Proper handling of Lantus - why is it NOT rolled?

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Blue

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On FDMB, it's been said all the time that I have been a member - Do not roll Lantus.

Sure, some insulins may need to be 'gently rolled', but I had been told that Lantus and Levemir should not be rolled or shaken. Even the sticky in the proper handling states as follows:
PROPER HANDLING OF LANTUS and LEVEMIR

Lantus and Levemir should be inspected visually prior to administration and should be used only if it appears clear and colorless.
Never shake or roll your vial, cartridge, or pen.

For bubbles, tapping on the syringe has been needed at times, so is that harming the insulin, going against the do not roll instruction? A video on the Levemir site for Canada at one points instructs to tap the cartridge section of the pen, so I am thinking what's the deal? Tapping is OK, but a gentle roll is not OK?

In the facebook FDMB group, there's talk about the Lantus should be rolled, according to the instructions given to a group member from someone at Sanofi-Adventis, so now I am wondering, did that member really call the company, and speak to someone who knows or someone who is in error, or does it really matter.

Can someone provide some sort of official documentation that supports rolling or no rolling?
I would hate to think that some people are actually harming their insulin because of some misguided instructions.
 
The mixture of Lantus does not separate thus not needing 'mixed' where, for example, Humulin N, separates and must be 'mixed' each time. Having used both, there's a WORLD of difference in their 'makeup'. After an hour or two, Humulin will have a white sediment looking ring at the bottom where Lantus never does. Not sure about 'official' docs tho'....
 
Gayle:

I would seriously question who the member was speaking to at Sanofi. Other types of insulin are suspensions and as a result, need to be rolled in order to evenly re-distribute the particulates. Lantus and Lev are solutions. By definition, they don't need to be mixed. I can't find much that specifically states that Lantus shouldn't be rolled.The link to this section of the Lantus site warns against shaking. This is a link from the Dept. of Endocrinology from Children's Hospital in Dallas where they specify to not roll Lantus.

There are any number of websites where there is information that indicates Lantus can be rolled. I put a call in to our Dept. of Pharmacy and they are researching the question.
 
Before using Lantus, I was using ProZinc on Blackie, which needed to be rolled gently as there were 2 separate sections to it in order for it to work properly on her. That's the difference between Lantus, and another insulin such as ProZinc. And I agree with Sienne about that person. It sounds like that they were misinformed about the proper handling of Lantus.
 
Suspensions, like Humulin N, need to be rolled to mix up all the components. Think of a suspension like oil and water. Unless you shake it, the oil and water remains separate layers.

Solutions, like Lantus, do not need to be rolled. All of the components are uniformly present throughout the liquid. Think of plain water. There is nothing to mix up in plain old water before drinking it, cooking with it, etc.

Anything you read online needs to be taken with a grain of salt, IMO. Not everything you read is true or accurate.
 
Can someone with experience address the question of tapping the syringe? I always have to tap it to get out the bubbles. Am I damaging the insulin?
 
When we had bubbles in our insulin, peter would flick (not sure if that's the same as tapping?) the syringe with his fingers, kinda like a real quick flick and usually that took care of the bubbles ..
 
Thanks so much everyone; I was concerned to see contradictory info being given to others on the FDMB facebook group.
I have shared the link to this thread so that members can follow and comment.

ETA:
The wording in both links provided above have all the same wording as other places...
"you do not have to shake" or 'you do not have to roll', so that's why I am trying to find out if it actually means "you don't have to roll or shake, but if you want to, it's not going to make a difference and your insulin will still be ok and not harmed."
 
The pharmacy wonks here specifically found that Lantus does not require it being shaken or rolled.

I would presume that agitating the solution has the risk of causing the insulin to break down (i.e., drop out of solution). I didn't know to specifically ask this. I do, however, suspect that if it weren't an issue, the instructions would not include language about not shaking, etc.
 
The (Human) prescribing information for Lantus says this: You do not have to shake the vial of LANTUS before use. http://products.sanofi.us/lantus/lantus.html

Here's the pharmacology of Lantus: http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021081s024lbl.pdf
LANTUS consists of insulin glargine dissolved in a clear aqueous fluid.

Since the glargine is completely dissolved in the fluid, there is nothing to mix up by rolling or shaking. I'm guessing that rolling/shaking/improper handling of Lantus may cause the fragile molecular structure of glarine to be altered in a way that would make the insulin less effective.

Oh, and hidden within all the scientific jargon, is this: If OptiClik®, the Insulin Delivery Device used with the LANTUS
cartridge system, or SoloStar, disposable insulin device, malfunctions, LANTUS may be drawn
from the cartridge system or from SoloStar into a U-100 syringe and injected.

Proof that you can use insulin syringes with the pens or cartridges, despite what the pharmacist or vet says :smile:
 
Blue said:
On FDMB, it's been said all the time that I have been a member - Do not roll Lantus.

Sure, some insulins may need to be 'gently rolled', but I had been told that Lantus and Levemir should not be rolled or shaken. Even the sticky in the proper handling states as follows:
PROPER HANDLING OF LANTUS and LEVEMIR

Lantus and Levemir should be inspected visually prior to administration and should be used only if it appears clear and colorless.
Never shake or roll your vial, cartridge, or pen.

For bubbles, tapping on the syringe has been needed at times, so is that harming the insulin, going against the do not roll instruction? A video on the Levemir site for Canada at one points instructs to tap the cartridge section of the pen, so I am thinking what's the deal? Tapping is OK, but a gentle roll is not OK?

In the facebook FDMB group, there's talk about the Lantus should be rolled, according to the instructions given to a group member from someone at Sanofi-Adventis, so now I am wondering, did that member really call the company, and speak to someone who knows or someone who is in error, or does it really matter.

Can someone provide some sort of official documentation that supports rolling or no rolling?
I would hate to think that some people are actually harming their insulin because of some misguided instructions.
Click to expand...

this topic caught my interest as i try to update/add to/correct stickies whenever necessary. as in human medicine, information is in a constant state of flux as advancements are made.

i sent the following email to sanofi-adventis (lantus) and a similar one to novo nordisk (levemir) yesterday. i was hoping i'd get an email response so i could copy and paste, but no such luck!


"I'm getting conflicting advice from my medical professional and the pharmacist. One says to roll/shake Lantus insulin prior to use and the other says not to.

Questions:

1. Are you supposed to shake or roll Lantus insulin prior to each use?

2. Is it possible to damage Lantus insulin by shaking and/or rolling prior to each use since it's a solution rather than a suspension?

3. Can shaking or rolling Lantus insulin prior to each use compromise it's effectiveness?

Thank you for your prompt reply!"


i just got off the phone with a nurse from sanofi-adventis.

  • the nurse confirmed sanofi-adventis does NOT recommend rolling or shaking lantus prior to use.
  • sanofi-adventis has NOT performed the studies necessary to determine if lantus can be damaged from rolling or shaking as lantus is a solution rather than a suspension and solutions don't have to be mixed.
  • sanofi-adventis has NOT done studies to determine if rolling or shaking will compromise the effectiveness of the insulin. however, the nurse told me they recommend hospitals do NOT use pneumatic tubes (like what they use in drive-up banking facilities) to transport lantus within the hospital to avoid the risk from motion. the nurse went on to say she tells patients NOT to store their lantus in the door of a refrigerator where there's constant motion or in a drawer where it can roll back and forth for the same reason.

hopefully, novo disk will respond soon...
 
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