glass to help me get consistent dosing, in spite of the syringe markings.
 
Wendy&Neko said:
Some syringes are worse than others for bubbles and stickiness. We only have the BD's available here, so that's what I use. Make sure you work the plunger up and down a few times when you first start, to lubricate the path, before inserting into the pen. I prefer pen/cartridge to vial, so I'd stick with that. I usually draw out an extra .5 or 1 U to balance out any bubbles. After removing the syringe from the cartridge, I pull down the plunger so there is a little bit of air on top, Then I tap and try to get rid of the bubbles. It seems that bubbles seek other bubbles so they merge together. Then I push the plunger if I need to make a big change, but I twist it if I'm making small changes at a time. You should be able to twist out one drop at a time.

If you look at the Where Can I Find note, there are a couple of posts on the bottom that might help. One is Dosing With Calipers and the other is Testing and Shooting Tips. I find that the syringe markings are rather inconsistent from syringe to syringe, so I used calipers and a magnifying glass to help me get consistent dosing, in spite of the syringe markings.
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I use the bd as well, I'm going to try moving the plunger up and down a few times as you suggest, think it's sounds like a great idea to get the plunger lubricated, and moving more smoothly, as its when it sticks that I tend to ' overshoot ' and have to end up refilling.

Would you be so kind as to clarify(I've cut and pasted from the notes on proper handling notes below)

Is it OK if, when we overfill and then try to get rid of the excess by squirting we accidentally squirt too much and end up with less than we need, to reinsert syringe and draw some more? (As long as we are not squirting insulin or air into the pen)

The way I read the note is that the silicone coating inside the syringe that can contaminate the insulin, so hopefully I haven't messed up my lantus pen :nailbiting:
:nailbiting::nailbiting:. At any rate I shall keep inspecting my insulin for any sign of floaties.


PROPER HANDLING OF LANTUS and LEVEMIR

  • Lantus and Levemir should be inspected visually prior to administration and should be used only if it appears clear and colorless.
  • Never shake or roll your vial, cartridge, or pen.
  • In-use and unopened Lantus and Levemir should be stored in the refrigerator between 36 to 46 degrees F (2 to 8 degrees C).
    Be careful your refrigerator is not so cold that the insulin freezes. Do NOT use Lantus or Levemir if it has been frozen.
  • Never reuse syringes. You'll run the risk of contaminating the whole vial/cartridge/pen.
  • 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 (this is probably what makes "floaties", it forms a white precipitate). Better to waste a drop than ruin whole vial, cartridge, or pen.
 
Sharon14 said:
@woodsywife found this. Looks interesting, it's for use with a vial, but she makes it work with the pens. I may pick one up myself.

http://www.bd.com/us/diabetes/page.aspx?cat=7002&id=7420
Click to expand...

Once you draw up your insulin just hold this on the syringe barrel, it's grooved for syringes. Then tweak your dose.

For whole units I'm using up the relion syringes I have. For the quarter and half units doses I use monoject syringes. They are so much better to see.
 
Thanks for all the great info everyone! I have much to read and investigate tonight. Was out buying kitty supplies today, my purse is much lighter now. :rolleyes:

I have been very paranoid about contaminating my insulin, so have wasted several doses and I hate to waste my liquid gold! :banghead:
 
GTS said:
I use the bd as well, I'm going to try moving the plunger up and down a few times as you suggest, think it's sounds like a great idea to get the plunger lubricated, and moving more smoothly, as its when it sticks that I tend to ' overshoot ' and have to end up refilling.

Would you be so kind as to clarify(I've cut and pasted from the notes on proper handling notes below)

Is it OK if, when we overfill and then try to get rid of the excess by squirting we accidentally squirt too much and end up with less than we need, to reinsert syringe and draw some more? (As long as we are not squirting insulin or air into the pen)

The way I read the note is that the silicone coating inside the syringe that can contaminate the insulin, so hopefully I haven't messed up my lantus pen :nailbiting:
:nailbiting::nailbiting:. At any rate I shall keep inspecting my insulin for any sign of floaties.


PROPER HANDLING OF LANTUS and LEVEMIR

  • Lantus and Levemir should be inspected visually prior to administration and should be used only if it appears clear and colorless.
  • Never shake or roll your vial, cartridge, or pen.
  • In-use and unopened Lantus and Levemir should be stored in the refrigerator between 36 to 46 degrees F (2 to 8 degrees C).
    Be careful your refrigerator is not so cold that the insulin freezes. Do NOT use Lantus or Levemir if it has been frozen.
  • Never reuse syringes. You'll run the risk of contaminating the whole vial/cartridge/pen.
  • 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 (this is probably what makes "floaties", it forms a white precipitate). Better to waste a drop than ruin whole vial, cartridge, or pen.
Click to expand...
That is what I have been afraid of! I do move the barrel up and down first, but still having trouble getting that micro dose. If you don't see any air bubbles or floaties in your pen, I am sure it is ok.
 
Lynn & Rupert said:
That is what I have been afraid of! I do move the barrel up and down first, but still having trouble getting that micro dose. If you don't see any air bubbles or floaties in your pen, I am sure it is ok.
Click to expand...
I hope so, it's expensive stuff. I'll keep checking it for floaties.
 
In response to your comment/question from yesterday:
Lynn & Rupert said:
I am following SLGS for now Julie, I want to really understand how Lev works and how Rupert responds to it. I plan on switching to TR soon. Just want to get a little more experience first! Would it be okay to increase the dose to 3.5U soon? Or should I wait a few days? I don't want to rush things, but he is getting high numbers at amps and pmps and nadir is well above 100. Or am I rushing it? I won't be around as much tomorrow to test, but will be the next day. Any thoughts? Thanks!
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Would you add SLGS to your signature line please? It helps us help you.

With SLGS you hold the dose 7 days - then re-evaluate. I understand wanting to understand your insulin - that makes sense. Just want you to also understand that the best chances for remission come within the first year after diagnosis, and we know that the sooner the cat's blood sugar gets into normal numbers, the better the chance that the cat's pancreas might heal and begin putting out insulin again. Not every cat will go into remission, but for those who may be able to heal, sooner into normal numbers is better. That's one of the benefits of Tight Reg - you're adjusting the dose as often as every 3 days, depending on the numbers.

I'm not twisting your arm - it's ok to go with whichever you want, but if no one points this out to you, you wouldn't have any way to know. I wouldn't try to combine them. At this point with SLGS you'll hold the dose until next Sunday morning, and then increase by 0.25u. It looks like this dose is getting Rupert into upper blue numbers.

from the SLGS sticky:
Hold the dose for at least a week
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L) if kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!
​
Just to give you a comparison, if you were using the guidelines from Tight Regulation Protocol, assuming the cycles stay about the same, you would increase the dose by 0.25u on Wednesday morning.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
The link that Wendy mentioned is right here - likely it has some ideas that will help you with testing and shooting.

Yes, if you need more insulin it's ok to re-insert the needle into your insulin and withdraw a little more. The potential contamination would be from the lubricant inside the syringe, not from the needle itself. You might find something helpful in this video we did a few years ago on how to draw up your dose from either the pen or the vial.
 
If the needle hasn't been anywhere except in the insulin and in the air, there isn't any possibility of contamination. I don't know why it wouldn't be ok.
 
julie & punkin (ga) said:
If the needle hasn't been anywhere except in the insulin and in the air, there isn't any possibility of contamination. I don't know why it wouldn't be ok.
Click to expand...
Maybe. It's possible if the needle wasn't set down for a second or recapped or coughed on or any of the many things that could happen to the syringe when drawing/re-drawing a dose. You said it with such certainty that I thought the procedure may have changed.
 
Lynn & Rupert said:
I usually draw more than I need, but when I try to dispel some to correct dose, I get it too short.
Click to expand...

She's describing drawing up her dose, trying to get out bubbles and ending up short.

Jill, are you saying that you would discard a needle/syringe in that situation and use a new syringe to start over? With what you are describing, we wouldn't be able to put the needle in the insulin in the first place because it might have touched a germ in the air after the cap was removed.

Lynn, I trust you can figure out that you don't want to touch the needle against anything, cough or sneeze on it, etc. if you're going to put it back in your insulin.
 
julie & punkin (ga) said:
Jill, are you saying that you would discard a needle/syringe in that situation and use a new syringe to start over?
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Sure have... and so have many others.
I'm really surprised to hear you'd re-insert a needle back into an insulin vial or pen.

julie & punkin (ga) said:
With what you are describing, we wouldn't be able to put the needle in the insulin in the first place because it might have touched a germ in the air after the cap was removed.
Click to expand...
Kind of a gross exaggeration don't you think? :)

Given the cost of Lantus and Levemir, I would think one would want to do what ever they could to make it last as long as possible. I did, but Alex was on low doses of insulin. A single pen could and did last for months when taken care of properly.
 
Lynn & Rupert said:
Not sure it is a full 3.25 dose, I think there was an air bubble. :( Really having a hard time hitting that .25 mark, have wasted several doses. I even use a magnifying glass, it's not helping, it's more my hand doesn't have enough control. I either get too much and when I try to squirt out the extra, I end up with too little. I dump that dose and try again, with the same results. Any tips on how to work that plunger better?
Click to expand...
There is a video on this in the "where do I find" it is awesome--I was doing the same thing and I have not thrown 1 syringe away side watching the video-
It is in the L+L section with all the info on how to store/handle your lantus- I can't believe how much easier and more accurate I get the dose now- good luck!
 
Thanks again for all the great info, I will take a look at the video and read all that was suggested here, probably will print it too. I am very careful not to touch the needle to anything when inserting into the pen, I will continue to be careful. :)

Julie, I did print all the info about SLGS method and the TR method, guess I was still trying to decide which to go with. Someone mentioned that I test enough to do TR and I am feeling braver now. I am going to give it a go. Rupert has been having higher numbers for 4 months, just couldn't get him regulated, so the longer I wait, the less chance he has of remission. I know he might never go into remission, but I would be happy to at least have him better regulated. I don't think these swings make him feel very good. Thanks for all your help!
 
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