Bubbles in new vial of Lev - normal?

[Melanie and Smokey]

Any Lev vial users out there? We are switching Smokey over the Levemir so this is our first vial and it seems odd there there are quite a few bubbles at the top of the vial. We haven't shaken it. The pharmacy filled the script when I got there so I kind of watched him handling it to fill the script. Seems kind of weird.

 

[Vicky & Gandalf (GA) & Murrlin]

Levemir is pretty sturdy stuff, so I wouldn't worry too much. It's not frothy looking, is it? The only thing which might disturb it is if it would shaken hard. It's a suspension, which is why it's clear, not cloudy like PZI and you don't have to roll the vial or anything before f=drawing a dose.

Has anyone made you aware that the 5 pack pens are actually a lot cheaper because they last longer and there's 15ml of insulin total rather than 10ml?'' I would be concerned about using the vials after 6 months, just because so many sticks into the vial over that time could introduce something that could make the insulin lose its potency. A 3ml pen lasts about 3 months at 1U BID.

 

[Melanie and Smokey]

It is just clear bubbles, but it is quite a few of them at the top, not like 3 or 4, more like 15-20. We don't roll it. We've just started to use it. I'm just confused on how and why it would have bubbles in the first place.

I have gotten pens with Lantus a couple of times, but here they did not end up cheaper and I actually found the pens to be less durable and didn't get 5 months out of a box so I went back to vials. Even if was able to use the pens for 5 months they wouldn't be cheaper: Pens $240/5 months = $48/month; Vial $130/3.5 months = $37/month. The Lev appears slightly cheaper since the vial was $114, but I don't see the pens being a significant discount to make the cost/month better.

ND pharmacy laws are different and we don't have the quantity of discount pharmacies to drive costs down. My insulin is something I am not trusting enough to order online and have shipped.

With Smokey's likelihood of getting back up to a high dose, using a vial before it is bad is probable. We used her last Lantus vial in 3.5 months. If we land at a lower dose for her I will be more than happy to throw away insulin I didn't need to use before it went bad.

 

[Vicky & Gandalf (GA) & Murrlin]

It is just clear bubbles, but it is quite a few of them at the top, not like 3 or 4, more like 15-20. We don't roll it. We've just started to use it. I'm just confused on how and why it would have bubbles in the first place.

I have gotten pens with Lantus a couple of times, but here they did not end up cheaper and I actually found the pens to be less durable and didn't get 5 months out of a box so I went back to vials. Even if was able to use the pens for 5 months they wouldn't be cheaper: Pens $240/5 months = $48/month; Vial $130/3.5 months = $37/month. The Lev appears slightly cheaper since the vial was $114, but I don't see the pens being a significant discount to make the cost/month better.

ND pharmacy laws are different and we don't have the quantity of discount pharmacies to drive costs down. My insulin is something I am not trusting enough to order online and have shipped.

With Smokey's likelihood of getting back up to a high dose, using a vial before it is bad is probable. We used her last Lantus vial in 3.5 months. If we land at a lower dose for her I will be more than happy to throw away insulin I didn't need to use before it went bad.

If you end up on a higher dose such as you had with Lantus, I understand your cost concern. I don't know the history here, but have you done or considered the acro/IAA testing? I see she was OTJ for a period. The fact that she needed such a high dose on Lantus makes me suspicious. Also, it might be advisable to reconsider the starting dose of Lev in this case.

 

[Melanie and Smokey]

Yeah, we've considered the testing, but she had a pancreatic biopsy done when she had her double radical mastecomy last month and they found a 2cm dark green mass and some small irregular ones on her pancreas and some liver changes. The doctors consulted after the biopsy and believe she has nodular hyperplasia and that is what is causing the diabetes to reoccur and didn't believe further testing was necessary - we aren't likely to get that pancreas working again. We just need to find an insulin and dose that will keep her in as good of numbers as we can get.

The start dose is a big drop, but my vet doesn't start any insulin higher than 1U and holds for 1 week unless the numbers in that week go cazy high or ketones start to get high. She doesn't risk a different reaction to a different insulin because we can always put more in, we can't take it out.


The Lev just seems bubblier than Lantus in general. Getting the bubbles out of the syringe this morning I noticed everytime I tapped the syringe to get a bubble to surface I just created 3 more.

 

[Larry and Kitties]

Lantus and Levemir are solutions, there are no particles in the insulin. Insulins like ProZinc are suspensions, you have to roll the vial to re-suspend the particles in the liquid.

Levemir is pretty sturdy stuff, so I wouldn't worry too much. It's not frothy looking, is it? The only thing which might disturb it is if it would shaken hard. It's a suspension, which is why it's clear, not cloudy like PZI and you don't have to roll the vial or anything before f=drawing a dose.

Has anyone made you aware that the 5 pack pens are actually a lot cheaper because they last longer and there's 15ml of insulin total rather than 10ml?'' I would be concerned about using the vials after 6 months, just because so many sticks into the vial over that time could introduce something that could make the insulin lose its potency. A 3ml pen lasts about 3 months at 1U BID.