Lubricant in vial?

[Vinnie Van Gogh's Mom]

I just read some posts which talk about syringe lubricant getting into the vial from the syringe and contaminating the insulin. Up until now, I have always pulled in more insulin than needed and squirted the excess back into the vial (sometimes several times to get rid of air bubbles). I will no longer do that after reading the posts about contamination, however should I replace my insulin immediately? I did 11 doses from this vial, squirting the excess back into the vial. I use ulticare u-40 syringes.

 

[Noah & me (GA)]

I've seen strings of black goop almost microscopic in Caninsulin, don't know what it was and no one else could see it but I tossed it immediately.
Do your syringes have an expiry date?

 

[Sarah&Soph]

The way you describe is exactly how the Prozinc user guide says to do it so I would think it’s fine. FWIW, that is also the way that I do it as well.

https://prozinc.us/sites/prozinc/files/downloadable-resources/cat-administration-guide.pdf

 

[Vinnie Van Gogh's Mom]

I've seen strings of black goop almost microscopic in Caninsulin, don't know what it was and no one else could see it but I tossed it immediately.
Do your syringes have an expiry date?

Yeeks! Thankfully I don't see anything like that and it looks fine. My syringe expiration isn't until 2025.

 

[Vinnie Van Gogh's Mom]

The way you describe is exactly how the Prozinc user guide says to do it so I would think it’s fine. FWIW, that is also the way that I do it as well.

https://prozinc.us/sites/prozinc/files/downloadable-resources/cat-administration-guide.pdf

Thank you so much for the reassurance & for the link to the prozinc guide. I've not seen this before.

 

[Daddy Jack's Mommy (GA)]

I've always squired it back into the vial as well. Then I came across the same link that Sarah just shared, and that made me feel better because I had also heard that it was a big no no. But once I read that it's OK, I didn't give it another thought. Worry not!

Added the next day: Actually, it's not true to say that I didn't give it another thought. I've learned to be more accurate at drawing the right amount so that I don't have to be too concerned about whether it's OK to squirt back into the vial. But overall, I don't worry if I have to.

 

[Shelley & Jess]

There's a lubricant in insulin syringes. Shooting the excess insulin back into the vial can contribute to the insulin degrading over time. If you are able to replace your insulin every 60 days, as the manufacturer recommends, not as much of an issue.

Properly stored and handled Prozinc can last 5-6 months. By the time you reach the 5 or 6 month mark how much lubricant do you think you've shot back in the vial and why take the chance in degrading the insulin when a vial can last this long?

 

[Daddy Jack's Mommy (GA)]

There's a lubricant in insulin syringes. Shooting the excess insulin back into the vial can contribute to the insulin degrading over time. If you are able to replace your insulin every 60 days, as the manufacturer recommends, not as much of an issue.

Properly stored and handled Prozinc can last 5-6 months. By the time you reach the 5 or 6 month mark how much lubricant do you think you've shot back in the vial and why take the chance in degrading the insulin when a vial can last this long?

Actually, since I've heard that you're not supposed to inject back into the vial (even considering that I then read on prozinc's page that you can inject back in), I've been careful to try and draw the right amount. And if I go over it's with not too much to spare. For me, shooting the extra into the sink or the air would mean that I couldn't go past the right amount (and I guess I have a hard time being precise), as then I would be drawing up a little more insulin and doing the squirt in the sink routine all over again. Also, Jack is so high dose that I go through a vial of prozinc quickly anyway. And now that I've switched him to Levemir flexpen, I am very careful to draw the right amount. But, if I do go over (slightly), I do inject back into the vial so that I don't have a "do it over and over" thing going on twice a day. I've gotten a lot better at drawing the right amount.

 

[Vinnie Van Gogh's Mom]

Thanks everyone! @Shelley & Jess that makes sense that it's not an issue if you're replacing the insulin when recommended. Vinnie has been on fairly low doses so my bottle could very well last beyond the 60 days. I will make sure to replace the current bottle at that point and be more careful with the draw like @Daddy Jack's Mommy (and shoot excess into the sink) going forward so the next bottle can last longer. Thankfully I have really good pet insurance so it's not a problem to replace every 60 days if needed.

 

[Pattylynne and Tigger]

I have been reading up on this today, I must have read a thread about lubricant and not putting excess back into syringe. This is a link to the Lantus manufacture site.
https://www.lantus.com/how-to-use/how-to-inject#solostar-pen
It indicates it is okay to shot back into the vial, it does not address this with drawing from a pen but I do not see there would be a difference. You do not want to inject air into the pen in the fashion you would a vial, they are already set up for the pressure. I was curious when I had read the emphatic warnings not to shot insulin back in. As an RN we have done this forever. There may be issues that I am unaware of with longer storage due to mini cat doses. I am always leery to give any advice here as I am usually called out for it so please read link and make your own conclusions.
Additionally there is a problem with drawing medication and lubricant in syringes that seems to be a big concern in optical procedures.

 

[Sienne and Gabby (GA)]

It is OK to inject back into a vial. It is NOT ok to inject back into a pen. The pen mechanism is different than the vial. There is a plunger in the pen that operates on a negative pressure gradient. The plunger keeps the insulin at the stopper end of the cartridge. If you inject back into the pen, you're also injecting air back in which is a problem.

 

[Pattylynne and Tigger]

Then as to the matter of lubricant, is this a problem?
As to the negtive pressure aspect I think you are taking out and reinstalling equal amounts and should not change pressure gradients. I'm not sure about this this but will research further tommorow. Tks

 

[Shelley & Jess]

Then as to the matter of lubricant, is this a problem?

The Lantus and Prozinc INSULIN CARE AND SYRINGE INFO Proper Handling and Drawing stickys both say:

"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."

....The stickys were written by very knowledgeable members that put alot of time, effort and research into those stickys to help keep our kittys safe. They have proven time and again they know a heck of alot more about all things FD related than most vets. They use the terms 'could' and 'may', so again, my question, why take the chance?

Further, copied from a post by Jill & Alex
https://felinediabetes.com/FDMB/threads/proper-way-syringe-bottle.196148/#post-2196130
Yes, the lubricant in both disposable and glass syringes could contaminate insulin if shot back into the insulin vial or pen. It is thought that the silicone lubricant may affect Lantus more than other insulins... which is why it's mentioned in the stickys in the Lantus/Levemir forum, but it's actually a good practice no matter which insulin is used.

A silicone lubricant is used in disposable syringes in both the syringe barrel and on the plunger. Disposable syringes come with the lubricant applied at the manufacturing level. One adds the lubricant when using a glass syringe. The lubricant makes it possible to easily slide the plunger up and down the barrel in order to draw the dose. See: Medical syringe and syringe lubricant.

 

[Pattylynne and Tigger]

Yes I've read this and it doesn't agree with general medical practices, that's what started my searching. Was trying to see which is correct, or if both are okay. As I said in forty years of medical practice I've always seen it done, put back overdrawn, working the plunger up and down to expel air and excess solution into vial (while needle still inserted, not breaking aseptic technique) This is more of a curiosity, have nurses been doing this wrong forever? Lantus manufacturing describes putting excess back into the vial. With the tiny doses we use on cats it probably best to be prudent a waste a few drops down the drain, I understand that there has been lots of knowledge accumulated here and it has been a life saver for many kitties, it is greatly appreciated. There has also been a lot of research done in the human medical field. When there is a disagreement in practice knowledge it makes me want to find which is correct, not an argument but an open mind. It certainly won't hurt to waste a drop or two. I wonder if the degradation of the insulin mentioned here is more from mechanically drawing and repeatedly reinserting the solution/molecules than with the lubricant, just a thought as there are warning on several of the insulins regarding shaking vs rolling to reconstitute. As I said the lubricant has not been seen to be an issue in humans except in the field of ophthalmology, that is where I saw mention and studies of the syringe lubricant being an issue. Again using feline doses and using months past the expiration dates (28-42 days on most after opening) may change the need to use more discrete handling, ie, keeping pen refrigerated during use.
As with any technique or practice, human or feline, just because it has always been done a certain way doesn't necessarily mean it is correct. Not asking you to reinvent the wheel on this issue but do you know of any external citations on this practice or is this accumulated internal knowledge? In the future when I post in this manner I will be sure to state that the FDMB knowledge base has an opinion that conflicts and they certainly have a much greater experience base and as such should be the first authority, that my opinions are just for further thought.
Yes I agree there is a great knowledge base here on things feline and you do have much info that even Vets don't about kitties but this is more of a general technique problem that would cross over into the much larger human practice, it should not be a species specific question. As I said it maybe prudent with extending the use of a pen/vial that would make it feline specific. Just wondering if the lubricant is the real issue?

 

[Sarah&Soph]

Further, copied from a post by Jill & Alex
https://felinediabetes.com/FDMB/threads/proper-way-syringe-bottle.196148/#post-2196130
Yes, the lubricant in both disposable and glass syringes could contaminate insulin if shot back into the insulin vial or pen. It is thought that the silicone lubricant may affect Lantus more than other insulins... which is why it's mentioned in the stickys in the Lantus/Levemir forum, but it's actually a good practice no matter which insulin is used.

A silicone lubricant is used in disposable syringes in both the syringe barrel and on the plunger. Disposable syringes come with the lubricant applied at the manufacturing level. One adds the lubricant when using a glass syringe. The lubricant makes it possible to easily slide the plunger up and down the barrel in order to draw the dose. See: Medical syringe and syringe lubricant.

I see that it is written in that post, but based on what? Does anyone happen to have any sources I can read about lubricant degrading insulin over time? I always appreciate the advice given here of course, but sometimes I feel like information gets passed around as fact just because “that’s the way it’s always been done”. I do understand that cats get small doses, but the manufacture of the inulin says that’s the proper way to do it. And as previously stated, that’s also the way it’s done frequently in the medical field as well. I get weekly immunotherapy injections and that is always the way they draw the syringes, and the vials have expiration dates of 6 months. Just want to make sure I have all the correct information

 

[Pattylynne and Tigger]

An old story. At Easter a mother was teaching her adult daughter to prepare the dinner in their traditional way, the way she and her mother had for years. She instructs heat the oven to 325, cut the ham in half, put in the oven for 3 hours and baste with glaze. The daughter later ask her grandmother why she cut the ham in half, because she had a small oven years ago. We always need to think and question our beliefs in all most all areas of life.

 

[Sienne and Gabby (GA)]

@Sarah&Soph - this is the information/article where pre-filling syringes is discussed. It applies to Lantus. I'm assuming this is what you were referring to in your post above.

@Pattylynne and Tigger - In some instances, there is similarity between management of human and feline diabetes. One difference is in some of the mechanics. For example, the pens were developed so that they could be put into a purse and carried along with you if you needed to dose insulin when not at home. The pens don't require refrigeration the way vials typically do. However, unless you have a cat with a high dose condition, we are using far smaller doses with cats and it's prudent to keep a pen refrigerated. The more consistent temperature is better for the pen mechanism. In addition, the pens do not dose in small enough units to be useful with cats. That said, since we're using syringes, even if a human was dosing with a syringe out of a pen, it's unlikely that they would be using the pen for as long as we do given the smaller amounts that are dosed for cats. So, if every time you drew off a dose and injected the excess back into the container (regardless of whether it's a pen or vial), the amount of lubricant potentially injected back into the container will be far more if you're treating a cat vs a human given the number of times we draw off insulin. I would have to do major research to see if there are any discussions of this in the literature. I'm going to guess there's not much out there on the topic. This may be an FDMB legend but it strikes me as one that makes some degree of sense since by not pre-filling syringes or not injecting excess back into the container we're not causing harm. Should there be a build up of lubricant in the container over the longer duration for which we use insulin with a cat, we've avoided a potential problem.

 

[Sarah&Soph]

@Sarah&Soph - this is the information/article where pre-filling syringes is discussed. It applies to Lantus. I'm assuming this is what you were referring to in your post above.

Thank you for the article, I will be sure to check it out! It is quite dated at this point - nearly 18 years - but even from my own search it appears information on this subject is quite sparse, so I'm sure it will still be helpful. I don't have any issue with doing things out of an abundance of caution, but if we're going to go against the advice of vets, healthcare practitioners, and pharmaceutical manufacturers, I guess I would just like a little more evidence than speculation and "it's possible's", so thank you again for the link

 

[Sienne and Gabby (GA)]

I work in healthcare. Not to put too fine a point on things, many people in healthcare get their information from pharmaceutical reps. It's a bit of a conflict of interest. Big Pharma was literally chased out of medical centers because there were free lunches, cruises, and a guest and I were even invited to attend a continuing education weekend at a rather high end resort in La Jolla, CA. It finally dawned on everyone that there was a conflict of interest - we'll take you to dinner, etc. if you prescribe our drug! And while this was some time ago, the recent opioid crisis is anchored in how the drug industry misrepresented the addictive properties of narcotics.

I'd also keep in mind that there are many people who join here who find that their vets are not well versed in feline diabetes. I'm not trying to throw a brick at vets. I think they have an impossible job if they are in a general practice and need to know about every illness for every species of animal that comes through the front door. We all have a hard time staying on top of innovations in our own narrow areas. I'm not sure how most vets manage.

 

[Pattylynne and Tigger]

As I said yesterday I have no problem with wasting a few drops of Insulin as an abundance of caution for what ever reason. We use the Insulin much longer than recommended due to mini doses and financial consideration. I agree with your last statements totally re pharma reps and vets with limited knowledge basis re FD although I am unsure what that has to do with the question of lubricant.
As Sarah said, I see this info mentioned on serval threads and sticky notes but am unable to find outside citations listed or this information on outside sources myself regarding lubricant. If we are going to give/use information that conflicts with professional standards of care and established practice we need to have a rational behind our actions. I agree that with the dosing used in FD we need to be extra vigilant with our care of Insulin. This is really not a big deal but I want to be able to trust the information on this site to be accurate and not just someone's supposition especially when it is listed as a teaching protocol.
As a long time RN I have was taught to pull out more medication than needed then to push the plunger back to needed dose, easier to see the marks on the syringe. When I saw this procedure was considered a "Do Not" technique without regard to which was being used, pen or vial, the reason given in the sticky is silicone contamination. I started a search to understand the rational behind the statement as it conflicted with my training. It stated that the silicone can contaminate the insulin, I can not find this issue of lubricant in but two areas on the internet, on FDMB and Ophthalmic research articles. The only outside reference made in FDMB is actually in a thread a couple years ago on the same subject of lubricants. It refers to the article below but is actually in the instructions not to prefill Lantus. That article references pre-filling Lantus but nothing concerning lubricant or silicone in the article, neither word appear in the entire article. It discusses types of syringes tested and evidence of turbidity developing; this test is why Lantus does not recommend prefilling, BD syringes also advise against pre-filling. The Lantus manufacture show in their literature to put excess back in vial.
"How Long Should Insulin Be Used Once a Vial Is Started?" MARTIN M. GRAJOWER, MD1: Diabetes Care, Sept 2003 is the article I reference.
I truly just wanted to know about the lubricant as I had not heard about this before. As you say the lubricant part may just be a FDMB legend, as there is not a good reference for the statement maybe it should be taken out. Since we use the pen and even more so the vials longer than recommended we certainly want to use every precaution and there are several good suppositions as to why we would do these things differently, but we should not list these as established facts. I think there is a potential for the lubricant to contaminate but that doesn't make it so.
Possibly the sticky should advise again pushing back into the vial or pen of all types of insulin due to the multiple mini-doses and the length of time the insulins are used by felines.
@Sienne and Gabby thank you for all your work to help with our furbabies and to keeping them safe, I know it take hours and shows a great amount of dedication, I do not mean to give you a hard time, the question was out of curiosity and inquiry, respectfully, Patty and Tigger

 

[Sarah&Soph]

I work in healthcare. Not to put too fine a point on things, many people in healthcare get their information from pharmaceutical reps. It's a bit of a conflict of interest. Big Pharma was literally chased out of medical centers because there were free lunches, cruises, and a guest and I were even invited to attend a continuing education weekend at a rather high end resort in La Jolla, CA. It finally dawned on everyone that there was a conflict of interest - we'll take you to dinner, etc. if you prescribe our drug! And while this was some time ago, the recent opioid crisis is anchored in how the drug industry misrepresented the addictive properties of narcotics.

I'd also keep in mind that there are many people who join here who find that their vets are not well versed in feline diabetes. I'm not trying to throw a brick at vets. I think they have an impossible job if they are in a general practice and need to know about every illness for every species of animal that comes through the front door. We all have a hard time staying on top of innovations in our own narrow areas. I'm not sure how most vets manage.

And I am a biomedical researcher, so I just like to be sure to have some evidence when making a decision which is why I said I appreciated the link to the article And I do agree that there are many vets that are not experienced in feline diabetes, but I also feel that if we are going to criticize them for that, then it’s even more important that WE stay up to date on information as well, so as not to be hypocritical

 

[Pattylynne and Tigger]

Sarah, biomed? My brother retired after 30 years as biomed researcher at Purdue, despite that he's ok

 

[Mocha's_mom]

Thank you @Pattylynne and Tigger and @Sarah&Soph. None of us want to step on the toes of the moderators or long time people here. We specifically came here for information and I think we've all found it invaluable!! And we thank you all for that!
But those of us who have a lot of experience with drug formulations, research, pharmacology and the like feel disheartened sometimes. We are data driven scientists and we thrive on research studies, not anecdotal evidence. So I think there needs to be a bit more of that as reference material to ease our minds.

I appreciate everything I've learned here and truly believe that most of us care a whole lot more than our regular vets do about our cat's care. The fact that most of them don't want us to home test is just shocking. So it's so nice to have like-minded cat parents who will actually do the work necessary to keep our cats healthy. I always thought I was a crazy cat mom because I went to extremes to keep my babies healthy. I'm glad to hear that I'm not the only one.

It's heartwarming that there are so many of us willing to do whatever it takes to make our fur babies healthy. But we are all here to learn and share our knowledge. Science is always evolving and we should appreciate the many viewpoints we have here. There are a ton of really smart people here that keep up to date with drug studies and the like. We shouldn't put them down because it differs from the previous held beliefs.

 

[Marje and Gracie]

Thank you @Pattylynne and Tigger and @Sarah&Soph. None of us want to step on the toes of the moderators or long time people here. We specifically came here for information and I think we've all found it invaluable!! And we thank you all for that!
But those of us who have a lot of experience with drug formulations, research, pharmacology and the like feel disheartened sometimes. We are data driven scientists and we thrive on research studies, not anecdotal evidence. So I think there needs to be a bit more of that as reference material to ease our minds.

I appreciate everything I've learned here and truly believe that most of us care a whole lot more than our regular vets do about our cat's care. The fact that most of them don't want us to home test is just shocking. So it's so nice to have like-minded cat parents who will actually do the work necessary to keep our cats healthy. I always thought I was a crazy cat mom because I went to extremes to keep my babies healthy. I'm glad to hear that I'm not the only one.

It's heartwarming that there are so many of us willing to do whatever it takes to make our fur babies healthy. But we are all here to learn and share our knowledge. Science is always evolving and we should appreciate the many viewpoints we have here. There are a ton of really smart people here that keep up to date with drug studies and the like. We shouldn't put them down because it differs from the previous held beliefs.

@Pattylynne and Tigger
@Sarah&Soph

You might be surprised to know that Sienne, Wendy, and I are also data driven scientists. I believe Sienne has been in her field about +45 years, Wendy 41 years, and I in mine for 44 years so we aren’t new to science, research, data, etc.

The sticky we have now was done by Jill, a Moderator who trained us three current Mods. She had a Master’s degree in a related medical field and she was also data driven. Sadly and tragically, she passed away suddenly two years ago. I don’t know if she had any data behind what she posted but she was not the type to just make arbitrary stickys based on FDMB legend. She worked closely on this board with an extremely knowledgeable FD vet tech, JoJo. I also doubt JoJo would just pull something out of a hat.

We Mods will try to track this down and see what we find. For those of you who are Pharmacists, Nurses, researchers, we respect your fields and devotion to science but it is important to keep in mind that what does not affect humans can often affect cats very differently. They are not just furry humans. Silicon injected back into a pen or vial might not degrade the insulin quickly and so, at a human dose, the insulin might be used before there is an effect upon its efficacy. That might not be the case for cats.

Until we are able to find more literature that is recent and, hopefully, applies to cats, I, personally, would err on the side of caution and not reinject back into the vial or pen. With the ability to dose using calipers, there’s no need to overdraw a dose to the extent that you have to squirt a lot back out of the syringe. After I started using calipers, I rarely overdrew.

 

[Sienne and Gabby (GA)]

I'm not sure where you're looking for articles. I just did a quick PubMed search. There are a variety of issues with lubricants in syringes. There are over 100 citations I found on an initial pass and I have to admit, I'm to sufficiently familiar with the technology they are using in the publications. The take away appears to be that there is an interaction between the silicon oil that is used as a lubricant and its effect on protein aggregation.

I suspect the effect is minimal when you are using a syringe to inject insulin. If you are repeatedly injecting back into a vial or pen, the effect may be cumulative. There were also one or two papers that were looking at allergic reactions to the lubricant. We've had a few caregivers how mentioned their cat getting itchy from injections. I wasn't aware of this latter issue.

A side issue with using a syringe with insulin pens: you should not inject air/excess insulin back into the pen because the pen is on a negative pressure gradient. It's what allows the plunger mechanism to move down the cartridge and keep the insulin at the end of the cartridge. If you inject air back, it may limit the functioning of the pen. I could not fine any information on a first pass that discussed using syringes with the pens.