Injecting air into Lantus/Levemir vial

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Brian & Monkey

Brian & Monkey

Member Since 2018
Hi there, I was just reading the Lantus/Levemir basics and I saw that it's never recommended to introduce air into the vial because it's supposed to be negative pressure. The instructions for Lantus from the manufacturer recommend injecting air into the vial and tapping bubbles out and injecting those back into the vial too: https://www.lantus.com/-/media/EMS/...op/PDF/Injecting Vial ,-a-, Syringe.pdf?la=en

It appears that Levemir also has the same recommendations for their vials. https://www.novo-pi.com/levemir.pdf (page 26).

There doesn't seem to be an issue with air damaging the insulin.

Maybe this has already been hashed out already, I'm just noting this in case it hasn't.
 
It's the insulin pen you do not want to introduce air into.
Vial is ok. But not too much air, or the rubber stopper on the top of the vial will start to bulge out.
I wouldn't shoot excess insulin back into the vial, to get the air bubbles out.
Since you would be introducing more of the lubricant from the syringe into the liquid insulin.
As long as you keep your insulin syringe needle tip, below the level of the insulin, and not sticking up into the air pocket of the vial, you're not going to be drawing air from the vial back into your syringe.

Perhaps if your insurance covers the cost of the lantus, which is $350 to $550 dollars for a 10 ml vial in the US, then you could afford to risk contamination. But with our cats getting such tiny doses, we try to make the insulin stretch as long as possible.

It's not a concern with the air damaging the insulin. It's the lubricant in the syringe, contaminating and shortening the life of the lantus. Floaties. Particles in what should be a clear liquid.
It's also a concern of not introducing too much air into the vial, so you don't blow out the rubber seal.

Not recommended to inject air into the pen, because then you might get a big air bubble in the pen, and it's tougher to draw out the insulin without getting a huge bubble of air as your dose. There is a way to withdraw the excess air from a pen, if this happens to you.

Simply tip the pen seal end up, air will rise to the top and then pull out the excess air with your syringe.

The instructions from the manufacturer also say to toss the vial after 42 days. Don't know too many people that adhere to that recommendation.

p.s. Tech support forum is more for issues with the software or an issue with your spreadsheet or your access to the message board. Info like you posed here, would be better in Feline Health, or the Lantus ISG forum or maybe Think Tank. I'll ask one of the moderators to move it.

@Wendy&Neko Could you move this post to a more appropriate forum please? Thanks.
 
Sorry I didn't know where to put it since it had to do with guidelines. I did watch the video, it also showed putting air back into the vial, so I thought it was odd the written recommendation was different. The recommendation to put back in only the same volume as you're extracting would keep from any issues of rubber stoppers bulging.

Can you share the primary source document on the syringe lubricant issue? Lubricant is most an issue when the plunger is fully depressed (so all material is expelled back into the vial). No worries if you can't find it, it's just for curiosity.
 
The lubricant issue was mentioned in several documents, advising not to prefill an insulin syringe with lantus. Since the acid base of the lantus could react with the lubricant of the syringe and change the stability of the insulin.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362151/

Also, this document.
Pre-loading of insulin syringes for people with diabetes to ...

If you can afford to replace your insulin vial or pen of lantus, every 42 days as recommended by the Lantus website, then you may not run into the degradation issue caused by the lubricant, when you inject the air back into the vial/pen and introduce the syringe lubricant into the Lantus insulin.

Many people here can not afford to do that. Replace their insulin that frequently. They are trying to stretch that vial as long as they can before spending $300 to $500 US dollars on a new vial of Lantus. Or switch to the lantus pens.

So we recommend that you overdraw a bit of insulin, remove the syringe from the pen or vial, then tap the air bubbles out of the syringe. Better for your wallet, than the Sanofi recommendation to inject the air and air bubbles back into the pen/vial and draw up the dose again.

One of the moderators may have more information on the lubricant issue.
 
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