I’ve been a member at TUD for about 7 years now and was originally diagnosed as Type 2. I quickly learned that I was probably Type 1 or LADA but had a hard time finding Drs that agreed.
Well, today I was finally told that insulin is probably the best choice of therapy for me now. I’m not happy but very relieved. The Dr has me booked in July 12th for a “Start insulin” appointment and indicated he will start me on a low dose of Lantus and see how that goes.
I’m just wondering if this will be a pen or needle?
Lantus is available as a vial or a pen. I think the pens are more expensive. My insurance doesn’t cover them, but they will cover humalog pens. I only take Lantus twice a day, but I take humalog frequently (for correction and meal doses), so it was more important to me to have a humalog pen. I feel comfortable dosing with my pen in public. I would need to give my Lantus dose privately anyway because of where I give my shots.
If your insurance covers both, I would guess the pens would cost more, so you’ll just have to weigh the convenience of a pen against the cost. Obviously, I don’t really think it’s worth it, but you may feel differently.
The choice of pen or syringe (pens use needles, too ) will depend on what your doctor and insurance plan prefer, and/or on the person—doctor, nurse, CDE or whoever—from whom you get your training. Pens are generally more popular than syringes because of the convenience factor. But insulin is insulin, regardless of how it’s administered. The real core of using insulin correctly is getting the dose right. That takes effort, knowledge, and experience.
Hi Paul!
I was diagnosed in January 2016 as type 1 LADA. I just started a small dose (5 units) of Lantus 3 weeks ago (and still taking Januvia). My Lantus is a pen. I’m going to assume yours will be to. Its very simple and relatively painless. I was a nervous wreck but quickly realized I was worried over nothing. The darn lancets hurt worse than the pen injections!! The 5 units isn’t doing much for me. I go back to Endo on Tuesday and I’m sure he’ll up the dose - I hope he does anyway!
I think this could be a good thing as I know you have struggled with your blood sugars. It is likely that this will be a pen and if it isn’t you should feel empowered to ask for a pen. And while you are not being started on a mealtime insulin I also think you should feel able to ask (and even demand) a mealtime insulin if you cannot achieve blood sugar goals after meals.
We will always be here listening, so I hope you know you can come back and talk.
The pens are more convenient assuming you can get the correct dose from them. The pens I used before moving to a pump were all setup to increment in full units which made it difficult (impossible) to do a fractional unit dose if that’s what I needed. For me this resulted in under dosing the fast acting Humalog most of the time. I believe pens are available that can do doses in half units but I don’t know of any that are more precise than that.
Moving to a pump eliminated this issue for me and is something to keep in mind if you are very sensitive to insulin.
The point about precision dosing is a good one, and one of the reasons I choose to use syringes. With a syringe that has half-unit markings, I can easily dose down to ¼ unit without difficulty. But there’s no getting around the fact that a pump offers the greatest precision of all–when there is no occlusion, empty reservoir, dead battery, bad cannula, or . . .
I think in most cases the limitations of our ability to count carbs precisely or predict other pretty fuzzy variables in our metabolism probably outweigh the differences in incremental dosing of different methods…
Eg if my best estimate of how much insulin I’d need to take is +/- 2 units… The ability to fine tune the dose to .025u (or whatever) rarely is significant to me. I guess for the people who need to take super small doses, like .050 u for an entire carby meal the dynamic is a bit different… But those are more unique cases…
Pens work well for me… Their limitations are smaller than my own… To the OP-- I started insulin in 2012 and they never even discussed syringes, it was pretty much “here you go here’s a lantus pen, here’s how you use it, good luck” so based on my experience I think pens are most likely what they’d start you out with, much easier and less archaic.
Good luck with your appointment and I think they will start you on a pen most likely. Someone in the hospital told me her brother was put on an insulin pump because his insurance wouldn’t pay for lantus. I guess it all depends on what your insurance will cover. Have you ever had antibody testing to see if you have them?
My PCP treated me as a type 2, also. I had to practically starve myself in order to keep my A1c at or under 7.0. It was a year and a half and I got down to a scrawny BMI of 17.5 before she finally referred me to an endo who gave me the antibody tests and prescribed insulin. Then he was going to turn me back over to my PCP and have her adjust my doses.
From my past experience with her, I knew she was not at all knowledgeable about diabetes and that it would take forever to get my doses right. So I took matters into my own hands. At the suggestion of people on another diabetic message board, I bought the book Using Insulin by John Walsh and got my doses all adjusted before I even went back to my PCP. That was three years ago and I’ve managed an A1c between 5.5 and 5.9 for nearly that long.
Your situation is a little different in that you’ll be dealing with a single doctor. But I still think it will be to your advantage to learn the ins and outs of insulin on your own without counting on your doctor, who might not be totally current. I’m not suggesting that you not follow his suggestions, but you’ll want to be in a position to offer suggestions of your own if need be. Even if you aren’t starting with a meal time insulin, it wouldn’t hurt to learn about it as well as the basal, so you’ll again be in a better position to advocate for yourself should the situation seem appropriate. Another book that covers much the same information as the one I mentioned above is Think Like a Pancreas by Gary Scheiner. Both of those authors also have a more limited amount of information free online.
There is one consideration (once you get going) that COULD steer you toward pen or syringe. If you use a lot of insulin, it won’t matter, but if you’re not using a lot, pens make more sense, because they hold less. Vials generally hold 1,000 units, while pens hold 300? 350? (It’s been a while since I’ve used a pen).
The “life” of insulin once you take it out of the fridge is 28 days, so if you use considerable less than 1,000 units a month, pens are more economical.
(I use 1,100 units a month, but it’s put in a pump. So, I get vials. But pumpers use the same insulin for basal as they do for bolus purposes).
Timbeak has a good point. A pen typically holds 300 units. When I first started Lantus, I only needed six units a day. I’m something of an oddball in that respect, because I need roughly three times as much bolus insulin as I do basal. Most people use closer to 50-50 basal/bolus. I still only need eight units a day three years later. So a pen still lasts me more than a month. Getting a vial would be a waste for anyone like me who uses such a small amount.
If you really are a type 2, though, you are likely to use much more. But even a lot a type 1s on MDI use enough basal to make a vial practical.
One more comment about vials. If you can keep your insulin refrigerated all the time, a vial of insulin can last a LOT longer than the benchmark 28 days that the manufacturers stipulate. For some people, that’s practical, for others it’s not.
Just a word of caution. If you have pens of different insulin(fast and slow acting) keep them apart. It happens to all of us then at sometime or other you will use the wrong pen. They save yourself a panic attack
I wish that I could “swap” my 50 unit syringes for ones with half-unit markings. When I DO have to use syringes (which is not very often), the lack of precision drives me crazy. I’ll definitely ask my endo to change the prescription, but I’ve got more than a box left. I only use about 35-39 units total (basal and bolus) daily.
This is why I always preferred syringes while on MDI. I also remember, years ago, my father took full advantage of this while giving my my shots. If I was a little on the high side, he would go just below the mark, and vice versa. Or I was going to be extra active, he would draw up to just about the line (kind of so the plunger was “resting” on the top of the line) It is no way an exact science, but it did seem to help. Before my pump I would do this, too. If I was, say 140 before a meal, I would have only needed a tiny correction with my food bolus. I would just position the plunger so the line was sitting on top of it to give me a tad more insulin.
I’ve only used pens on MDI, and the pens covered by my insurance only come in full unit measurements. But that doesn’t bother me particularly. That’s just an excuse to have a half ounce of peanuts as a snack a couple of hours after my meal if my calculations for the meal came out to a half instead of a full unit. One unit of insulin lowers my BG about 42 points and an ounce of peanuts raises it about the same amount. Problem solved. If one has a problem with possible weight gain, I suppose snacking might not be a desirable solution.
) will depend on what your doctor and insurance plan prefer, and/or on the person—doctor, nurse, CDE or whoever—from whom you get your training. Pens are generally more popular than syringes because of the convenience factor. But insulin is insulin, regardless of how it’s administered. The real core of using insulin correctly is getting the dose right. That takes effort, knowledge, and experience.