Insulin pen questions


#1

Hi!

New here, and I have a few questions I thought you could all help me on!

I have LADA and I’ve recently switched from using insulin from a bottle to that from a pen and while the pen seems easier, I have a few questions. For reference the insulin I was using is Levemir twice daily and now it’s Basaglar once a day.

  1. Is it typical that you’d just get one insulin pen per prescription and you have to go back to the pharmacy every 28 days to get another? It would be more convenient for me if I could get several at a time, but not sure how that works with insurance co-pay and all that. I’m in the USA on private insurance.

  2. When using the insulin pen, do you continue to hold the button down the entire time you have the needle under the skin? Instructions talk about holding the needle in for 10 seconds before removing it from the skin, but is this also while holding in the button? Or, like push in the button, release it, and then wait 10 seconds before removing?

  3. I have stretch marks on my abdomen from when I weighed more… It seems harder to inject in those areas. Any suggestions/experiences with that? Just something I’m running into with trying to rotate injection spots.

  4. I am currently injecting the long lasting Basaglar in the morning but thinking of switching it to the evening, so that my morning blood glucose numbers are better. Any advice on making this switch?

I also use Humalog as needed for bolus insulin but still trying to figure out when I need that. Sometimes I try to eat more low carb and recently I’ve had a couple of incidents of low blood sugar. It’s been very frustrating and I’ve been trying to figure out what the correct dose of the basal versus bolus should be. Right now I’m at 12 units of Basaglar per day and only 0-2 units of Humalog per meal depending on the number of carbs. Sometimes my after meal readings are too high but then other times I go low, especially with exercise, so I’m still trying to figure this out!!

Thanks for your advice!

Lin


#2

Hi Lin:

Welcome to the forum!!!

  1. No, it is not normal that you get 1 pen and then return to pharmacy every 28 days. Have your prescription written for 90 days. Based on 12 units per day, your pen will not even last 28 days. Don’t forget, you need to prime the pen with 2 units before each injection so in effect you are using 14 units per day x 28 days = 392 units and the Basaglar Kwikpens® only hold 300 units so you will run out after 21 days.
  2. Yes, continue to hold the button down for about 10 seconds. We keep using thinner and thinner needle guage to minimize pain and as a result the insulin continues to enter the body from the pen for a few seconds while you keep the button in.
  3. I am very thin and abdomen shots are not comfortable so I use hips, butt, legs and other areas to inject both basal and bolus insulin from pens. Different injection site locations have not affected my blood glucose results.
  4. I have used Levemir and Lantus for Basal but not Basaglar. Injections are always at night, as one of the most important ways for me to stay in control is to start the morning at about 100 on the meter. 1 unit difference makes the difference for me between going low during the night. Actually at 8 units my BG gradually goes down during the night and goes low between midnight and 2 AM. 7 units and my BG gradually rises. I use a digital pen with cartridges so my ideal basal that does not create an excessive drop or increase is 7.4 units.
    Hope this helps - I have also included a link to the Basaglar web page that shows the pen and how to use it. There is also a short video available.
    Hope this helps.Basaglar Pen

#3

There is a lot of information here on bolusing as well as the web. I am hoping you doc gave you some guidance on this also. You bolus is based on your current bg and how many carbs you are going to eat. You have to determine your carb to insulin ratio to cover the carbs and your insulin sensitivity to cover highs, again hope your doc gave you a starting point. I am not comfortable giving you any numbers but there are others who are, just don’t fell overwhelmed by all this we jade to start here and these sites are a God sent as there are many people going through or have gone through whatever may come up who are willing and able to help.


#4

How about asking your doc for pens? I’ve gotten EVERY kind of insulin in every form factor I’ve desired, from my doctor. Novolog and Humalog in both vials and pens, Lantus Pens. Perhaps your doctor’s office is well stocked like mine is!


#5

Thank you for the responses! Sorry, yesterday got very busy and I am only now following up.

Thanks CJ114, for all of the specific responses! Later I thought maybe I should have written these as separate threads. I think maybe I’m just expecting to figure out too much too soon, as I’ve only had the Bolus insulin for a month and even less time for the Basaglar, so I’m just new to all of this. I think my doctor prescribed a slightly too high basal dose, so I lowered that by one unit and am trying an Insulin/Carb ratio of 1:20 approximately… I did this with the meal last night and then woke up this morning with a reading of 125 which is really pretty good for me, especially since I’m doing the basal in the morning, and it sounds like that should be night time.

Searching for more on insulin/carb ratio, I just read this article this morning and found it really helpful, although he talks about variations in I:C ratios based on time of day and other factors… so it seems like this is going to take some time to get good at.

I’ll follow up with my doctor about getting a 90 day supply. Thanks for doing the math for me!

The switch from Levemir in a bottle to Basaglar in a pen was a result of changing insurance and also a new doctor. My insurance dropped the Levemir from their formulary. I did read some bad reviews about Basaglar but then I searched for reviews of other insulin and found some bad reviews on pretty much all of them!! So far, the Basaglar seems to be working OK. It actually does seem to be lasting a full 24 hours which is really nice!

I actually wish I had gotten bolus insulin sooner. My last doctor only prescribed Levemir for me, probably because I’m LADA and still in the honeymoon period but the only reason my A1C was OK (about 7) was because I was eating very low carb… Meals with carbs would always cause big after meal spikes. So I’m definitely benefitting from the bolus insulin, and hoping to get an even better A1C next time.

Thanks again for the quick and informative answers! Glad there’s a forum like this :slight_smile:

Lin


#6

I can’t answer to all of your questions but for stretch marks i recommend you to try TriLASTIN Coupons. I also tried on my stretch marks and it worked very well for me. I hope you will also get rid of your marks too.


#7

You don’t need to prime 2 units every time. I often just prime 0.5 units on my echo pen and that’s enough. As long as you see a drop come out it’s fine.


#8

It depends what you are eating. Humalog is not a good insulin for a very low carb meal, the profile will not match the digestion meaning you will drop low and then rise later. You should consider using Regular insulin, which you can buy cheap without a prescription from Wal-Mart, for meals where you aren’t eating carbs. It takes 30 min to an hour to take effect and lasts 6-8 hours, which matches the profile of gluconeogenesis (when protein converts to carbs) much better.


#9

My post was based on calculations given by Lin that said that she primed using 2 units. Not sure if her 2 units were based on recommendations from the manufacturer of the insulin or her pen. I have a digital Pendiq pen and it is set to 0.5 units for prime, which is the minimum my pen allows for a prime.


#10

I believe “prime with 2 units” is the recommendation for U-200 insulin pens like U-200 Tresiba and Humalog U200 Kwikpen. I think they replicate that 2-unit instruction for the U100 pens to not confuse people although of course it is unnecessary.

After almost 40 years using only vials and syringes, I started using Tresiba in a pen about a year ago. Still getting used to the “giving up the control” of drawing it out using a syringe and visually inspecting for bubbles etc, and instead trusting the pen to measure everything right. Also still (slowly getting used) to trusting the screw on needle thing. Am thinking about converting my humalog to a pen in the future but haven’t done it yet!

To help re-assure myself that the pen won’t screw things up, I have actually disassembled fully-used pens to inspect the measuring and dispensing mechanism. Kinda neat inside.


#11

The original post by Lin was to show that based on recommended calculations she was not getting enough insulin in a 30 day period either due to her prescription or to pharmacy “rounding”. Many of us stretch insulin and supplies in various ways. I re-use the same bd fine needle, for example, dozens of times until it is either bent, plugged or no longer comfortable while others use a new needle for each injection and therefore needles are mostly pre-primed, The only thing I also need to be careful is that certain basal insulins thicken after a few injections in a row, plug needle, therefore need to flush out insulins such as Levemir with Humalog which does not thicken or needle will block after about 4 injections in a row. Lantus is not as bad, Levemir appears to be the worst for multiple injections with same needle.


#12

I extensively re-used plastic syringes for decades, where I could inspect and “feel” how they were working. Yes I had a couple “plug up” but more typically I could re-use them until the scale markings were wearing off the sides! But I have no such confidence in re-using pen needles because I feel so separated from the drawing-out and visual inspection process.

Getting back to Lin’s original question: Speaking not as a medical professional (because I’m not), but as an insulin user, I personally have no problem using analog insulins after the official 28-days-first-used expiration date. I know that it doesn’t magically stop working after 28 days, and that if it’s been stored in cool conditions it has to be good beyond that because the manufacturer built in some safety margins for poor storage and exposure to sunlight. And note that some new analog insulins, specifically Tresiba, do not have the official 28-day expiration that other analog insulins have.


#13

This was my original answer to Lin. It had nothing to do with using insulin beyond 28 days. It was about running out of insulin by day 21


#14

When I used syringes and pens, I didn’t like how they felt upon insertion after about 3 times. Too dull for my taste. Lancets, however I can comfortable reuse hundreds of times but the last few years I’ve been using the Accucheck Fastclix. When I got an Rx for the drums, Medicare insisted that it be filled for the same quantity as my strips, so over the course of 6 months or so, I received a lifetime supply of them and no get refills. Because I have so many on hand, I flick the button prolly at least once a week or so, to the next tip (6 per drum).


#15

CJ, to come back to my original question, I found out that my prescription was for 25 days instead of 30. I had incorrectly assumed it was a 30 day supply. This was clarified by my pharmacist. I don’t prime it a full 2 units every day, and so it’s working out. Also although I was prescribed 12 units, I found 11 units to be a better dose.

I’d ask to switch to a 90 day supply except that I am now thinking about switching to an insulin pump. The problem I have with the insulin pens right now is dosing for the humalog, which I take before most meals. I skip it if the meal is really low carb or I’m going to be exercising. Otherwise, I use 1 or 2 units. The issue is, sometimes 0.5 or 1.5 would be a better dose, but you can’t dial in half unit doses. I end up either high post-meal or with low blood sugar. I don’t know if a pump would be the solution to this, but thinking about bringing this up with my doctor next visit. Also, exercise really makes dosing difficult – my blood glucose can drop from 200 to 70 after a mile walk!


#16

My digital pen doses in .1 units starting at a minimum of .5 units. I have many low carb meals that I dose my Humalog at 1.7units or 3.7 units if I also eat 2 dried plums. Digital pens are becoming more common in the US. I have had to order my digital pens from Germany but have been using them for more than a decade. My pen is not FDA approved but I don’t care as it does such a nice job on MDI


#17

You can get half-unit dosing pens. Why doctors never seem to tell anyone this drives me nuts.