Potency of the basal. Can it change near end of Pen?

[NewdestinyX]

Hey gang,
I guess I'll ask this question here to as there are probably more insulin users here.

I'm just on Day 19 of using Lantus and for the last 3 days I've noticed less control than earlier in the Pen's reservoir. I really haven't changed my diet at all in the last 3 days and I've even gone up another unit in that time. Has anyone ever experienced that near the end of the Pen's reservoir the 'strength' of the basal insulin gets weaker? It's also 17 days or so from the start of this Pen. They say it's good for a month. This would be only about halfway thru a month..And my last 3 doses have been just under the 50 units left mark.

But I'm worried that at the bottom of this pen -- I'm not getting 'potent' enough a dose. Am I crazy?

Is there a perfect way to store your pen like on its side rather than on its end, top or bottom, that could prevent potency or mixture issues if that's even a potential?

Thanks in advance for any input!

[plattb1]

Grant, I have not experienced this. I think so long as you keep it in the right temperature range (below 85 degrees) & use within 28 days, you should have no problems. I have likewise never seen any storage instructions for the pens.

Other DF members may have more information for you.

[Bountyman]

I've been using the Lantus SoloSTAR for about 3 months. I use 2 units to clear the needle of air, and inject myself with another 25 units at bedtime. That's 297 units so each pen lasts me 11 days. I have noticed that there's always about 10 units left in the pen when I'm done with it. Whether the pen contains 307 units when it's full...or the injection accuracy is just a little off, I don't know, but I'm not concerned about it.

The instructions for pen usage tells me to inject those 10 units at my next injection and make up the difference with the new pen. Yeah, like that's gonna happen! I have to twist my own arm just to inject myself ONCE. Twice in row is gonna have to be done by a 400 pound male nurse with a taser!

As to the potency waining...I doubt that very much. As to storage...store it at room temperature in any position you'd like, but I suggest you put the needle on with the pen in the vertical position. I put the needle on one of my pens while it was horizontal when I first started on insulin and got a bubble in the fluid. Never could get it out.

[SB_Krista]

Hi Grant, I've been using Lantus now for about 2 months, and I had the same suspicion as you are having! A pen for me lasts slightly less than a month, and near the end of my first pen, I swear the stuff was less potent, and then when I started a new pen, I had two am hypos without changing the dose. But, now that I'm on my third pen, I'm chalking the variability up to just me...me being a normal, pre-menapausal mother of two teenage boys, who typically eats low-carb, exercises routinely, and deals with the usual amount of work & home related stress. In other words, I've let go of the idea that this disease and it's drug-related management should be predictable. BTW, I store my pen in the bathroom, on it's side with the cap on. I'd say give it more time....Good luck!

[NewdestinyX]

Hi Grant, I've been using Lantus now for about 2 months, and I had the same suspicion as you are having! A pen for me lasts slightly less than a month, and near the end of my first pen, I swear the stuff was less potent, and then when I started a new pen, I had two am hypos without changing the dose. But, now that I'm on my third pen, I'm chalking the variability up to just me...me being a normal, pre-menopausal mother of two teenage boys, who typically eats low-carb, exercises routinely, and deals with the usual amount of work & home related stress. In other words, I've let go of the idea that this disease and it's drug-related management should be predictable. BTW, I store my pen in the bathroom, on it's side with the cap on. I'd say give it more time....Good luck!Thanks Krista! I store my pen in the bathroom too and use it first thing in am.

So if you've been on it only 2 months then you've been through only 1 pen change and yet had those results. I start a new pen tomorrow. If I see amazing control again like I did on Day 1 I WILL remain suspect of the quality of the insulin in the last few units of any pen. :) --Today and yesterday have been exactly like the days before I started Lantus. No number under 125 and as high as 151... This is unacceptable -- and NO change in diet these last 2 days at all (still under 110g carbs) ..

Now I HAVE been coming OFF of my Lisinopril (BP med) which gave me unacceptable side effects. I stopped it 2 days ago after 8 days on. That 'could be' in this equation as my body readjusts.

But if I have amazing control tomorrow with the start of a new pen -- I will start chucking everything below 50 units in the pen. It's not 'that' expensive at my dose (17units).

Thanks!

[Bountyman]

Like I mentioned, I use a pen up every 11 days. Here's a list of numbers for FBG starting the 5th of October, the last injection in that particular pen. The FBG that morning is on the left, the number of shot taken that night is on the right. Y'all tell me if you see a waining trend here:

125 11
118 1
122 2
125 3
124 4
118 5
120 6
113 7
94 8
115 9
105 10
103 11
105 1
102 2
114 3
95 4
110 5
112 6
113 7
87 8
98 9
102 10
103 11
105 1
100 2
102 3
112 4

[SB_Krista]

Certainly doesn't appear to be any waining trend, Bountyman. A new pen every 11 days is probably why you wouldn't be seeing any potency decrease over time with any one pen. I only take 10 units a night, plus with the 2 units to prep the pen, one pen last me about 25 days. I've had two pen changes since I started using Lantus and although I'm suspicious of the potency decreasing near the end of a pen, I also realize that so many other factors come into play so I try really hard to not focus on any one FBG. I keep a log and instead look at weekly averages.

[NewdestinyX]

Like I mentioned, I use a pen up every 11 days. Here's a list of numbers for FBG starting the 5th of October, the last injection in that particular pen. The FBG that morning is on the left, the number of shot taken that night is on the right. Y'all tell me if you see a waining trend here:There'd be no waning trend in a Pen used up in 11 days.. if 'time' is a factor in potency.. I know that wasn't my initial question.. but just an observation now..

Certainly doesn't appear to be any waining trend, Bountyman. A new pen every 11 days is probably why you wouldn't be seeing any potency decrease over time with any one pen. I only take 10 units a night, plus with the 2 units to prep the pen, one pen last me about 25 days. I've had two pen changes since I started using Lantus and although I'm suspicious of the potency decreasing near the end of a pen, I also realize that so many other factors come into play so I try really hard to not focus on any one FBG. I keep a log and instead look at weekly averages.
I started my new pen today.. And even on my most sedentary day of the week where I eat out 3 times and don't always choose to keep my carbs under 120g on a day like today, each of my fasting numbers was back under 110.. Range: 103-106 and a new pen started this morning.. So I'm still suspicious of the potency in the last 20-30units of a pen. But that's just me. Not saying there's any veracity to my claim.

But thanks all for your input. Just to be sure.. I'm not using anything in the last 30 units of my pens in the future.. My prescription just isn't that expensive with my insurance. So I'm blessed on that front. Now if my final dose needs to be higher I may need to rethink this.

Thanks!

[TommyC1]

There's a lot of things besides the insulin that could cause a change in your numbers. Stress, illness, allergies, other meds, weather, exercise patterns, time of the month and of course digestion.
I'd have to see a consistant change from one pen to the next for at least a few pens before I'd even suspect the insulin.
I've never noticed anything I could attribute to a change in the Lantus. But I use roughly the same amount as Bountyman and I keep it in the fridge.

[NewdestinyX]

Thanks everyone for your input here. I'm pretty sure it can't be Lantus potency issues.. Just not logical. Though since my Lantus isn't that expensive and last well beyond the month of my purchase of it, at least at my current dosage, I'll still likely be in the habit of discarding the last 20-30 units in the pen - just to placate my mind.. :)

[PatrickR]

I've been using Lantus about 18 months. I started with vials, and kept them in the fridge. I didn't have any problem even going up to 45 days on a vial (but then, it was in the fridge).

I've probably been through about 10 pens by now. I too had some early suspicions about potency - but it turns out it was just the variability of D.

Yes, there's always those last few U in the pen that don't come out. I do split doses between pens when they run out, and there's no difference between that and using a new pen.

Just my 2 cents worth.

[dbaratta]

Hey gang,
I guess I'll ask this question here to as there are probably more insulin users here.


But I'm worried that at the bottom of this pen -- I'm not getting 'potent' enough a dose. Am I crazy?

Is there a perfect way to store your pen like on its side rather than on its end, top or bottom, that could prevent potency or mixture issues if that's even a potential?

Thanks in advance for any input!

Insulin pens failed me, I went to vials and needles and don't have anymore problems. :T

[Dougster]

Hi Dbaratta, when you say the pens failed you. Could you please expand on that? I am using the Lantus SoloStar and am very new to this, so any thoughts would help. My nurse had suggested on getting the vials when I refill and use the same type of pen (Humapen Luxara) I will be using for my Humalog, to create less waste. Thanks in advance!

Be well and happy!

A comfortably numb,
Dougster

[Bountyman]

Insulin pens failed me, I went to vials and needles and don't have anymore problems. :T

I'd be interested also in hearing how insulin pens failed you, D.

[Subby]

Just to be sure.. I'm not using anything in the last 30 units of my pens in the future.. My prescription just isn't that expensive with my insurance. So I'm blessed on that front. Now if my final dose needs to be higher I may need to rethink this.

Thanks!

That's pretty clear, and wasting 20 or 30 units is hardly the crime of the century. If you do decide to change your mind for whatever reason, I wanted to mention for those who do want to use the last of a pen, and don't want to take two shots, here is one way to do it.

Have some syringes. Use one to suck up the last of the pen into the syringe (without nib, it's just a penfill/skinny vial), then complete your dose sucking up from the new pen.

Yes, I realise a lot of people feel syringes are scary or antiquated. But a pen is just a mechanically complicated, socially acceptable syringe. Once accustomed to syringes, you get all the same benefits, same length needles etc if you wish. Personally I prefer syringes for a few reasons, but that's to the side: to all intents and purposes for delivery they really are the same. As many take long acting at home, the socially acceptable part might not sting so much.

Once you suck out the second part of your dose from the new pen and have taken your one shot, you need to re-align your plunger next shot with the new pen, as sucking out some insulin means the insulin level has progressed but the plunger has not. Which shouldn't be a problem with some rough dialling up until you hit resistance, and priming properly as per normal.

Yes, I realise this might involve more than some might wish to engage in or bother with. My post wasn't for you, but for those in that particular situation of wanting to use the last of a pen, but not wanting to take two shots, and who don't mind finding proficiency with a syringe.

[NewdestinyX]

That's pretty clear, and wasting 20 or 30 units is hardly the crime of the century. If you do decide to change your mind for whatever reason, I wanted to mention for those who do want to use the last of a pen, and don't want to take two shots, here is one way to do it.

Have some syringes. Use one to suck up the last of the pen into the syringe (without nib, it's just a penfill/skinny vial), then complete your dose sucking up from the new pen.

Yes, I realise a lot of people feel syringes are scary or antiquated. But a pen is just a mechanically complicated, socially acceptable syringe. Once accustomed to syringes, you get all the same benefits, same length needles etc if you wish. Personally I prefer syringes for a few reasons, but that's to the side: to all intents and purposes for delivery they really are the same. As many take long acting at home, the socially acceptable part might not sting so much.

Once you suck out the second part of your dose from the new pen and have taken your one shot, you need to re-align your plunger next shot with the new pen, as sucking out some insulin means the insulin level has progressed but the plunger has not. Which shouldn't be a problem with some rough dialling up until you hit resistance, and priming properly as per normal.

Yes, I realise this might involve more than some might wish to engage in or bother with. My post wasn't for you, but for those in that particular situation of wanting to use the last of a pen, but not wanting to take two shots, and who don't mind finding proficiency with a syringe.What a super helpful post, Subby.. Great idea - for those inclined to use up all their available insulin.

Thanks everyone for your help in this thread.. There was, for me, better results the day I started the new pen.. Coincidence? Psychosomatic? Who knows.. We'll see when I start my next pen. I also retired the 2nd pen early because of 2 large air bubbles I couldn't move to the top. Don't know how to deal with that.

[Bountyman]

"I also retired the 2nd pen early because of 2 large air bubbles I couldn't move to the top. Don't know how to deal with that."

Air bubbles are the reason I retired the syringe and changed to the pen. I got tired of trying to purge the last little air bubble from the syringes. If the needle end of the syringe were conical then the bubble would reside in the center of the syringe and be easily purged. They aren't. Trying to center that bubble reminded me of that hand-held game where you roll the bb's around trying to get them into the holes.

When I first started using the pen (SoloStar) I figured there was no way I could air into it. The instructions suggested that I use 2 units to clear air from the needle. Actually, those instructions are suggested because one choice of pen needle is a 1/2" 29G. That particular needle does require you use 2 units of insulin to clear the air from it.

I now use the BD Ultra-Fine 5mm 31G. In fact, that needle is so small that when I screw the needle onto the pen it purges itself. I get a little drop of insulin at the end of the needle each time. I attribute that to a small amount of pressure in the pen and the capillary action of the inside diameter of the needle wicking the insulin up the needle.

I'm on my 10th pen right now. I found in applying and removing the needle to the pen if I didn't keep the pen in a vertical position that it would suck air into the pen. Here's how to prevent that:

First I alcohol off the spot I'm going to inject into. Then I remove the sterile cover from the bottom of the needle cap. Holding the pen vertically, screw the needle on and slip the cap and needle protector off. Dial up 2 units and clear the needle still holding the pen vertically. (I blot the insulin off the needle, but that's not a requirement). Dial up your dose and inject it. [I inject my insulin very slowly so it doesn't shoot out the end of the needle like a fire hose.] Withdraw the needle and holding it vertically replace the cap and unscrew the needle.

Using this method for the last 9 pens I've never gotten any air in them. Good luck.

[NewdestinyX]

Air bubbles are the reason I retired the syringe and changed to the pen. I got tired of trying to purge the last little air bubble from the syringes. If the needle end of the syringe were conical then the bubble would reside in the center of the syringe and be easily purged. They aren't. Trying to center that bubble reminded me of that hand-held game where you roll the bb's around trying to get them into the holes.

When I first started using the pen (SoloStar) I figured there was no way I could air into it. The instructions suggested that I use 2 units to clear air from the needle. Actually, those instructions are suggested because one choice of pen needle is a 1/2" 29G. That particular needle does require you use 2 units of insulin to clear the air from it.

I now use the BD Ultra-Fine 5mm 31G. In fact, that needle is so small that when I screw the needle onto the pen it purges itself. I get a little drop of insulin at the end of the needle each time. I attribute that to a small amount of pressure in the pen and the capillary action of the inside diameter of the needle wicking the insulin up the needle.

I'm on my 10th pen right now. I found in applying and removing the needle to the pen if I didn't keep the pen in a vertical position that it would suck air into the pen. Here's how to prevent that:

First I alcohol off the spot I'm going to inject into. Then I remove the sterile cover from the bottom of the needle cap. Holding the pen vertically, screw the needle on and slip the cap and needle protector off. Dial up 2 units and clear the needle still holding the pen vertically. (I blot the insulin off the needle, but that's not a requirement). Dial up your dose and inject it. [I inject my insulin very slowly so it doesn't shoot out the end of the needle like a fire hose.] Withdraw the needle and holding it vertically replace the cap and unscrew the needle.

Using this method for the last 9 pens I've never gotten any air in them. Good luck.Thanks, Bountyman. Super helpful post!! I did not think of the VERTICAL pen hold idea. I usually hold them sideways but I do all the other things you mentioned.. Slow injecting.. BLotting off the extra insulin after the 2unit check.. Do you blot off with the alcohol swap? That's what I do and was hoping that wasn't a problem. But I will start doing the VERTICAL attachment of the needle.. Makes perfect sense.. SoloStar Pen 2 must have gotten those two bubbles when I attached the needle holding it horizontal and even upside down.. so I could see what i was doing..

Thanks again!

[Bountyman]

No, I don't use an alcohol swab. The needles are coated so that they inject easier. Swabbing them with an alcohol swab would wipe the lubricant off. What I do is have a roll of Scott, 1000 sheet single-layer toilet paper handy. The Scott 1000 sheet doesn't have any "poofy" perfumes or butt lubricant in it and the 1000 sheet means less times I have to dig out a new roll. Anyway...I tear off 2 sheets and fold them so there is a sharp corner and use that corner to blot the insulin by just touching the liquid, the paper wicks it up immediatly.

I also don't use alcohol swabs. Can't afford those. What I do use is a couple sheets of Scott folded into a 2-inch square and 91% solution isopropyl alcohol. The bottle cost $2.29 at Raley's and lasts about 2 months.

[Bountyman]

Meant to ask you. You mentioned a SoloStar Pen 2? Was that a typo or am I using a pen that has an upgrade?