? 12/15 How to draw insulin from a disposable pen using a syringe?

Bandit's Mom

Bandit's Mom

Member Since 2019
Hi, I've looked for videos on YouTube for how to draw insulin from a pre-filled insulin pen (disposable) using a syringe but I haven't found any.

Is the method the same as drawing insulin from a vial? Inject air equal to number of units then draw the required number of units of insulin with vial/pen upside down?

Any links to videos would be greatly appreciated.

Thanks!
Bhooma
 
Hi!! Same way as would draw from a vial except with the pen you don’t need to inject the air so I’ve read with the Lantus pen. I mistakenly did inject air. Don’t shake the pen or roll it as it’s not needed. Hope this helps!
 
Hey there. If some air bubbles get into the pen they will eventually dissipate. I have accidentally gotten air into one of mine and it did go away.

There used to be a wonderful video in the stickie : Insulin care and Syringe Info. It seems to have been removed and replaced with manufacture info. Do read that stickie as there is a lot of good info in it .

You would use your syringe and draw from the pen the same way you would from a vial. Remember to not shot any overage insulin back into the pen as the lubricant in the syringes can cause the insulin to become contaminated and breaks down the efficacy of the insulin.
 
You do not want to inject air into the pen. The way the pens work involve a mechanism where a "plunger" moves down the pen as you draw off the insulin so the insulin is always in contact with the rubber gasket. In a sense, the insulin is under pressure. You don't want to add extra pressure by injecting air.
 
What Bobbie was referring to is that most of us draw off a bit more insulin than we need to inject. So, there's more in the syringe than needed. Don't adjust the dose by injecting the excess insulin back into the pen. Rather, withdraw the syringe and then adjust to the correct dose.

I've used Lantus to pretty much the last drop in the pen and never had a problem with the needle hitting the black plunger. I suspect that the pens are designed for the needle tips so the problem of banging into the plunger is avoided regardless of whether you're using a syringe or a needle tip (which we don't recommend since you can't adjust the dose in small increments).
 
Bandit's Mom said:
Thanks @Sienne and Gabby (GA) . I did notice the plunger going lower and lower as I use the pen. At some point wouldn't the needle hit the plunger when one is at the last few units of the pen?

@Bobbie And Bubba , I didn't get what you meant about overage insulin. Could you please explain?
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I see Sienne explained about the excess insulin not being shot back into the pen. You will just have to express it out into the air ( like you see doctors and nurses do). Pretty soon you will get very good at drawing up almost exactly what you need and wasting less. Remember before drawing up insulin to take the syringe plunger up and down the barrel a few times. This spreads the lubricant around helping the plunger to glide smoothly inside the barrel which helps in drawing the insulin and injecting it.
 
@Sienne and Gabby (GA) , @Bobbie And Bubba - one last (stupid?) question on the subject. i am using a disposable, pre-filled insulin pen right now . when i'm done with this, i could just buy the insulin cartridges that one gets for re-usable pens and draw the insulin using the syringe from them, right? or do i need to buy a reusable pen too - to be able to do so?

basically, will i need a pen to draw the insulin from the pen cartridge?
 
Are you using a Solostar pen? If so, then no, you can't buy the cartridges and replace them in the pen. Cartridges are only available outside of the US. If you get the glass cartridges, you can use them exactly the same way.

My biggest concern is that they are small. You would have no protection for them from breakage. I'm tagging @Wendy&Neko who has more experience with the cartridges than I do. (They were available in the US when Lantus pens first came on the market and I used them for a while. It's been a long time, though.)
 
Sienne and Gabby (GA) said:
Are you using a Solostar pen? If so, then no, you can't buy the cartridges and replace them in the pen. Cartridges are only available outside of the US. If you get the glass cartridges, you can use them exactly the same way.

My biggest concern is that they are small. You would have no protection for them from breakage. I'm tagging @Wendy&Neko who has more experience with the cartridges than I do. (They were available in the US when Lantus pens first came on the market and I used them for a while. It's been a long time, though.)
Click to expand...

I am in India and we get reusable insulin glargine pens (All-star, Insupen Ez etc). So you buy the pen and there are cartridges (insulin glargine) that are available for these pens. So you can use the same pen several times by just changing the cartridges.

We also get disposable pre-filled insulin pens which have to be thrown after they are used.

So, I could buy just the cartridges without a pen if I could extract insulin from these cartridges with a syringe.

However, if it is safer/easier to extract insulin from the cartridge when it is loaded in the pen, I will buy both pen and cartridge.
 
Bobbie And Bubba said:
You would use your syringe and draw from the pen the same way you would from a vial. Remember to not shot any overage insulin back into the pen as the lubricant in the syringes can cause the insulin to become contaminated and breaks down the efficacy of the insulin.
Click to expand...

This is all pretty new to me as we only started using syringes with the pen a few months ago.

With regards to not shooting overage back into pen - I cannot find anywhere on the internet that says not to do this. Instructions on how to draw insulin from vials actually direct you to shoot insulin back into vial if you get air bubbles or something. Is this something specific to the pen? Here is what I found from Lantus with regards to injecting insulin with a vial and syringe and it directs you to shoot back into vial when there are air bubbles.

I have also been shooting equal units of air into the pen before drawing as I assumed it would be the same as a vial. What is the risk with that?
 
The risk is always contamination. I've read several times that the lubricant inside the syringe can be harmful to Lantus - that's why you shouldn't prefill syringes or inject insulin back into the cartridge. There's some evidence to support this. To me, it's the same kind of thing with shooting air into the cartridge, and since the cartridges are designed with a plunger that moves as the insulin is withdrawn, there's no reason to do it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362151/
 
The term "pre-filled" may mean something different here. We have had some vets buy a quantity of Lantus (e.g., a vial) and re-package the Lantus into another container. If that is what happens with a "pre-filled" pen, please do not use this type of packaging. You want something that has come directly from the manufacturer. If the cartridges fit into any sort of pen, that's great. You'll still be using a syringe so no problem.

@Marc & Jen -- I don't want to hijack Bandit's thread. As Camille pointed out, one issue that's related to injecting back into any container is contamination. The other issue is that the Lantus pens have a different delivery system than a vial. With the pens, as you draw off insulin, there is a plunger that moves down the pen so there is a constant pressure that pushes the insulin against the rubber gasket. If you inject air into the pen, you are increasing the pressure. While it may be unlikely, there is always the risk that the added pressure from adding air could cause the glass cartridge to eiither become more fragile and/or break.
 
Jumping in this because I was about to ask this same question, so if you need 1 unit but draw up 2 you shouldn't inject back into the pen but just squirt it out into the air and call it a loss?
 
I am in Canada where my choice is vial, pens or cartridge. I started out using a Lantus vial, but then switched to cartridges based on recommendation of the pharmacist. She had a lot of kitty patients on Lantus. In five years, I never had a problem breaking a cartridge. I liked the small size, I could hold a cartridge and the syringe in the same hand quite easily. Cartridges are also a lot less waste, and a bit cheaper to buy.
 
Sienne and Gabby (GA) said:
The term "pre-filled" may mean something different here. We have had some vets buy a quantity of Lantus (e.g., a vial) and re-package the Lantus into another container. If that is what happens with a "pre-filled" pen, please do not use this type of packaging. You want something that has come directly from the manufacturer. If the cartridges fit into any sort of pen, that's great. You'll still be using a syringe so no problem.

@Marc & Jen -- I don't want to hijack Bandit's thread. As Camille pointed out, one issue that's related to injecting back into any container is contamination. The other issue is that the Lantus pens have a different delivery system than a vial. With the pens, as you draw off insulin, there is a plunger that moves down the pen so there is a constant pressure that pushes the insulin against the rubber gasket. If you inject air into the pen, you are increasing the pressure. While it may be unlikely, there is always the risk that the added pressure from adding air could cause the glass cartridge to eiither become more fragile and/or break.
Click to expand...

when i say "pre-filled" i mean a disposable insulin pen (like solostar) from the manufacturer that comes with insulin in it. it has to be thrown away once fully used/expired. the other option is re-usable pens/device (like allstar) for which one can buy cartridges of insulin that are sold separately from the pen/device. the pen/device can be used several times by changing the insulin cartridges. all of these are sold by the manufacturer.
 
Wendy&Neko said:
I am in Canada where my choice is vial, pens or cartridge. I started out using a Lantus vial, but then switched to cartridges based on recommendation of the pharmacist. She had a lot of kitty patients on Lantus. In five years, I never had a problem breaking a cartridge. I liked the small size, I could hold a cartridge and the syringe in the same hand quite easily. Cartridges are also a lot less waste, and a bit cheaper to buy.
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so i don't need the pen into which the cartridge goes in order for me to extract insulin from the cartridge using a syringe?
 
@Bandit's Mom
Rather than hijack another thread...

hi, i am sorry to hijack this thread, but i didn't realize that feeding times were linked to onset and nadirs for the kitty? does one need to feed at particular times?
my bandit is still on kibble and a graze eater, i try to spread out her meals across several installments through the day (and night). i read somewhere that this is better for BG regulation and avoids food spikes. am i doing the wrong thing?

(i do take away the food 2-3 hours before a shot so that the pre-shot reading is not influenced by food and i do give her food with the shot.)
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With respect to feeding at spedific times -- yes and no. You need to feed your cat at shot time. In most cases, you want to try to not feed past nadir since there is less insulin available to offset the effect of food. Some cats benefit from when you feed them (i.e., feeding more early in the cycle if your cat has an early nadir and tends to have numbers that drop fast and hard). My suggestion for Bandit is to first, transition to a low carb, canned food diet. (I don't know what dry food you're using but in general, canned food is better due to the high moisture content.) Spreading out the food is just fine. You do not want to have food available within the 2 hours prior to shot time, though.
 
The Sticky Note on insulin care and syringe info has a picture of taking insulin from a cartridge with a syringe. The picture is a Levemir cartridge, but the only difference is the colour of the cartridge. I have used both Lantus and Lev cartridges, no difference.
 
Sienne and Gabby (GA) said:
@Bandit's Mom
Rather than hijack another thread...



With respect to feeding at spedific times -- yes and no. You need to feed your cat at shot time. In most cases, you want to try to not feed past nadir since there is less insulin available to offset the effect of food. Some cats benefit from when you feed them (i.e., feeding more early in the cycle if your cat has an early nadir and tends to have numbers that drop fast and hard). My suggestion for Bandit is to first, transition to a low carb, canned food diet. (I don't know what dry food you're using but in general, canned food is better due to the high moisture content.) Spreading out the food is just fine. You do not want to have food available within the 2 hours prior to shot time, though.
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  1. I live in India and cat food options are practically non-existent (only Whiskas and Royal Canin and a couple of other unknown SE Asian brands). Wet food also has carbs of 10-25%! Ordering from abroad is exorbitantly expensive and unsustainable.

  2. There is no caloric information on cat food labels here and manufacturers have just ignored my emails. Using the guaranteed analysis info available, I have calculated that wet food here is not as calorie dense as the ones available in the US. Bandit would need to eat nearly 1.1 lbs of wet food in day to get around 225 kcals! The wet food is basically largely water!

  3. I'm vegetarian and have no experience with buying/cooking meat. I guess at some point, I am going to have to go down that path.

  4. Bandit has lost a lot of weight and is now 9.5 lbs. At her heaviest she was only 11.5 lbs (never overweight and not much of an eater). She needs to gain back the 2 lbs she has lost.

  5. She is still unregulated and highly symptomatic. She's hungry all the time. Her BG levels are still over 350 at pre-shot and she is still showing high flat BG curves.

  6. We've only just started insulin (3 weeks back, SLGS) and I had to wait for 1/2 unit syringes to arrive from the US to up her dose by 0.25 which we did a couple of days back.

  7. I'm not a 100% sure of this but I feel that she displays fasting hyperglycemia. So going for longer than 4-5 hours without food spikes her BG levels.
I think I have no choice right now but to gradually keep upping her dose till I see lower levels. I guess with the kibble she is eating (25% carbs), she is going to need more insulin.
 
Sienne and Gabby (GA) said:
On Wendy's behalf, that is correct. You can draw off insulin directly from the cartridge.
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I found an air bubble in my insulin pen this morning. I have been using a syringe to draw insulin from the pen for the last 5 days but I have never injected air into it.
How have I managed this? :(

And do I need to do anything about it?
 
There's not a problem with an air bubble. It happens. If it worries you, get a syringe and see if you can draw off the air. Otherwise, I wouldn't be concerned.
 
Sienne and Gabby (GA) said:
There's not a problem with an air bubble. It happens. If it worries you, get a syringe and see if you can draw off the air. Otherwise, I wouldn't be concerned.
Click to expand...

thanks! would it affect dosage if I were to use the pen? if and when i need to inject full units?
(i would like to save syringes since I have to get them from the US!)
 
I'm not sure I'm understanding your question. If you mean using the pen to get rid of the air, that's would be fine.

None of us use the pen for actual injections. Because we use such small doses compared to the dosing that occurs with humans, I wouldn't be confident that the pens would give an accurate dose for just a small amount of units.

Have you thought to contact a hospital pharmacy and see if you can buy syringes there? I can't imagine they would send a human diabetic home without syringes. Not all insulin comes in pens.
 
we only get 1ml syringes in India. have checked everywhere (including BD distributor, pediatricians, vet hospitals - the works). we don't have syringes with 1/2 unit markings here. i have to get people coming from the US to bring them for me - so I have to use them carefully!

so, when i have to give Bandit insulin in entire units, i'd rather use the pens which are easily available here and save the syringes fractions of a unit.
Bandit is on 1.25 now. if i have to reduce her at some point to 1 unit or (god forbid!) we get to 2 units, I would like to use the pen.

so wondering if the air bubble in the pen would result in a incorrect dosage when using the pen.

hope i'm clear?
 
I would not be concerned with a air bubble in your pen. I had them once and they dissipated. It’s more of a concern to get the air bubble out of the syringe once your draw your dose so you know he is getting the full dose.

must a shame you can’t get syringes with 1/2 unit markings. What about calipers?
 
we get only 1ml syringes here so there are 100 units in the same barrel size as the 30 units. which makes dispensing even 1 unit really difficult. let alone fractions of a unit.
also, i read somewhere that pens are more accurate than syringes for smaller doses - not sure if that's true.

i would therefore like to use the pen directly when dispensing whole units and use syringes i get from the US when dispensing fractions.
that's why the concern about whether the pen would dispense an accurate dose if there was an air bubble in it.
 
The information is the reverse. The pens are not accurate for smaller doses.

See if you can track down digital calipers. This is a way to help with consistent dosing. They may be available on Amazon or through a local instrument supply company. I. use a 4-inch digital caliper. I just checked and they are available on the US Amazon site.
 
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