Prefilling syringes

Status
Not open for further replies.
Charlotte & Prop

Charlotte & Prop

Member Since 2011
Have any of you ever been prefilling syringes with levemir and for how many days?

I have a chance to go to Greece with my work in september and my mom can give the cat her shots, but she cant fill the syringe since it is such a small dose. Is it possible to prefill for 8 days?
 
Generally, no. There is a lubricant in the syringes that will disolve into the insulin over time. Can you find someone to just come and measure for your mom?
 
Charlotte did some web surfing last night. At least in humans Levemir can be prefilled in a syringe and refrigerated up to a month.

@BJM
Lantus can not be prefilled because of it's acidic base. Levemir can be because of it's neutral base. I also double check this with my mom's former hospice nurse and they routinely prefill Levemir syringes with up to a week's worth of syringes for their clients. However do not with Lantus.

Mel and The Fur Gang
 
Thanks Mel. I wonder if i need a speciel kind of syringes then since BD says that they dont recommend it. Did you read anything about what kind of syringes?
 
Thinking about contacting Novo Nordisk who produces levemir, since they are a danish company. Maybe they can help with the syringe question as well.
 
I got an answer from novo nordisk allready this morning. Pretty good service i think.
I have put i through google translate, think i make sense most of the way. If not let me know.
Had to take a picture of it since i couldnt copy.
 

Attachments

  • image.jpg
    image.jpg
    36.6 KB · Views: 756
This is good information. So basically, they've never tested it and the concern has more to do with the needle being clogged by dried-up insulin and/or leaking some of the insulin, causing a reduction in dose. Now I'm wondering how long it takes for Levemir to dry up?
 
You may be able to upload the image to your Google Drive account and link it that way.
 
Prefilling syrings with insulin is SAFE. Two studies from: PubMed and American Journal of Hospital Pharmacies

Prefilled insulin syringes that are prepared … using good aseptic technique and are stored in the refrigerator appear to remain sterile for up to one month after preparation Am J Hosp Pharm.

A prefilled syringe with regular insulin is stable for at least 28 days when refrigerated. A safe and effective practice. Even if the potency declines a small bit it is likely compensated for by the cats healing pancreas that was helping out. PubMed - for MEDLINE Stability of U-500 regular insulin in prefilled syringes.
 
What does it say about the lubricant dissolving into the insulin in the syringe?
 
joanngold said:
Prefilling syrings with insulin is SAFE. Two studies from: PubMed and American Journal of Hospital Pharmacies

Prefilled insulin syringes that are prepared … using good aseptic technique and are stored in the refrigerator appear to remain sterile for up to one month after preparation Am J Hosp Pharm.

A prefilled syringe with regular insulin is stable for at least 28 days when refrigerated. A safe and effective practice. Even if the potency declines a small bit it is likely compensated for by the cats healing pancreas that was helping out. PubMed - for MEDLINE Stability of U-500 regular insulin in prefilled syringes.
Click to expand...

please link or attach files to the studies in their entirety. we like to document new information when offering it to our members.
thank you!
 
BJM said:
What does it say about the lubricant dissolving into the insulin in the syringe?
Click to expand...
Check page 3 of this article for more information on prefilling syringes with Lantus.

Summary
Aventis Pharmaceuticals does not recommend prefilling syringes with Lantus and storing for any period longer than needed for application. In addition BD states the
following: “BD does not recommend that any of our syringes be prefilled more than a few minutes in advance of the injection. There are no conclusive studies to determine the safety or risks associated with this practice."
Click to expand...
 
A pharmaceutical or related company that has to worry about liability will never recommend it. A properly documented research protocol I would trust. Thank you contributors for taking the time to contact the manufacturers and find some research.

I will now pre-fill for my vacation in a few weeks. Not fussy about my parents filling 0.5 or 0.75 units themselves given their seniors' eyes and hands ;)
 
Thanks for the great info! I normally don't prefill, but 2 weeks ago I took a prefilled syringe to NC State for G's 10 am shot, leaving home about 6:30 am and arriving an hour later. They would not use the syringe... said it was not viable. I thought about this later, and realized that ProZinc, which needs to be rolled, might be the reason (and they didn't realize that Lev did not roll). I hadn't thought about the acidity of Lantus. Better to err on the side of caution, so they charged me ~$5 for a single 1u dose and all was well. Next time, I'll be armed w/ that info!
 
Jill, I apologize for the delay, I had not checked back until today 11/6/2014
Here is the abstract of the article. You can get the full text in at least 2 ways: by going to your local library's web site, then go to research articles that are offered through EBESCO. It would take a full text to describe the process. You can find EBESCO articles fairly easily. Then type in the name of the article.

Or, go to http://www.ncbi.nlm.nih.gov/pubmed/23699679 where the abstract is listed. You might notice below the article an invitation to join pubmed. It looks like non research people can join or can join by inviting themselves. It is far easier to use the library. Right now my card is expired.


J Am Pharm Assoc (2003). 2013 May-Jun;53(3):304-6. doi: 10.1331/JAPhA.2013.12164.
Stability of U-500 regular insulin in prefilled syringes.
Lull ME1, Piacentino JJ, Traina AN.
Author information
Abstract
OBJECTIVE:

To evaluate the stability of U-500 regular insulin in prefilled syringes stored under refrigeration for up to 28 days.
METHODS:

U-500 regular insulin was drawn up in 1 mL insulin syringes in a clean, nonsterile environment to emulate conditions of a patient's home. Samples were assayed using a stability-indicating reverse-phase high-performance liquid chromatography method immediately after preparation (day 0) and after 7, 14, 21, and 28 days under refrigeration. Before evaluation, all samples were diluted to a concentration of 40 units/mL in the starting mobile phase. Stability was determined by evaluating the percentage of the initial concentration remaining at each time point.
RESULTS:

At least 93.3% of the initial U-500 insulin concentration remained throughout the 28-day study period, with no statistically significant changes in the amount remaining. The percent of initial concentration remained above 97% for the first 21 days of the study.
CONCLUSION:

A prefilled syringe with U-500 regular insulin is stable for at least 28 days when stored under refrigeration. These data are similar to those reported for U-100 regular insulin, indicating that prefilling syringes with U-500 insulin is a safe and effective practice for patients who are unable to accurately draw up their own point-of-care doses.

PMID:
23699679
[PubMed - indexed for MEDLINE]
 
Thank you, Jo Ann. No need to apologize for responding late. I had forgotten all about this thread over the last several months.

Regular insulin is a fast-acting insulin some of us use as a bolus insulin with longer-acting basal insulins such as Lantus or Levemir for our diabetic kitties. Regular insulin is called Humulin R or Novolin R here in the USA. I've heard some members joke around and say regular insulin is virtually indestructible and lasts forever so I'm not surprised at the outcome of this study.

Do you happen to know if any studies have been done using syringes prefilled with Lantus or Levemir? Those are the insulins I'm curious about. I wonder about the stability of Lantus and Levemir after several days or weeks in a syringe. I also wonder if the lubricant found in the barrel of disposable syringes would/could degrade or possibly contaminate Lantus or Levemir over time, given that they appear to be more fragile than regular insulin.

Having said that, over the years I have known a couple dozen caregivers who have occasionally prefilled syringes with Lantus or Levemir for short periods of time (usually for less than 10 days) without any obvious problems. I've been told if one does prefill syringes, they should be stored needle side up to prevent the needles from clogging, but I don't have first-hand experience. It's not an issue I ever had to deal with.

I recently told someone the longer I've been active in the FDMB, I have more questions than answers. :-D

Thank you and have a good evening!
~ Jill
 
I merge articles on the same topics. They are just my private notes. It never occurred to me that others might look at the articles. So I've been unruly in identifying authors titles etc. I think there is a lot of material from the FDMB. But you might find something worthwhile.
There are several valuable articles. I was very relieved to learn that I could prefill syringes without losing the insulin's potency. My insulin is drawn from the first vial I bought in August. One person commented that he almost immediately knows its time to get a new prescription through the blood glucose test results. As for prefilling needles, Medline Abstract is good enough for me. Your word is followed by many people, so I realize that you want everything nailed down. I stick with Medline. I fill about 20 syringes at the same time. I've never seen a problem.

One of the articles addressed lifespan of insulin. Pharmaceutical firms posted their responses at the end of the article. They danced around the key question and stuck by the advice that vials should be renewed every 30 days.

Some people say that the lantus loses its potency going in and out of the refrigerator. Hot. Cold. Hot. Cold. It doesn't need to be shaken or warmed by rolling it in one's hands since that contributes to the undesirable temperature perturbation. I do warm the insulin in the syringe before injecting. The lantus lives in my refrig and comes out for filling syringes ea 10 days or so. Then back into the refrigerator. People find what works for them. I'm very satisfied.

I cant remember where I read this advice but it was recommended to store the vial on the shelves not the door which is always moving around, opening and closing. Sometimes slammed shut. It made sense to me so I put the lantus on a stable shelf.

All in all it is an evolving field, with FDMB setting the pace. So I find everything very interesting.
 

Attachments

I'm sorry. I'm unable to open the document containing your notes. I must not have that particular program on my laptop.
Unless your notes contain something to support your statement, I don't think it really matters.

joanngold said:
Prefilling syrings with insulin is SAFE.
Click to expand...
I/we cannot use the study you've cited to support the idea that prefilling syringes is safe because the insulin used in that study was regular insulin... not Lantus or Levemir. It's an interesting read, but does not support your statement. Actually, there really isn't really anything with much substance in this entire thread to support the claim that prefilling syringes with Lantus or Levemir insulin is safe.

joanngold said:
As for prefilling needles, Medline Abstract is good enough for me.
Click to expand...
You are Big Shot's caregiver. You hold the syringe and make decisions for him. If an abstract from a study using another insulin "...is good enough for me", that's your prerogative as Big Shot's caregiver.

At this time, I/we can't change existing suggestions on the FDMB based on a Medline abstract regarding prefilling syringes from a study using another insulin. We subscribe to the concept of "doing no harm". Our number one priority on the FDMB is to keep kitty safe. We have a responsibility to our membership to offer more than "good enough".

However, as you say, this is an evolving field. Most of the "Stickys" I've written or have been responsible for have been edited and updated numerous times... any time we learn something new. I came to the FDMB in 2006. MUCH has changed since then.

I'm hoping for a day we're able to say with confidence, "Prefilling syringes is safe." To my knowledge, we're just not there yet.
 
Status
Not open for further replies.
Back
Top