Syringes. Brand and accuracy

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kim and simon

kim and simon

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I have been looking over various posts about syringe accuracy. We use Relion 3/10 syringes due to the half units.

This one is a couple of years old:
http://www.felinediabetes.com/phorum5/read.php?22,1462377,1462377#msg-1462377

And very recent:
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=56778&p=615848&hilit=terumo#p615848

Questions: what is the current consensus on Terumo? I was wondering what Sienne decided to use after her post on 11/18/11.
The first article seemed to say the Terumos tested as more accurate, the second thread mentioned problems. Looks like BD and Monoject had problems across the board?

In the end, I am relatively new and teachable, but I am having trouble condensing the info on this topic. Maybe I haven't stumbled upon the right page. My cat was diagnosed in early january and we are down to .5u. I want to maximize his chances of remission by being accurate. What are some best practices for measuring fractional doses? I have looked over the pictures, but if the syringe is .5 off...what's the point?
 
I use the Relion 3/10 cc, 8mm 30 gauge needle, with half unit markings for U-100 insulin. I'm not doing micro doses, so the air bubbles aren't an issue.

Here's another thought: any chance the measurement in the syringes actually takes into account the small amount of air? Has anyone asked?
 
Because humans don't do microdosing, the syringe manufacturers aren't required by law to make their syringes 100% accurate. Marje (Gracie) just had her final "debate" with the Monoject people. Because of her complaints, they did a bunch of testing of their syringes and found they met all the requirements, even the one's Marje had sent back because she could tell the lines were off a bit. I don't know that there is a truly accurate way to microdose.
 
Just an FYI, no scientific data just my observations. I had been ordering the Monoject syringes from ADW just so I wouldn't have to deal with the lines at Wal Mart. The last time I ordered they were out of stock so I had to go to Wal Mart. I use the Relion 3/10 cc 31 gauge 5/16 needles. I noticed the box was white, the last time I got them the box was blue. I have used about 18 of these syringes & so far I can really tell a difference. The plunger is moving smoothly & best of all I have had no trouble with air bubbles. I have tried to pay attention to the first line & so far it seems as if it's consistent & not crooked like I had noticed before. I'm really liking them now, I just hope the consistency continues & the bubbles stay away! It seems as if they have done some much needed improvements!
 
Hmmmmm.....so now that I just bought three boxes of Monojects, Relion finally makes a better syringe?!!!! I ended up hating those syringes because the plunger wouldn't move after I drew in the insulin, when I was trying to get out the every present air bubble. I would twist, I would try to gently push....and would alway end up shooting the insulin into the air. Drove me nuts!!!
 
Patty, I felt the same way which is one reason I started using the monojects, plus I didn't have to deal with Wal Mart. Then I had trouble with bubbles in the Monoject ohmygod_smile I thought I was going crazy! I was reluctant to go back to the Relion but had no choice. I have been very happy with them so far. I don't know if they changed manufacturers, got better quality control or what. I hope it continues!
 
Mm, and here I thought I was doing something wrong with the syringes. By your descriptions, the BD brand ones I'm using aren't up to par, either. I'm constantly getting large air bubbles that I can't squeeze out and then the plunger sticks and I end up shooting half the insulin in my face. Maybe I should switch brands. @-)
 
You may already know this but there is some sort of lubricant on the inside of the syringe. You should be pulling the plunger out then when you put it back in pull it back & forth a few times. That distributes the lubricant. I have never tried the BD but figured if any were great they would be. It would be worth it to try the Relion, they are at least cheap! Make sure you get the white box. If it's the blue box that would be the old ones I think, if they don't have the white maybe your Wal Mart hasn't used all their inventory yet. This is just my opinion, I have not heard that they actually changed anything but these sure seem better.
 
Been through 3 different brands of syringes and I just keep coming back to the Relions..The last box of Monojects that I got the needles were visibly twisted, couldn't get bubbles out and out of 100 I would guess I trashed 60-70 of them because of rough needles. Absolutely hated the BDs huge air bubbles that nothing in the world would remove, plunger didn't slide etc. My all time favorites so far are these http://www.americandiabeteswholesal...vetrx-half-unit-insulin-syringes_5739_112.htm No bubble problems, easy to read, and that triple bevelled needle makes them insert like a hot knife through butter, but a little pricey for our budget right now since they are only 60 to a box...of the ones available locally..Relion's hands down are the best so far.

Mel, Maxwell, Musette & The Fur Gang
 
Yup, tried spreading the lubricant and twisting the plunger to measure the right dose. But there's either a large air bubble that won't come out, or the plunger gets stuck around the 2u mark. Some of them are fine, some are cruddy. I have tossed 2 or 3 this week out of frustration :sad:

Canadian Walmarts don't carry the Relion stuff so I might order online next time. Hmm. DCIN sent me some Relion ones but they are the bigger needle with no half unit markings so I'm saving them for ... something.
 
I've been using the Monojects. I actually order from Hocks and I was wondering if Marje got a few batches from ADW that were bad. I've never had the problems that Mel described. There are occasionally bubble issues but drawing the insulin slowly, helps.
 
I also ordered the Monojects from ADW...wonder if there's something to that. I was quite surprised when I started getting all those bubbles with them. I really did think I was doing something to cause it.

Mel, I ordered those UltiCare from ADW....I hate them! :lol: I guess it's just a personal preference!

My vote for now is with the Relion's in the white box! :smile:
 
I just got a box of MJs from Hocks. They are the same lot number as the last ones I got at ADW. So far out of the first 15 syringes that I just looked at, four have been noticeably off on the placement of the "0" unit line.
Other than that, I really like the MJs.

I did speak with the diabetes counsellor that MJ's distributor, Can Am, referred me to. Of course, in my conversations with everyone, they think I'm shooting a child because they will not even talk to you if they think it's a cat. This gentleman told me that he has been going to all these conferences and meeting with insulin syringe manufacturers desperately trying to get them to produce a pediatric syringe that only holds 3u and has .1u markings. He said they always tell him that their "target audience" is overweight, type II diabetics on large doses and it doesn't work for them financially to produce the pediatric syringes. He was very frustrated.

He told me what he has his clients do is to drop up the next higher dose in an accurate syringe, and then squeeze out a drop (even if it's large) on a table to the correct dose. Then get the inaccurate syringes, draw up the same way, and compare the drop sizes and then you can estimate what drop size to squeeze out in the inaccurate syringe. For me, that's still so darn subjective from drop to drop.

I might check out the Relions. I used them a year ago and then the BDs and was so frustrated with them both that I went to the MJs. Now I'm finding these inaccuracies in the MJs and the Terumos were worse.
 
We have done micro-dosing on the Lev ISG. There are 2 methods which have worked well, although both take a bit of practice.

#1 is the drop method. Pictures are here: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

Explanation of drop method is here: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=15637#p156967

The best way, in my experience, to get consistent, accurate microdoses is by using a micrometer. You can get them on Ebay for about $15-$20. It was invaluable to me, but I grew up playing with my dad's tools. Here are pictures, just click on them to read the info. http://s5.photobucket.com/albums/y161/FindingNeo/Micrometer instructions/

The only issue with this method is you have to determine what millimeter measurement equals 1U. With the syringes I used, GNP from Hocks, it was a simple 1U=1mm measure. Other brands are going to have a different size barrel and because you are measuring how far down you move the plunger not volume of insulin, you have to decide how "long" 1U is! You also need good eyes for this method, but holding it up to a TV or phone screen or daylight helps tremendously.

The mcirometer is not for everyone, but I felt confident that I was giving consistent doses even at measures down to .2U. Below that the drop method works better.
 
Thanks, everyone! I appreciate all the responses. I was out of town this weekend and am just getting back to the board

Incidentally, I'm seeing that the accurate fractional doses are going to be more important based on what my kitty is doing today. Lowered dose for pet sitter and he is lower than ever this afternoon!

I may check out the white boxed Relions. Mine are only 2 weeks old but are in the blue box. Boo.

:roll:
 
The first ones I've used were the ones the vet got for me. I used the ADW site and ordered a box of 100 and it was specialized for pets- I just typed in the name, u, and gauge I wanted and it came up. $22 for syringes and s/h.

I haven't used them yet as I still have 10 left in the other container, so my mind may change quickly. It came with a sharps case.
 
I've used Relion syringes from the beginning with Kazi because of the convienance of being able to pick them up while running errands. They discontinued the 1/2" needles and I ordered Monoject off of Hocks. WHAT A DIFFERENCE! I must be in the minority here but I much preferred the Monojects. Relion's lines have varying thicknesses and are rarely actually level. I was always having to adjust by eyeballing things which made it difficult if someone else had to give her a shot. The Monoject seems to go in more smoothly and the lines are all the same. My only complaint is that they draw in a LOT of air for some reason.
 
I just had to update...

I was previously using the BD Ultrafine II syringes. They were 3/10cc, 8mm needle, 31g with half unit markings. I HATED them. The plungers were sticky and hard to move... it was impossible to measure precisely. And they got big air bubbles. Combine those two, and I wasted many units of insulin trying to squeeze the air bubbles out just to have the plunger stick and end up shooting the whole dose at the wall. Frustrating.

I picked up a dusty old box of Ulticare syringes at a grocery store pharmacy. Woman was surprised I wanted them because they were seriously caked in an inch of dust and grime and there were only 2 boxes there. They are 3/10cc, 8mm needle, 30g with no half unit markings. I don't love them, but they are way better than the BD syringes. The plunger moves SO smoothly, shaving off a drop is a breeze. They get some air bubbles, but I find I can get rid of them easily if I draw back air on top of the insulin, and then squeeze it out. Scooter flinches sometimes at the needle but overall I would pick these any day over the BDs. But how accurate they are, I have no idea. The 0 line seems to be a bit off on some of them, but I over/under draw just a little hair to compensate. The BDs were just as bad.
 
I use the Walgreen's brand. They have i/2 marks, 3ml, 5/16 (8mm). They're usually a sometimes a little tight when you start but the lubricant usually gets them going and bubbles are never a problem nor are the lines. The caps are a pain though. Sometimes I swear they expect you to be superman or something. :lol: They also have a nice chiseled 31 gauge tip. If you have a problem with them you can bring them back usually and their convenient.

I also have a little trick with the bubbles that I read or heard about that seems to help if I get an occasional one I pull my plunger back to the amount I will want before I put it in the bottle, then put it in and slowly release that air in the bottle, then draw my insulin..It seems to help to take out exactly what you displaced. If you happen to get an air bubble anyway, I flick the needle towards the top near the bubble and it usually goes away.

Melanie
 
I really like the BD syringes, but they are twice the cost of the Monojects and Relions. I HATED the Monoject syringes; they draw SO much air and I found anything below .5U to be extremely inconsistent. Sometimes it would draw so much air that the drop of insulin was half the size it should have been. Usually when it was really bad I'd notice that I didn't see it draw anything and get another one and redo it, and when that happened, I'd squirt out the discarded dose for comparison and sure enough, not correct. I never knew what to expect because Mikey was probably getting a different dose about every time, even though I was drawing them the same (he only gets .25U)

I mentioned maybe trying the Relions, and someone on the board generously sent me some to test. I really like them. I can see the insulin when I draw and feel like I'm getting a consistent dose. The only thing I don't like is that the lines are wider than on the other brands, but I learned to work with it by comparing the drop to the correct dose from the BD until I know where to draw to. It could be total coincidence, but Mikey's curves have been much more consistent since I tried them, and I will be making the trip to Walmart this week to buy a whole box.
 
Linda posted about a new syringe from ADW, in 1/2 units and easier to read. Here's what she wrote.

There was quite a bit of interest in the UltiCare syringes I mentioned yesterday. I would recommend them. I haven’t had any trouble with bubbles. I did start a new vial at the same time, and sometimes I think the bubble problems may have as much to do with the pen or vial as with the syringe. But on the bubble issue, no problems to report. They have a smooth draw. The spacing between the markings makes it much easier for me to read. Although I certainly don’t have an experienced eye for micro dosing, it appears to me that the top of the plunger aligns truly with the first (zero) unit marking.

And I see that ADW is now a FD shopping affiliate.
 
I got some white box relions yesterday and I'm ordering some monojects and ulticares from ADW right now. I am going to see how each feels in my hands! I'm having to measure some micro doses at this point, so I need to get myself standardized.
 
I went and got a box of the Relions in the white box....hated them!!!! The lines are so thick and not consistent.

I ordered the Ulticares from ADW and after reading Christie's post on them and looking at them, i sent them back. I agree that the distance between some of the markings is not consistent at all.

So I'm back to the MJs. I can't understand, though, why the boxes I order from Hocks (more expensive) seem to have syringes with less error than the ones I order from ADW. It's the same distributor. I just got three boxes from ADW and the first 22 syringes were so far off on the "0" line that I can't even think of a way to draw a consistent dose with them.
 
I have had no issues with the Relions in the white box. The thicker lines make it easier for me to microdose, actually, and I've never noticed them being uneven-the plunger always hits the bottom of the first line when pushed all the way, and my practice draws were very consistent, where as with the Monojects, I didn't get the same amount every time.

I have most of a box of the Monojects, and if anyone wants to try a few to see if you like them, PM me and I will be happy to send you some.
 
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