Concerns drawing insulin from pen cartridge

[Julie and Honey]

I want to use the pen cartridge vs. vial but am worried after watching video on drawing out the insulin of messing up cartridge. I guess since there is no air in cartridge (and we don’t want any in there) the cartridge vacuum wants to pull anything drawn out back in if you don’t continuously hold syringe plunger. Then if that happens, the lubricant from syringe or air bubbles can go in cartridge and then it is contaminated and no good.

I am therefore looking at buying vial, which I don’t want to do, because I am really worried I won’t be able to get insulin out of the cartridge without messing it up. I mean if someone experienced in video got air in cartridge, what chance do I stand of not messing it up?

Can someone that has been using these for a long time explain how people are able to do this? The video says to hold the plunger so it won’t draw back in the cartridge. I don’t see how this is possible with only two hands. Can you push needle in and then lay the cartridge on counter so you have both hands free for syringe barrel and plunger? Then I suppose you would still have to remove a hand from the barrel to pull cartridge off. Seems like using a cartridge would require two people to easily get insulin out without contaminating cartridge.

I delayed starting insulin due to changing diet, then because I was having trouble testing her. Both of those are now resolved and I am ready to start insulin, but now I am afraid I will screw up getting insulin out of cartridge and have to throw it out. I really can’t afford to be buying insulin in the first place right now, let alone worrying that if I buy it, it will end up in the garbage and not in the cat.

Until I get a job, I was planning on buying one pen for now, which should hopefully last 4-6 months on a low dose providing I don’t mess up the pen. If that happens and I have to throw out the pen, I would have been better off buying the vial in the first place for more money...

 

[Ramon's mom]

I don't know if this is a truly approved method, but I push the air out before poking the syringe into the pen. That seemed to stop the suction action. (I am now using a vial because I was switched to Prozinc which apparently only comes in vials).

 

[Julie and Honey]

Right, that is what I understand you should do, but I guess somehow it is still possible to get air sometimes. It seems too complicated, unless I am really overthinking it, which is very possible..

 

[Kris & Teasel]

You won't get air into the cartridge unless you purposely push it in there. Here are the steps:

1. Open pen to expose the rubber seal end of the cartridge. It's a light grey colour.
2. Push the empty syringe's plunger back and forth a couple of times to get it moving smoothly inside the barrel.
3. Push the syringe plunger firmly against the top of the inside of the barrel closest to the needle to expel as much air as possible from inside the syringe. This is to avoid an air bubble in the insulin once it's drawn.
4. Insert the syringe needle through the rubber seal of the cartridge into the insulin while maintaining some pressure on the plunger.
5. Draw up a tiny bit more insulin than the dose you want.
6. Pull the syringe needle straight out of the cartridge.
7. Expel the extra insulin to the dose level you want by using a sort of turning (screw-like) action on the end of the plunger. Expel the excess onto a tissue, not back into the cartridge.
8. Give injection.

Make sense?

 

[FurBabiesMama]

It is no big deal at all. The pens are great. You will get so much more value (at least with a box of 5; I have no idea about buying 1 pen). Get the pens!

When you draw from a vial, you are supposed to pull the syringe plunger back to the mark of the dose you plan to give then push that air into the vial before you flip the vial over and pull back the plunger to get the insulin. The difference with a pen is you just don't do that. You can move the plunger back and forth a few times to loosen it up, then push it all the way back in. Stick it in the pen and draw your insulin out going a little past the mark of the dose you want to give to allow for getting out any bubbles after you pull the syringe out of the pen.

 

[Squeaky and KT (GA)]

You're overthinking Julie - a glass vial works on positive pressure, you do shoot the approximate equivalent of air into the vial that you're going to withdraw. this keeps the pressure the same on outside and inside of vial. It's not going to hurt the insulin if you don't do it, just makes it harder to draw the closer to the end of the glass vial.

A pen works on negative pressure - when you withdraw a dose, it pulls the bottom stopper up toward the top. You do NOT shoot air into a pen/cartridge. Doesn't hurt if you do - I insert needle then pump plunger a bit with does release a few very small bubbles. If I get too big of a bubble as I nearer to the end making it harder to get insulin, I just use a syringe and draw out the air. I've used vials and pens over the years - much prefer pens.

Make sense?

 

[Tom & Thomas (GA)]

The video says to hold the plunger so it won’t draw back in the cartridge. I don’t see how this is possible with only two hands.

I just recently switched to a pen. All you have to do is maintain the very slight pressure you needed to draw from the pen until you have pulled the needle out. With three fingers on the syringe this is pretty easy. For fluid to be drawn back into the pen, you'd have to consciously let go. Believe me, it won't be a problem.

 

[Julie and Honey]

Thanks all. I guess I am thinking the negative pressure will be a strong force and hard to counteract. Sounds like it is not severe. I am thinking it is like tug of war trying to hold plunger back. I am having severe anxiety just thinking about trying to do this.

Great! Hopefully problem solved on the insulin. Does it end there? Not in my world. Don’t expect a reply on item below, just venting...

Finally got cat settled on top of clothes dryer with towel for testing and that seems to be working. Plan to use that area for shots too. I am in a lower unit of a townhouse and the guy upstairs has his 2 boys on the weekends. Totally forgot about that. They run around like a herd of elephants and it is directly over my laundry room. Normally I go in another room and ignore it, was hoping they will grow out of it someday or move, lol. This is going to be a problem with the cat though. Bad enough sticking the cat in quiet if she hears a loud crash from over her head while I am doing it, she will only be afraid of the testing area, which is the only place left to do it.

 

[Squeaky and KT (GA)]

Here's an empty pen cartridge - notice that the red stopper is all the way up against the top. The negative pressure pulled it there as insulin was withdrawn. This is a Levemir cartridge but all of them work the same. You can click on this pic making it bigger if needed....

 

[Kris & Teasel]

Thanks all. I guess I am thinking the negative pressure will be a strong force and hard to counteract. Sounds like it is not severe. I am thinking it is like tug of war trying to hold plunger back. I am having severe anxiety just thinking about trying to do this.

Great! Hopefully problem solved on the insulin. Does it end there? Not in my world. Don’t expect a reply on item below, just venting...

Finally got cat settled on top of clothes dryer with towel for testing and that seems to be working. Plan to use that area for shots too. I am in a lower unit of a townhouse and the guy upstairs has his 2 boys on the weekends. Totally forgot about that. They run around like a herd of elephants and it is directly over my laundry room. Normally I go in another room and ignore it, was hoping they will grow out of it someday or move, lol. This is going to be a problem with the cat though. Bad enough sticking the cat in quiet if she hears a loud crash from over her head while I am doing it, she will only be afraid of the testing area, which is the only place left to do it.

There's absolutely no pull back when you draw insulin from the cartridge. There's a black plunger mechanism inside the cartridge that "follows" the insulin as you draw it out. Over time it makes its way to the rubber seal end of the cartridge. That mechanism is why you don't need to put air into the cartridge before drawing insulin and also why there's no negative pressure to fight against.

 

[Julie and Honey]

There's absolutely no pull back when you draw insulin from the cartridge. There's a black plunger mechanism inside the cartridge that "follows" the insulin as you draw it out. Over time it makes its way to the rubber seal end of the cartridge. That mechanism is why you don't need to put air into the cartridge before drawing insulin and also why there's no negative pressure to fight against.

Thanks, then I am confused as to why in the video the syringe plunger would move back toward the cartridge if you let go of the plunger before pulling it out of the cartridge? So you are saying there is no negative pressure from cartridge trying to pull the syringe plunger back toward cartridge? Seems like other people have had a different experience?

 

[Kris & Teasel]

Thanks, then I am confused as to why in the video the syringe plunger would move back toward the cartridge if you let go of the plunger before pulling it out of the cartridge? So you are saying there is no negative pressure from cartridge trying to pull the syringe plunger back toward cartridge? Seems like other people have had a different experience?

No pressure at all. I'm not sure what others are referring to. It could happen when a large dose is being drawn from a 10 mL vial if a bit of air isn't inserted first.

 

[Hogan]

Thanks, then I am confused as to why in the video the syringe plunger would move back toward the cartridge if you let go of the plunger before pulling it out of the cartridge? So you are saying there is no negative pressure from cartridge trying to pull the syringe plunger back toward cartridge? Seems like other people have had a different experience?

I think perhaps because in the video, she previously accidentally injected air into it (she said she was demonstrating on a no-good pen) so perhaps the pen no longer has a good seal. I watched the same video, but I also do not get any pull back. All you have to do is make sure your syringe is pushed all the way to the top (no air) before inserting it into the pen (mine always have a little air in them, so I prime them and then push it all the way to the top). After you insert it into the pen, the main thing is to never push back into the pen. If you withdraw too much, just remove the syringe and squirt out the excess.

 

[Julie and Honey]

For crying out loud, you mean all this worrying for nothing?

I am surprised I still have my sanity (barely), worrying as much as I do about almost everything is exhausting and time consuming! Getting the pen! You guys are the best!!!

 

[Squeaky and KT (GA)]

For crying out loud, you mean all this worrying for nothing?

We told you that you were overthinking it... I'm glad someone besides me does stuff like that....

HUGS and silly dance...

 

[Hogan]

For crying out loud, you mean all this worrying for nothing?

I am surprised I still have my sanity (barely), worrying as much as I do about almost everything is exhausting and time consuming! Getting the pen! You guys are the best!!!

I was worried about the same thing! That's why when you mentioned it, I knew exactly what you were talking about!

Mistakes will be made along the way, but you will learn from each mistake, and before you know it, you will have a routine that works for you and Honey.

 

[Idjit's mom]

Julie, you are working out the logistics of the insulin injections, I think you are going to be fine. It is all a new learning experience to be sure, but look how far you have come!
Just a note, now that you are testing and going to begin insulin, it's time to set up that spreadsheet so that you can enter that data, and have it available for the more experienced members to review so they can offer advice.
Here are the INSTRUCTIONS If you have any problems, there are members who can help or set it up for you.
Here is a link on how to understand and read the spreadsheet GRID

 

[Julie and Honey]

Julie, you are working out the logistics of the insulin injections, I think you are going to be fine. It is all a new learning experience to be sure, but look how far you have come!
Just a note, now that you are testing and going to begin insulin, it's time to set up that spreadsheet so that you can enter that data, and have it available for the more experienced members to review so they can offer advice.
Here are the INSTRUCTIONS If you have any problems, there are members who can help or set it up for you.
Here is a link on how to understand and read the spreadsheet GRID

Thanks. Spreadsheet is on my list. I think I research things to death because I am afraid to make a mistake and it postpones actually having to do it, which is the scary part.

 

[Idjit's mom]

Thanks. Spreadsheet is on my list. I think I research things to death because I am afraid to make a mistake and it postpones actually having to do it, which is the scary part.

You may make some mistakes along the way, Julie. Join the club, it's a big one! But I absolutely respect that you are researching and trying so hard to learn. I also research a lot, it's a good way to learn. You should have seen DH and myself learning to test, talk about mistakes and misadventures!
You are doing very well, taking things step by step, but please don't let the fear of making a mistake keep you from doing what you can for Honey. She's a beautiful girl and I can tell how much you care about her.
I like this quote I picked up somewhere: Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible. - Saint Francis of Assisi

 

[Kris & Teasel]

postpones actually having to do it, which is the scary part.

Well understood by many here! Like any scary thing, the actual doing of it is less daunting than the anticipatory fear.

 

[Sandi and Toby]

I realize you can't ever drown out rowdy kids totally, but maybe you can always have a CD player going in the laundry room with some sort of soothing cd going at a decently loud enough volume -- nature sounds like the ocean maybe? -- every time whether the kids are there or not. Might help.

 

[Julie and Honey]

I realize you can't ever drown out rowdy kids totally, but maybe you can always have a CD player going in the laundry room with some sort of soothing cd going at a decently loud enough volume -- nature sounds like the ocean maybe? -- every time whether the kids are there or not. Might help.

Good idea, I have an app with nature sounds on my ipad, maybe I will see if she likes that and have that on when testing. Maybe ocean waves, no bird sounds or she will be looking around for them.Trying to figure out a way to get those kids to play in the street, lol. Sorry in advance to people with human children...

 

[Julie and Honey]

You may make some mistakes along the way, Julie. Join the club, it's a big one! But I absolutely respect that you are researching and trying so hard to learn. I also research a lot, it's a good way to learn. You should have seen DH and myself learning to test, talk about mistakes and misadventures!
You are doing very well, taking things step by step, but please don't let the fear of making a mistake keep you from doing what you can for Honey. She's a beautiful girl and I can tell how much you care about her.
I like this quote I picked up somewhere: Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible. - Saint Francis of Assisi

Appreciate it, I am an eternal pessimist if you have not figured that out. Life made me that way..after getting stepped on and screwed over enough times you stop expecting things to turn out well. Now I am wondering about a dental before starting insulin, she was already predisposed to dental problems from FIV and now I’m learning diabetes also lowers immunity and invites infection. Her untreated BG range is now 225-275 on AT meter. I am going to talk to her vet tomorrow, she has been on vacation for 3 weeks. I am wondering if it may be safer to do a dental before she is on insulin and it may even help her BG a little because she does need her teeth cleaned, gums are inflamed.

 

[Kris & Teasel]

There is merit in getting the dental done before starting insulin if you can get it scheduled sooner than later. You wouldn't have the worry of how to dose before the dental, etc. You'd be starting insulin with a clean slate so to speak.