How Long Should Insulin Be Used Once A Vial Is Started?
Editor’s comment: The commentary by Dr. Grajower has such important clinical relevance that responses were invited from the three pharmaceutical companies that supply insulin in the U.S. and the American Diabetes Association, and all of these combined in this commentary. The commenting letter and individual responses were authored separately and are completely independent of each other. Diabetic patients treated with insulin, whether for type 1 or type 2 diabetes, are prone to often unexplained swings in their blood glucose. These swings can vary from dangerously low to persistently high levels. Most diabetic patients, and most physicians, will adjust insulin regimens so as to avoid hypoglycemia at the expense of hyperglycemia. Among the “textbook” reasons for variable glucose responses to any given insulin regimen are 1) site of administration, 2) exercise, 3) bottles not adequately mixed before drawing the insulin (for NPH, Lente, or Ultralente), and 4) duration of treatment with insulin (1). A new insulin was marketed by Aventis Pharmaceuticals about 1 year ago, insulin glargine (Lantus). The manufacturer seemed to stress that patients not use a started bottle of this insulin for >28 days (2). Two patients of mine highlighted this point. L.K. is a 76-year-old woman with type 2 diabetes, diagnosed at 55 years of age, and treated with insulin since age 56. Her insulin regimen was changed to Lantus at night together with Novolog before meals. She monitors her blood glucose four times a day. She used a bottle of Lantus until it ran out; therefore, a bottle lasted for 2 months. Her recent HbA1c was 7.6%. I retrospectively analyzed her home glucose readings by averaging her fasting blood glucose levels for the first 15 days of a new bottle and the last 15 days of tha Continue reading >>
Find Resources To Help You With Toujeo (insulin Glargine Injection) 300 Units/ml --including Samples, Videos, Published Clinical Studies, And Faq's.
This site is intended for U.S. Healthcare Professionals only. PLEASE NOTE: This reprint includes information that is not contained within the full prescribing information (PI) for Toujeo (insulin glargine injection) 300 Units/mL and is not intended to offer recommendations about Toujeo that are inconsistent with the PI. Please read the full indication, the Important Safety Information and the full Prescribing Information . Sanofi US does not review the information contained in this website and/or database for content, accuracy, or completeness. Use of and access to this information is subject to the terms, limitations, and conditions set by the website and/or database producer. Sanofi US makes no representation as to the accuracy or any other aspect of the information contained on such website and/or database, nor does Sanofi US necessarily endorse such website and/or database. You are about to leave sanofi site for U.S. Sanofi US does not review the informationcontained on this website and/or databasefor content, accuracy or completeness. Useof and access to this information is subject tothe terms, limitations and conditions set by thewebsite and/or database producer. This site might not comply with the regulatory requirements of US You are about to move to an Unbranded site Toujeo is a long-acting human insulin analog indicated to improve glycemic control in adults with diabetes mellitus. Limitations of Use: Toujeo is not recommended for treating diabetic ketoacidosis. Important Safety Information for Toujeo (insulin glargine injection) 300 Units/mL Toujeo is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or any of its excipients. Toujeo contains the same active ingredient, insulin glargine, as Lantus. The concentra Continue reading >>
Unrefrigerated Lantus Question
Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Went to the drug store, picked up new boxes of Lantus Solostar and Humalog Pens. Went home, got distracted, forgot to put pens in fridge for almost two hours. They were at room temperature, no sunlight or other warmth exposure. Did some research on the net and also called the manufacturers. Bottom line is this: Humalog should be okay with only very minimal efficacy difference (<1% difference), so I'm okay there. Sanofi Aventis tells me that the Lantus pens will only be good for 28 days, even though they were not opened. This translates to my having to throw out 2 of the 5 Solostar pens. Question- anyone have any experience with using unrefrigerated Lantus longer than 28 days? I always kept my Lantus at room temperature. I used it beyond the 28 days without a problem. I've had Lantus vials, being used, out at room temp for up to 60 days with no measurable signs of lost potency for me. Room temp in the summer time can be in the upper 70s for short periods. I don't see having left the pens out at room temp for 2 hours as a problem here. I keep my Lantus at room temperature. I only refrigerate vials if I know I'm not going to be using it any time soon. 1 vial usually lasts me about 45 days, so I'm guessing it fits in the "average use" range. I think your insulin should be fine after just 2 hours. Owlyn, I kept my Lantus that was currently in use at room temps and used it for more than 28 days with no problem. Leaving it out for 2hrs should not cause you any problems. Thank you everyone. BTW, my research found that the 28 day timing on opened bottles of any insulin was due to the growth of bacteri Continue reading >>
Giving Yourself An Insulin Injection With The Lantus Solostar Pen
This information describes how to prepare and give yourself an insulin injection (shot) with the Lantus® SoloStar® pen. Your nurse will review these steps with you and help you practice them. Storing Your Lantus® SoloStar® Pen Keep all new, unused insulin pen devices in the refrigerator. Do not freeze them. Never put the pen you are using back in the refrigerator. Keep it at room temperature, away from heat and sunlight. Discard the Lantus® SoloStar® pen 28 days after piercing the rubber stopper. Gather Your Supplies Clear off a clean, flat tabletop to work on and gather the following supplies: Lantus® SoloStar® pen A new single-use pen needle Alcohol swabs A wastebasket A sharps container (a strong, plastic container with a tight cap). Do not store your sharps in glass bottles, soda bottles, milk jugs, aluminum cans, coffee cans, or paper or plastic bags. For more information, please read How to Store and Dispose of Your Home Medical Sharps. Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer. Open an alcohol swab and wipe the rubber tip at the top of the pen (see Figure 1). Remove the tabbed paper from the outer case of a new single-use needle (see Figure 2). Follow the steps below to prime the pen, set your dose, and inject the insulin. You must prime the pen before you set your dose and inject the insulin. You will do this by giving an “air shot.” This removes the air bubbles and ensures the pen and needle are working properly. Dial 2 units (to the number 2) on the dose selector dial by turning it clockwise (see Figure 6). You will hear and feel a faint click for each unit as you turn the dial. The punger button on the pen will also rise. If you dial past 2 units, turn the dose selector counterclockwise to correct it. Po Continue reading >>
Insulin Pens Are Welcome Back To The Fridge!
We all know that unopened insulin must be kept in the refrigerator. But once in use can we put it back in the fridge to protect it from excessive heat? The answer to this simple question is not as easy as one might think. All manufacturers explicitly recommend to ‘Not refrigerate’ insulin pens in use. This guideline that causes confusion among users is now being revoked by one manufacturer. Let’s try to understand the reasoning behind it and what it means for users now. What? I shouldn’t put my insulin pen back in the refrigerator? When it comes to storing medications, it is recommended you follow the leaflet or packaging instructions. For insulin in particular, there are two different situations: storing and in-use. · Before Opening: When insulin is to be stored long-term and has not been opened, keeping it in the fridge ensures it lasts until expiration date. · During Use: Once a vial, a cartridge or a new disposable pen are used for the first time, the insulin can be kept at room temperature. But it needs to be used within weeks. It makes sense: higher temperatures and an open product mean a shorter shelf life. But there is one extra sentence on insulin pens packages, which has caused quite some confusion: Pens in use — ‘Do not refrigerate.’ What does ‘do not refrigerate’ mean for users? Let’s take a trip back to 2003, when the recommendation to not refrigerate opened insulin first appeared. Take Lilly’s Humalog for example, for which the label was first altered 14-years ago: What was the reason behind this? People started to speculate this warning was a result of preventing any kind of temperature extremes from affecting the insulin once it is in use. Many insulin users know from experience that high temperature can lower the effectiveness of Continue reading >>
Can Insulin Go Back In The Fridge?
After removing insulin glargine (Lantus) from the refrigerator for use, can it be refrigerated over and over again after having warmed to room temperature, or does this degrade it? Continue reading >>
Toujeo Solostar Insulin
Share: Toujeo Solostar (insulin glargine injection), is a new long-acting insulin for adults with either type 1 or type 2 diabetes. Read here to learn more about this newer insulin. How to Store Toujeo Insulin Unopened pens should be kept refrigerated between 36-46 F until the expiration date; and opened pens can be kept at room temperature below 86 F for 28 days. Share: Toujeo Solostar (insulin glargine injection), is a new long-acting insulin for adults with either type 1 or type 2 diabetes. Read here to learn more about this newer insulin. Check Your Glucose Whatever insulin regimen you are on, remember to always check your glucose. Checking your glucose and keeping glucose logs is the only way for your healthcare provider to know if you are on the proper regimen. Continue reading >>
What Are The Possible Side Effects Of Insulin Glargine (lantus, Lantus Opticlik Cartridge, Lantus Solostar Pen)?
LANTUS® (insulin glargine) Injection DESCRIPTION LANTUS (insulin glargine injection) is a sterile solution of insulin glargine for subcutaneous use. Insulin glargine is a recombinant human insulin analog that is a long-acting, parenteral blood-glucose-lowering agent [see CLINICAL PHARMACOLOGY]. Insulin glargine has low aqueous solubility at neutral pH. At pH 4 insulin glargine is completely soluble. After injection into the subcutaneous tissue, the acidic solution is neutralized, leading to formation of microprecipitates from which small amounts of insulin glargine are slowly released, resulting in a relatively constant concentration/time profile over 24 hours with no pronounced peak. This profile allows oncedaily dosing as a basal insulin. LANTUS is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. Chemically, insulin glargine is 21A-Gly-30Ba-L-Arg-3030b-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular weight of 6063. Insulin glargine has the following structural formula: LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS (insulin glargine injection) contains 100 Units (3.6378 mg) insulin glargine. The 10 mL vial presentation contains the following inactive ingredients per mL: 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, 20 mcg polysorbate 20, and water for injection. The 3 mL prefilled pen presentation contains the following inactive ingredients per mL: 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, and water for inje Continue reading >>
Refrigerating Lantus Pens?
Traveling With Insulin
Wouldn’t it be wonderful if you didn’t have to bother to refrigerate your insulin when you travel? I’m sure that in the past the need to have a refrigerator nearby kept many of us from adventure travel in the third world. Gel keeps insulin cool for 48 hours. While you do have to keep your insulin cool, you don’t have to strap a portable refrigerator to your back while you attempt your first ascent of Mt. Everest. Paddling down the Amazon can also be a bit inconvenient with a refrigerator. There are many more likely trips where you might think you need to have a refrigerator for your insulin. For example, I recently booked a short vacation in a cottage on Northern California’s Russian River. My wife, who uses both insulin cartridges and vials, insisted that we get a kitchenette so she could refrigerate the insulin. The kitchenette with its refrigerator wasn’t necessary, as we later realized. We could have used an insulin carrying case that included a cold pack. Our experience, however, had been only with those carrying cases that were tethered to refrigeration. The packs stay cold only until the ice in them melts, requiring repeated visits to the fridge. We were not familiar with a British company, Frio UK Ltd., which until recently had only limited representation in the United States. Frio’s cooling wallets keep insulin cool and safe for up to 45 hours—up to five times longer than ice packs—even if the temperature outside is 100°F. You activate the wallet by immersing it in cold water for 10 to 15 minutes. That makes the crystals in the panels of the wallet expand into a gel that will remain cool for several days with Frio’s patented process. Even though it makes use of evaporation to stay cool, the Frio wallet will remain dry to the touch after you Continue reading >>
Flying With Insulin
I recently received an e-mail asking about insulin storage conditions while flying from the United Kingdom to the United States. Paraphrased, it read: _"I use pens for diabetes control, containing Humalog and Lantus, which I store in a kitchen refrigerator. In a few weeks, I will travel to Texas. I will leave home at 3:00 am, drive to Heathrow and finally reach the motel in Texas at approximately 10:00 pm (UK Local time) (travel time of 19 hours). There is a refrigerator in the hotel room. I will need to take 4 pens of Humalog and 3 pens of Lantus insulin. Unfortunately the airline will not allow the boxed pens to be stored in the on-board refrigerator. What do you recommend I do? I can identify the following four options: Carry them in my hand luggage taking no extra precautions, and leaving them at room temperature in the hotel? Carry them in my hand luggage and put them in the hotel room refrigerator on arrival? Pack them in my checked luggage. I am sure the hold temperature is much colder than cabin temperature? Pack them in a small cooler surrounded by cubes of ice, which may cause a problem with airport security? I am at a loss what to do."_ My reply was as follows: _"I fly with insulin regularly, and have my own opinions for you to consider. Be sure to carry prescriptions signed by your physician in case someone asks about your supplies (the only time this happened to me was when I was flying from Canada to the US & the Canadians asked me)._ _For USA info on flying with diabetes supplies, see the US TSA website. Also see Your Traveling Medical Record and Travel Letter. I would make the following comments about the options you presented: Yes, but there’s some risk of overheating in summer. The present pen can stay at room temp, but spares should probably be kept Continue reading >>
Insulin Storage And Refrigeration
I had an insulin-dependent type 2 patient who was on Solostar Pens of Glargine 65u hs and Apidra 18u tid plus sliding scale for glucose control. The patient got their insulin from a mail order pharmacy, 90 days supply at a time. The patient was in fairly good control with a prior A1c of 6.9 and an average fasting of 122mg/dl. I got a call from the patient’s husband on Friday evening at 5 pm because his wife had had a glucose reading of 245 mg/dl at 3:30pm after taking an Apidra dose of 21 units before lunch. He told me that she had taken another 14 units at 2 pm and now at 5 pm the glucose was up to 319 mg/dl…. My first thought was that there was something wrong with the insulin because the bottle was almost empty so I instructed them to get a new vial of Apidra and try dosing 7 units then call me back in 2 hours. At 7:30 pm I got a call and the patient was at 325 mg/dl and was in a panic. I had them go to the refrigerator and grab all the vials of Apidra. The patient came back to the phone with 6 unopened boxes of insulin. I had them check the expiration dates, which were all good and then I had them open each box. After the third box was opened I knew the reason for the glucose problems. There were ice crystals in the bottle because the insulin had been frozen. Whenever insulin freezes there is a possibility that it will no longer be effective. I found out from the patient that some of the bottles had got pushed to the far back corner of the fridge and must have frozen. I called a 24-hour pharmacy with a new prescription for the Apidra and the patient’s glucose was back under control by midnight. Lesson Learned For this particular patient the storage spot of insulin in the refrigerator caused the insulin to freeze but when the patient got the single new box out Continue reading >>
How Long Does Insulin Last Once It's Been Opened?
A fellow caregiver asked... My mother has type 2 diabetes and needs help with her insulin injections. After I open a new bottle, how long does insulin last for, how should I store it, and how do I know whether it's gone bad? Expert Answers As a general rule, most bottles of insulin are good for 28 days once they're opened. Of course, how quickly a person goes through a vial is highly individual. Some may go through a bottle in a week or two. Others, on a lower dosage, may not use all the insulin within four weeks. But the drug's stability and potency is only guaranteed for 28 days. Opened insulin pens typically last 14 days, though some last only 10 days. If you're uncertain, check with your mother's pharmacist to find out how long her insulin should last. When either of you opens a new vial or pen, make a note on the calendar -- and note the date when you'll need to throw out any remaining insulin. It's best to store an opened bottle of insulin at room temperature, even though manufacturers often recommend refrigeration for opened containers. It's usually less painful to inject insulin when it's at room temperature than when it's cold. Store unopened insulin vials and pen cartridges in the fridge, though, where they should last until their expiration date. Insulin shouldn't be exposed to extreme temperatures, so don't leave it in the car, next to the stove, in the freezer, or in the bathroom. If the bottle freezes, it must be discarded. Two typical signs that insulin has gone bad: poor performance and unusual appearance. If your mother is following her treatment plan and her glucose levels stay stubbornly, inexplicably high, her insulin may have lost its potency. Insulin that's cloudy when it's supposed to be clear or that contains particles, crystals, or small clumps Continue reading >>
Beware Summer Extremes With Insulin
Living with diabetes blog With summer arriving in Minnesota and many other places, I'd like to talk about how to manage insulin storage in extreme temperatures such as this season brings. A number of years ago, I met with a client who used a rapid insulin pen for meal dosing. She shared with me a story of how she attended the county fair on an exceptionally hot day, and had placed her insulin pen in the back pocket of tight jeans and walked around the fairgrounds all day. She used the pen for covering meals eaten at the fair, and her blood sugars were running higher than normal, but she related this to all the junk food. The next day her blood sugars continued to run high and when she took her (rapid) insulin, it didn't seem to affect her blood sugar level at all; in fact, it was like she was taking water instead of insulin. She wondered if the heat had affected her insulin, so she switched to a new insulin (disposable) pen, and soon after her blood sugars started to drop. Has this or something similar happened to you? I looked at insulin manufacturers' websites and found that for the majority of all types and brands of insulin, the maximum temperatures recommended are as follows: Opened room temperature insulin should not exceed 86 F (30 C) with the exception of Lantus, which should not exceed 77 F (25 C). Most manufacturers of insulin recommend discarding insulin if it exceeds 98.6 F (37 C). Other non insulin diabetic injectable medications: Glucagon and Byetta should not exceed 77 F (25 C). Symlin should not exceed 86 F (30 C). Avoiding potential problems Temperatures exceeding manufacturer's recommendations for insulin/medications Store your insulin in the refrigerator, in an insulated case or cooler with a freezable gel pack, or use a cooling wallet. Cooling wallet Continue reading >>
Managing diabetes often requires taking insulin shots throughout the day. Insulin delivery systems such as insulin pens can make giving insulin shots much easier. If you currently use a vial and syringe to deliver your insulin, switching to an insulin pen may make it easier to take your insulin and increase your compliance. Insulin pens do not eliminate your need to poke yourself with a needle. They simply make measuring and delivering your insulin easier. Insulin pens deliver anywhere from .5 to 80 units of insulin at a time. They can deliver insulin in increments of one-half unit, one unit, or two units. The maximum dose and the incremental amount vary among pens. The amount of total insulin units in the cartridges vary as well. The pens come in two basic forms: disposable and reusable. A disposable insulin pen contains a prefilled cartridge, and the entire pen is thrown away when the cartridge is empty. Reusable pens allow you to replace the insulin cartridge when it’s empty. The insulin pen you use depends on the type of insulin you require, the number of units you typically need per insulin shot, and the available pens for that insulin type. The needles on insulin pens come in different lengths and thicknesses, and most fit on all of the available insulin pens. Talk to your doctor or healthcare provider to decide which pen is best for you. Similar to vials of insulin, insulin pens do not require constant refrigeration once they’ve been opened. Insulin pens only require refrigeration before their first use. After its initial use, simply keep your insulin pen out of direct sunlight and in a room-temperature setting. Insulin pens typically stay good for 7 to 28 days after the initial use, depending on the type of insulin they contain. However, if the expiration da Continue reading >>