Very confused! Lantus vial vs. pen

[LaurieL]

After reading about the Lantus pen here I called the pharmacy where I filled my cat's first prescription for a vial of Lantus. I wanted to find out if I would need another prescription to change from the vial next time. I was told that I would need a new prescription for the pen and that I would have to inject with the pen, but I thought I could still use the syringes that I've been using? (I explained that this is for a cat so the dose is small and I was concerned about wasting insulin from the vial.)

I just read through the Lantus insert and it says that you can use regular syringes with the insulin that comes with the pen. Can I get a prescription for just the insulin for the pen without buying the actual pen?

 

[squeem3]

You want the Lantus SoloStar pens. They are pre-filled with 3 ml of Lantus. Here is a picture:

You don't need the pen needles. Just stick the insulin syringe needle into the rubber stopper.

You will need a prescription that specifies for the Lantus SoloStar pens.

 

[Steph and Java(GA)]

you dont need to inject with the pen, you can use your syringes. There is a diagram here that shows how it works, Iwill try to find it but no you dont need to inject with the pen.

 

[Jill & Alex (GA)]

After reading about the Lantus pen here I called the pharmacy where I filled my cat's first prescription for a vial of Lantus. I wanted to find out if I would need another prescription to change from the vial next time. I was told that I would need a new prescription for the pen and that I would have to inject with the pen, but I thought I could still use the syringes that I've been using? (I explained that this is for a cat so the dose is small and I was concerned about wasting insulin from the vial.)

I just read through the Lantus insert and it says that you can use regular syringes with the insulin that comes with the pen. Can I get a prescription for just the insulin for the pen without buying the actual pen?

the insulin pen is self contained. what you don't need is the needle tips which attach to the pen. use your syringes to draw insulin from the pen. there are some great pictures illustrating how to do this here: STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE.

the reason you don't want to use the needle tips that attach to the pen is two-fold:

• the pen (with needle tip attached) is designed to administer insulin in increments of whole units only. this doesn't work out too well for us because we dose in smaller increments (0.25u - 0.5u as well as more or less).

• the manufacturer suggests the pen (with needle tip attached) be kept at room temperature because temperature changes associated with refrigeration alter the volume administered by the pen (plastic expands and contracts, thus altering the volume of the dose). however, we like to refrigerate our pens to extend the life of our insulin. our kitties use so little and lantus is expensive. we like it to last as long as possible! using syringes allows us to refrigerate the pen.

hope this helps...

 

[LaurieL]

Thank you! The diagram is helpful, but just so I'm clear about this...the insulin reservoir is attached to the pen body and is not removable?

One other question: I have a container for used syringes because in our city we're required to take these for disposal/we can't put them into our regular garbage can. But what is the proper way to get rid of any leftover insulin?

Thanks again! There's so much to learn in the beginning.

 

[Jill & Alex (GA)]

Thank you! The diagram is helpful, but just so I'm clear about this...the insulin reservoir is attached to the pen body and is not removable?

correct. please see the pictures in the link i provided above.

One other question: I have a container for used syringes because in our city we're required to take these for disposal/we can't put them into our regular garbage can. But what is the proper way to get rid of any leftover insulin?

insulin is a hormone, not a drug. check what the rules are where you live. your vet, doctor, or local government should be able to give you an answer. in many localities it can be tossed i the trash.

 

[LaurieL]

the insulin pen is self contained. what you don't need is the needle tips which attach to the pen. use your syringes to draw insulin from the pen. there are some great pictures illustrating how to do this here: STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE.

the reason you don't want to use the needle tips that attach to the pen is two-fold:

• the pen (with needle tip attached) is designed to administer insulin in increments of whole units only. this doesn't work out too well for us because we dose in smaller increments (0.25u - 0.5u as well as more or less).

• the manufacturer suggests the pen (with needle tip attached) be kept at room temperature because temperature changes associated with refrigeration alter the volume administered by the pen (plastic expands and contracts, thus altering the volume of the dose). however, we like to refrigerate our pens to extend the life of our insulin. our kitties use so little and lantus is expensive. we like it to last as long as possible! using syringes allows us to refrigerate the pen.

hope this helps...

Thank you. I'm still very confused about some contradictory information concerning the proper handling of insulin. I was taught at the vet's that it's proper to shoot air back into the vial to get rid of any bubbles and to insure the correct dosage. I think the Lantus insert says the same thing. But this isn't proper according to the info here? Also, I was told at the vet's to roll the vial between my palms but the pharmacist who filled the prescription said not to do it. When I asked a different pharmacist at the same pharmacy the next day he agreed with the vet to roll it. All I know is how little I know about all of this...and I don't yet know who has the correct advice. I really don't want my cat Gracie to suffer because of my confusion with all of this.

 

[Jill & Alex (GA)]

Thank you. I'm still very confused about some contradictory information concerning the proper handling of insulin. I was taught at the vet's that it's proper to shoot air back into the vial to get rid of any bubbles and to insure the correct dosage. I think the Lantus insert says the same thing. But this isn't proper according to the info here?

we're all about preserving our insulin for as long as possible... which is why we take extra steps to make sure we don't introduce anything which may contaminate the insulin. the inside of the barrel of disposable syringes is coated with silicone oil. when you shoot insulin back into the vial there is a possibility of that silicone oil being introduced into the vial. why take any chances of contamination when you don't have to? lantus is too darn expensive!

Also, I was told at the vet's to roll the vial between my palms but the pharmacist who filled the prescription said not to do it. When I asked a different pharmacist at the same pharmacy the next day he agreed with the vet to roll it. All I know is how little I know about all of this...and I don't yet know who has the correct advice. I really don't want my cat Gracie to suffer because of my confusion with all of this.

unfortunately, pharmacists and vets are often going by what they've learned about other insulins. there's no need to roll the insulin before administering because there's nothing to mix. lantus is a clear solution, not a suspension. rolling to mix may actually shorten the life of the lantus.

 

[julie & punkin (ga)]

if you look at the Lantus website, actually what it advises is to (with the vials only) fill the syringe with air and shoot it into the AIR of the vial, not into the liquid itself. with the solostar pen, there is no air to inject into.

you close the plunger of the syringe, push it in kinda tight, put the needle into the end of the solostar pen (it's obvious, you'll be able to tell) withdraw a tiny bit more than you need for the dose.

withdraw the needle, hold it needle pointed up, tap out the bubbles so they rise to the top. then eject the air and the excess insulin to the right dose.

the insulins that need to be rolled are suspensions - they separate and when mixed look cloudy. lantus is already mixed.

i've seen & gotten tons of contradictory advice and totally get your confusion. i decided that in the midst of the contradictions, i'm going to believe the experts here. they care for diabetic cats 24/7 for years - and my veterinary practice has 1 other diabetic cat. i think the newest and most accurate information is here. Jill is one of those experts - there are several others as well (not me.)

 

[Smokey]

Forgive me if I missed the answer to this...

What is the advantage of using the Solostar Pen compared to the 100ml bottle of Lantus? From what I understand, you withdraw the insulin the same way with your own needles. How is the cost compared to the bottle? I am always open to better ideas therefore, I am curious to see if I am missing the advantages!

Thanks everyone!

 

[LaurieL]

if you look at the Lantus website, actually what it advises is to (with the vials only) fill the syringe with air and shoot it into the AIR of the vial, not into the liquid itself. with the solostar pen, there is no air to inject into.

.)

I feel terrible...I've been doing it the wrong way, but it's the way I was taught.
Please tell me if this is wrong, too: The vet tech had me practice with a vial of saline solution. She said that after I poke the needle into my cat I need to pull back on the plunger just a bit to make sure there isn't any blood entering the syringe because insulin shouldn't be injected into the bloodstream. That part of giving the shot has been the hardest for me because it bothers my cat and I have to be sure that I don't pull the needle out. When the needle came out here at home before I could inject the insulin I wasn't sure if it would be okay to reuse it so I started over again with a new syringe.

 

[Sienne and Gabby (GA)]

To add to what Jill posted...

Insulin comes in two forms -- a suspension or a solution. Unlike Lantus, many of the existing types of insulin are suspensions. For example, Humulin N, after sitting for a bit, will separate into a clear liquid and a white precipitate. You have to roll the vial to re-mix the contents and put them back into suspension before you withdraw any for use. Lantus is a solution. It's uniform and a clear liquid. As a result, you don't have to worry about re-mixing it. Lantus is also relatively fragile. The more you bang it around, the greater chance you will cause it to become unusable. So, don't shake, rattle, or roll your insulin and do not let your kitty use it as a hockey puck!

As others noted, the issue of whether to inject air back into the container differs depending on whether you are using a vial or pen. There's one additional reason you don't inject air into the pen. The pens are manufactured with a negative pressure system. As you use the insulin, there is a black plug that gradually moves down the cylinder to keep pressure on the insulin. If you keep injecting air, there's no place for the additional volume to go. You risk cracking the container.

The tech at my vet's office said the same thing -- pull back on the plunger to make sure you're not drawing up any blood. That might make a huge amount of sense if my cat were on an exam table at eye level. My cat is on the floor with her face in her dish when I'm shooting. I don't shoot in a technically "correct" way but I'm going to bet if we took a poll on the entire FDMB site, the majority of people just poke and shoot.

To answer Denne's (Smokey's bean's) question: The vials contain 10 ml. -- not 100 ml (unless you have a very, very big vial). Each pen contains 3 ml and are usually sold 5 to a box (total of 15 ml). According to the manufacturer, any unused Lantus should be discarded after 28 days. Going by that rule, you would be discarding well over half of a vial (unless your cat was getting a large dose). The amount you would be discarding in a pen would be much less. As a result, the pens are less costly. Even if you were getting more than 28 days from your Lantus, the likelihood is that you would have to discard some amount from a vial whereas you could use almost all of what's in a pen. The pens are more cost effective.

 

[Patty & Champ]

I've done a lot of homework on the cost of the vial versus the pen because money is very tight here. The vial (1,000 units in a 10 ml vial) costs approximately $110 while the Solostar pens (five 3 ml pens per box = 15 ml = 1,500 units) cost approximately $215. If you are very gentle with your insulin and keep it refrigerated (never room temperature), it could last you anywhere from as little as two months to as much as six months. I've researched this extensively and believe this to be true. It's all going to depend on how you handle the insulin as to how long it will last. The only way using a vial for six months would be safe is if you keep extensive blood glucose records on your cat and notice when the effectiveness of the insulin starts to decline. If the insulin becomes cloudy or has floaties in it, you have to throw it away, even if it's only a month old. If your cat's numbers start going all over the place and they've always been pretty steady, you know the insulin is no longer any good and you have to start a new vial (or pen). Personally, I'm going to throw out my vial at three months and get a new prescription for the Solostar pens. Each pen can last up to the last drop if you keep it refrigerated and treat it gently. If your cat is on 3u b.i.d. (6 units a day), one pen would last you approximately a month and a half. The countdown on the pens doesn't start until you poke your first needle into it. There's an expiration date on the box of insulin, usually two years from purchase, so if a pen hasn't been used yet, it's good until the expiration date. Also, if you live in the U.S., you can order your insulin from Canada online which is WAY cheaper, $125 for the Solostar pens.

If I've made any glaring errors, please someone correct me so I'm not giving out bad info.

 

[Smokey]

Ahh, okay. I'll have my vet write me a script for the Solostar pen this week! I opened my insulin almost 28 days ago and your right...I'm going to throw away 2/3rds of it! Seeing that you are keeping your vial for 3 months makes me feel better if I keep mine for an extra few weeks!

So, I just pick up the 5 pack of pens, take the cap off, use my regular syringe and withdraw the insulin and poke. Nothing is really different except the insulin itself is in a different container?

The countdown on the pens doesn't start until you poke your first needle into it. There's an expiration date on the box of insulin, usually two years from purchase, so if a pen hasn't been used yet, it's good until the expiration date. Also, if you live in the U.S., you can order your insulin from Canada online which is WAY cheaper, $125 for the Solostar pens.

So I'm clear, once you poke your first needle into the pen...it does not expire until the 'box' expiration date also? Do you have the website to the Canada pharmacy that I can order from? Hmm..I wonder if it comes to me cold and those UPS guys throw around boxes! I hope that wouldn't hurt it!

 

[Patty & Champ]

As soon as you poke a needle into a pen, the countdown starts on that pen. The countdown doesn't start on the other pens until they are first poked. If a pen has never been poked, it's good until the expiration date on the box. There's nothing different about the insulin except its container. I asked the question to everyone in Lantus Land about a good Canadian pharmacy and was directed to CanadaDrugsOnline.com or PharmacyRXWorld.com. Just call their 800 number and they'll be able to tell you what you need to do to get your insulin through them and what their procedure is for shipping. They usually ship with icepacks and I don't think there's any movement of the insulin inside the pens to worry about them getting shaken up. From what I understand, they're packaged safely, but I won't know until I get my first order in a month or so.

 

[julie & punkin (ga)]

not quite - the printed expiration date is good only until you start using the vial or pen. once you start using it you are on a countdown - somewhere from 28 days onward, depending on your comfort zone and what you see happening. you can see people do different things on this decision.

about the withdrawing the syringe plunger - i also saw that addressed, maybe on the Lantus site, maybe on a diabetes in feline site - i'm not sure where. that is true for OTHER injections but not insulin in cats.

You are lifting up a tent of fat and skin (you are lifting it up, right?) and there isn't blood flow through fat. you want to inject into the fat. One of the mistakes I was making was not putting the needle in far enough. because i had trouble mastering the whole injecting thing, i read a zillion online articles about this, but i can't tell you exactly where. it said that a cat will feel the injection the most if you hit muscle (did you lift the skin & fat up away from the muscle?) or if you don't put it in far enough, you are too close to the skin and it's not going into fat. So as long as you are lifting up and injecting into that fat, you aren't going to hit the bloodstream and you're going to get the best absorption.

for the vial/pen issue - i think punkin's dose of about 7.5u is about the dividing point in using up a pen. We go through a pen in just about a month. If your kitty is getting less than that, you are definitely getting a better deal on the pens. if you have a high dose kitty, you might go through a lot more. i'm paying $41 for 1 pen or $111 for a vial - so 2.5 pens a month would be the $$ equivalent of a vial, so at somewhere upwards of maybe 18u a shot you might be better off with the vial.

ETA: i get allergy shots - and i'll tell you that when nurses started withdrawing the plunger before injecting the solution it got way more painful. i hate it. just shoot the dang thing in. i'm not surprised your cat hates it too.

 

[squeem3]

So, I just pick up the 5 pack of pens, take the cap off, use my regular syringe and withdraw the insulin and poke. Nothing is really different except the insulin itself is in a different container?

Exact same insulin, just a different container :smile:

So I'm clear, once you poke your first needle into the pen...it does not expire until the 'box' expiration date also?

No. The date printed in the box and on the pen itself is for the unopened never been used pen. Same as with the 10 ml bottle. Once you pierece the rubber stopper and start using the insulin, you have about a month, maybe a little more, before the insulin starts losing effectiveness.

Do you have the website to the Canada pharmacy that I can order from?

This thread has suggestions: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=41640

One other question: I have a container for used syringes because in our city we're required to take these for disposal/we can't put them into our regular garbage can. But what is the proper way to get rid of any leftover insulin?

[/quote]

Personally, I treat insulin and used insulin syringes and used test strips as biohazardous medical waste. Theyall go into the Sharps container and properly disposed of. It can't hurt to be extra careful, IMO. Ask your pharmacist what to do with old insulin. Some cities have programs where you can bring in old medicines for proper disposal.

 

[julie & punkin (ga)]

i buy a sharps "container" from Hocks:
http://www.hocks.com/diabetic-supplies/sharps-containers/diabetes-safe-clip-bd.html

you clip off the needle from your syringe, and voila, you can drop the syringe into the garbage now. the concern with them going in the garbage is if someone got poked . . . and now it can't poke. these little things are like a nail clipper, sort of, and they are supposed to hold thousands of needles in one container. they take about 1 second to do. how's that for a good way to get rid of those needles?

 

[Jill & Alex (GA)]

Once you pierece the rubber stopper and start using the insulin, you have about a month, maybe a little more, before the insulin starts losing effectiveness.

that's what we used to think, but not any more. please read through the STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE for current recommendations about the longevity of lantus including, but not limited to:

HOW DO YOU KNOW WHEN YOUR INSULIN IS NO LONGER GOOD?

• When you lose regulation for no reason.

• If you see any hint of "floaties"/"tiny particles"... discard the insulin.

• If insulin is cloudy or discolored, or if rubber stopper is cracked... replace insulin immediately.

• The manufacturer of Lantus recommends discarding the insulin after 28 days of use (in-use, unrefrigerated, for humans).
  However, many Lantus users have been able to use a vial/cartridge/pen for as long as six months.

• The manufacturer of Levemir recommends discarding the insulin after 42 days of use (in-use, unrefrigerated, for humans).
  Many Levemir users have been able to use a vial/pen for four to six months... some to the last drop.

• Think Tank Discussion: How Long Does Lantus/Levemir Last Once Opened?
  
  • Opened Lantus and Levemir vials, cartridges, and pens can last longer than many FDMB members seem to think. Some caregivers of diabetic cats have used Lantus/Levemir down to the last drop. Lantus users from the German Katzen Forum have reported using opened Lantus for up to six months and Levemir up to four months if kept refrigerated and handled properly. Lantus is NOT as fragile as we once thought.
    
    From two of the leading researchers in the field of lantus use with feline diabetics, Jacquie S. Rand BVS, DVS and Rhett D.Marshall BVS (University of Queensland, Brisbane, Australia):
    
    "Glargine should be refrigerated because it has a shelf life of 4 weeks once opened and kept at room temperature. We have found that opened vials kept refrigerated can be used for more than 6 months. If using an insulin pen, the manufacturer recommends that once a vial of insulin is used, the pen be kept at room temperature because temperature changes associated with refrigeration alter the volume administered by the pen."
    http://www.uq.edu.au/ccah/index.html?page=43599&pid=0
    
    We use U100 syringes to draw Lantus from cartridges and pens. We do NOT use needle tips which can be attached to the pens to administer insulin. Therefore, refrigeration will not alter the volume administered by the pen apparatus. Refrigeration combined with the use of syringes to draw insulin (versus using the needle tip made for the pen) from the opened pen has been found to extend it's life well beyond the 28 days suggested by the manufacturer.
  • Unopened Lantus is good until the expiration date stamped on the box if refrigerated and handled properly.

 

[julie & punkin (ga)]

good to know, jill - i hadn't seen that update. punkin goes through his anyway, but i appreciate knowing the correct info.

 

[Ella & Rusty & Stu(GA)]

Hi Everyone,
Just to reply to the question about disposal of old insulin. I asked this question in the Loose Lips condo today (25 April). It had always bothered me and I have been keeping old insulin in the 'fridge for a year and a half because I was worried that disposing of it would harm the environment. Beth answered my question: yes, you can dispose of it without super precautions. See the Loose Lips condo for the thread.

Ella

 

[Patty & Champ]

Thanks Jill!! That's exactly where I got my information, but I couldn't remember where it was located! I'm seriously considering using my vial until it starts to look off or loses its effectiveness, but I'm going to have the pens in my refrigerator so I'm not stuck with no insulin and having to go to a pharmacy here in the states where it will cost a small fortune.

 

[LaurieL]

about the withdrawing the syringe plunger - i also saw that addressed, maybe on the Lantus site, maybe on a diabetes in feline site - i'm not sure where. that is true for OTHER injections but not insulin in cats.

You are lifting up a tent of fat and skin (you are lifting it up, right?) and there isn't blood flow through fat. you want to inject into the fat. One of the mistakes I was making was not putting the needle in far enough. because i had trouble mastering the whole injecting thing, i read a zillion online articles about this, but i can't tell you exactly where. it said that a cat will feel the injection the most if you hit muscle (did you lift the skin & fat up away from the muscle?) or if you don't put it in far enough, you are too close to the skin and it's not going into fat. So as long as you are lifting up and injecting into that fat, you aren't going to hit the bloodstream and you're going to get the best absorption.


ETA: i get allergy shots - and i'll tell you that when nurses started withdrawing the plunger before injecting the solution it got way more painful. i hate it. just shoot the dang thing in. i'm not surprised your cat hates it too.

Yes, they showed me how to make the tent. I called back when I was having trouble at home pulling back the plunger and was told that this was the ideal procedure but if I couldn't do it to just give the shot. I've been getting better at pulling back the plunger but if it's not dangerous to omit that step that would be great.

 

[Patty & Champ]

I was taught to pull back the plunger, too, and, while I was able to do it, it took way more concentration than I wanted to give it that early in the morning. Plus, I never drew blood into the syringe so I figured I probably never would.