Syringe
Syringes[1] are commonly used to inject cats and dogs with insulin. The strength of an insulin is measured in International Units (IUs)[2]. The two common strengths are U40 and U100, meaning 40 units and 100 units per millilitre, respectively. Cubic centimeters (cc's) and milliliters (mL's) are interchangable, so syringes marked 1ml equals 1cc; 0.5 ml equals 1/2cc. 3/10cc equals 0.3ml[3]. There are syringes designed for use with U100 insulin and syringes designed for use with U40 insulin. They were at one time color-coded: U100 syringes having orange caps while U40's have red ones[4][5]. Unfortunately some U40's now have orange caps, too -- check the barrel carefully for U40 or U100 to be sure! To inject, pull skin up first, and insert the needle firmly parallel to the body, bevel side up[6]. Insulin syringes are intended for a single use only. Using them twice[7] may contaminate and/or interfere with some insulin's activity, in addition to wearing the protective coating off the needle and causing more pain at injection[8]. When the protective silicon coating is worn away by re-use, it can also contaminate the insulin; white precipitates[9]can form in the vial from the silicon, possibly interfering with the action of the insulin[10]. Comparing the first use and the sixth use in the photo examples, you can see how the coating has almost been totally worn off by the sixth use. You can also see the point beginning to blunt after second use. When a needle becomes blunted from re-use as you see in the photos, it can create lipohypertrophy due to skin damage[11]. Injecting insulin into areas like this means poor or slow insulin absorption. Some people use yesterday's syringe or disposable needle as a lancet, though. You can also see that when the needle is held with the bevel Continue reading >>
Insulin Syringes
An insulin syringe has three parts: a needle, a barrel, and a plunger. The needle is short and thin and covered with a fine layer of silicone to allow it to pass through the skin easily and lessen pain. A cap covers and protects the needle before it is used. The barrel is the long, thin chamber that holds the insulin. The barrel is marked with lines to measure the number of insulin units. The plunger is a long, thin rod that fits snugly inside the barrel of the syringe. It easily slides up and down to either draw the insulin into the barrel or push the insulin out of the barrel through the needle. The plunger has a rubber seal at the lower end to prevent leakage. The rubber seal is matched with the line on the barrel to measure the correct amount of insulin. Insulin syringes are made in several sizes. Syringe size and units Syringe size Number of units the syringe holds 1/4 mL or 0.25 mL 25 1/3 mL or 0.33 mL 30 1/2 mL or 0.50 mL 50 1 mL 100 Use the smallest syringe size you can for the dose of insulin you need. The measuring lines on the barrel of small syringes are farther apart and easier to see. When you choose the size of syringe, consider the number of units you need to give and how well you can see the markings on the barrel. A 0.25 mL or 0.33 mL syringe usually is best for children (who often need very small doses of insulin) and for people with poor eyesight. A 1 mL syringe may be best for an adult who needs to take a large amount of insulin. This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.© 1995-2015 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Continue reading >>
Interactive Dosing Calculator
Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>
Insulin
What is it? Insulin is a substance produced by the pancreas that is used by the body to break down sugars in the blood. While in a healthy adult it occurs naturally in the body, it can be manufactured from synthetic materials or harvested and refined from animal sources so that it can be given to patients who have a shortage of insulin in their bodies. What is it used for? Insulin is primarily used in the treatment of diabetes. Someone who has diabetes has too much sugar in their blood; to maintain lower blood sugar levels that are in the normal range, diabetics are often given insulin. What is the correct dosage? The correct dosing of insulin is very important: Giving a patient too little insulin does not adequately lower blood sugar so that they are still left with too much sugar in the blood; too much sugar the the blood can cause damage to blood vessels, leading to blindness, kidney failure, severe problems with limbs (especially the feet), stroke and heart disease. Giving a patient too much insulin can lower blood sugar too much and lead to dangerously low levels of sugar in the blood, which can cause seizures and coma, because the brain depends primarily on glucose (sugar) in the blood for fuel. Even before a person's blood sugar level drops low enough to cause seizure or coma, low blood sugar levels can lead to mood swings, impaired mental function, blurred vision, nausea and vomiting, heart palipitations and shakiness. How is it given? Insulin is given by injection because it cannot be taken orally - the stomach will break it down so that is is no longer effective in breaking down blood sugar. Insulin should always be dosed using special insulin syringes marked with insulin units. Common insulin U-100 syringes can hold 100 units; there are also Lo-dose syringes, Continue reading >>
U40 Syringes
U40 syringes are intended for use with U40 (40 units per cc) insulin. The "units" therefore appear larger on a U40 syringe, making fine doses easier to measure than on a U100 syringe. But note -- 1/2cc remains 1/2 cc. Comparing two 1/2cc syringes side by side, you will see that the units on the U40 syringe appear larger than that of the U100 syringe. If you were to take the two syringes and fill them with insulin or fluid, both the U100 and the U40 syringe would each hold 1/2cc of it. Cubic centimeters (cc's) and milliliters (mL's) are interchangable, so syringes marked 1ml equals 1cc; 0.5 ml equals 1/2cc. 3/10cc equals 0.3ml. [1] General information and an overview of syringes at the link. U40 syringes are available in 4 barrel sizes: 2cc (2ml), 1cc (1ml), 1/2cc (0.5ml), and 3/10cc (0.3ml). The size refers to the maximum volume of insulin the syringe will hold. A 3/10cc-0.3ml syringe is available in UltiCare brand only. The 2cc (2ml) syringe was introduced in early 2007 in the UK by Intervet for Caninsulin; this appears to be the only market the larger syringes are sold in. [2][3] Some brands of U40 syringes (Caninsulin, [11] BD) also have all red barrel markings. Intervet branded Vetsulin syringes and Ulti-Care do not; theirs are in black like those of U100 syringes. [12] U40 insulin syringes are available in standard 1/2" length with a choice of either 28 or 29 gauge needles. The thinnest gauge U40 syringe currently available in the US is 29. [13] BD markets U-40 syringes with 30 gauge needles outside of the US under its MicroFine brand name. [14][15] The higher the gauge number, the thinner the needle. [16] AAHA recommends 12.7 mm or 1/2", standard length needles at 29 gauge. [17] Though it's not recommended by veterinarians, some caregivers use a U100 syringe with Continue reading >>
How To Read A Syringe
This article will explain how to read a syringe. As a nurse, it is very critical you understand how to properly read a syringe. There are many different types of syringes available for usage. The nurse will need to select the appropriate syringe size based on how much of a medication is ordered by the physician. For example, if a physician orders 0.25 mL of a medication, the 1 mL syringe is the best for achieving this dose because it allows you to measure very small amounts of a medication. Therefore, I will be discussing how to read 5 different types of syringe you will encounter as a nurse, such as: 10 mL 5 mL 3 mL 1 mL 100 unit Insulin Video on How to Read a Syringe Parts of the Syringe Adaptor: this is the area where you screw on a needle (if you were giving an intramuscular injection etc.) or onto the IV hub of the patient’s IV to give a medication. Barrel with a readable scale: this is where you will match up the top of the plunger (see image below) and the line on the scale with the amount of medication you need to administer. Most scales on the barrel are in mL (milliliters) or cc (cubic centimeters). If you are administering insulin you will use a syringe that measures in units. NOTE: always determine the capacity of your syringe because each syringe has different measurements on its scale..hence each line represents a different increment of measurement (more information on this below). Plunger: assists will drawing up and injecting the medication Tip: If you hear someone say give “10 cc” of this medication, cc is the same as mL. Therefore, 10 mL equals 10 cc. Reading a 10 mL Syringe This is a 10 mL syringe. Each line measures in 0.5 increments until it reaches a total capacity of 10 mL. TEST YOURSELF: How much is in this 10 mL syringe? (answer key below) Continue reading >>
How Do You Convert Units Of U-100 Insulin To Milliliters?
Our question this week was: Dr. Debra –I have a husky that is a diabetic. He gets 30 units of Humulin NPH insulin every 12 hours. It is a U-100 insulin and I have U-100 syringes and 1 ml syringes. I'm actually out of U-100 syringes and wondered if I can us a ml. How many milliliters are 30 units? Beverly H. Answer Hi Beverly – thanks for your email. It is possible to convert units to milliliters. Please be very careful when doing this type of calculations. The U-100 means there are 100 units in 1 milliliter. 30 units of a U-100 insulin are equal to 0.3 milliliters (0.3 ml). I have a chart that will help you. Go to: How to Convert U-100 Insulin in Units to Milliliters. A couple more articles that might be helpful to you are Insulin, Home monitoring or the Diabetic Dog and Diabetes Mellitus in Dogs. Best of luck! Dr. Debra To read most recent questions Click here! Click here to see the full list of Ask Dr. Debra Questions and Answers! Continue reading >>
Lantus 100 Units/ml Solution For Injection
Lantus 100 units/ml solution for injection in a vial Lantus 100 units/ml solution for injection in a cartridge Lantus SoloStar 100 units/ml solution for injection in a pre-filled pen Each ml contains 100 units insulin glargine* (equivalent to 3.64 mg). Vial Each vial contains 5 ml of solution for injection, equivalent to 500 units, or 10 ml of solution for injection, equivalent to 1000 units. Cartridge, SoloStar pre-filled pen Each cartridge or pen contains 3 ml of solution for injection, equivalent to 300 units. *Insulin glargine is produced by recombinant DNA technology in Escherichia coli. For the full list of excipients, see section 6.1. Treatment of diabetes mellitus in adults, adolescents and children aged 2 years and above. Posology Lantus contains insulin glargine, an insulin analogue, and has a prolonged duration of action. Lantus should be administered once daily at any time but at the same time each day. The dose regimen (dose and timing) should be individually adjusted. In patients with type 2 diabetes mellitus, Lantus can also be given together with orally active antidiabetic medicinal products. The potency of this medicinal product is stated in units. These units are exclusive to Lantus and are not the same as IU or the units used to express the potency of other insulin analogues (see section 5.1). Special population Elderly population (≥65 years old) In the elderly, progressive deterioration of renal function may lead to a steady decrease in insulin requirements. Renal impairment In patients with renal impairment, insulin requirements may be diminished due to reduced insulin metabolism. Hepatic impairment In patients with hepatic impairment, insulin requirements may be diminished due to reduced capacity for gluconeogenesis and reduced insulin metabolism Continue reading >>
95% Of New Start Basal Insulin Patients Rated Toujeo® Solostar® As Easy To Use After Training And 4 Weeks Of Use1,a
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. Contraindications Toujeo® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or any of its excipients. Warnings and Precautions Toujeo® contains the same active ingredient, insulin glargine, as Lantus®. The concentration of insulin glargine in Toujeo® is 300 Units per mL. Insulin pens and needles must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimens cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Changes in insulin regimen may result in hyperglycemia or hypoglycemia. Unit for unit, patients started on, or changed to, Toujeo® required a higher dose than patients controlled with Lantus®. When changing from another basal insulin to Toujeo®, patients experienced higher average fasting plasma glucose levels in the first few weeks of therapy until titrated to their individualized fasting plasma glucose targets. Higher doses were required in titrate-to-target studies to achieve glucose control similar to Lantus®. Hypoglycemia is the most common adverse reaction of insulin therapy, including Toujeo®, and may be life-threatening. Medication errors such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label bef Continue reading >>
Calculating Insulin Dose
You'll need to calculate some of your insulin doses. You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight. Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars. In this section, you will find: First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. Bolus – Carbohydrate coverage The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio. The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 6-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Bolus – High blood sugar correction (also known as insulin sensitivity factor) The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high bloo Continue reading >>
U-40 Insulin/u-100 Syringe
U40 versus U100 Conversion chart Diluted insulin Proper diluent Many people special order protamine zinc insulin (PZI) that is U-40. Some people order U-50 insulin, and some people use insulin that has been diluted. If you are using something other than a standard U-100 insulin, you must understand what the U means and how many units of insulin you are giving your pet. The U refers to actual units of active insulin. Units are a standard measurement system for many drugs. A U-100 insulin has 100 units of active insulin in each mL of liquid. You can think of it as being 100 pieces of insulin in each mL of liquid. A U-40 insulin has 40 units of insulin in each milliliter (mL) of liquid. This means that the same volume (liquid amount) of a U-100 insulin has 2.5 times more insulin in it than a U-40 insulin. Or, the U-100 insulin is 2.5 times stronger than the U-40 insulin. Most commercially available insulins are U-100 and the syringes we purchase at the pharmacy are U-100 syringes. U-100 syringes are specially designed to provide the proper dose of U-100 insulin. If you use a U-100 insulin and a U-100 syringe, you fill the syringe the way the vet showed you. If you use a U-40 insulin and the U-40 syringes that are provided with that insulin, you fill the syringe in the normal manner and don't need to do any conversions. Some people who use special order U-40 PZI often prefer to use the U-100 syringes because they are readily available at the local pharmacy and they have a very thin needle. But if you use a U-40 insulin and a U-100 syringe, you must correct for the difference in the strength of the insulin when you fill the syringe. The following information explains how to fill a syringe using a U-40 insulin and a U-100 syringe. To get a specific number of units of U-40 ins Continue reading >>
Insulin Delivery Options
There are many ways to take NovoLog®. You and your health care provider will choose the way that works best for you. Some people take their insulin injection using a vial and syringe or an insulin pump. But many people who take NovoLog® use an insulin pen called NovoLog® FlexPen®. NovoLog® FlexPen® There are many reasons why NovoLog® FlexPen® is widely used. NovoLog® FlexPen® does not stand out the way an old-fashioned vial and syringe might. So most people who see you take out your FlexPen® probably won’t even know what it is. This may make you feel better using it in front of others in restaurants, at work, and even at home. Your FlexPen® is prefilled with NovoLog® insulin. And, it’s ready to use in just a few steps. Simply dial the exact amount of insulin you need and inject by pressing a button. View NovoLog® FlexPen® instructions online or download a printable patient brochure. NovoLog® FlexPen® fits in a pocket or purse and is: Able to deliver from 1 to 60 units of insulin Adjustable in 1-unit dosing amounts Ready to go! Once in use, it can be used for up to 28 days without refrigeration. To view full storage details, click here. NovoLog® FlexPen® lasts up to 28 days without refrigeration after first use, so it can be taken almost anywhere. Once in use, NovoLog® FlexPen® must be kept at room temperature, below 86°F. NovoLog® FlexPen® is disposable, so there is no refilling. When you run out of insulin, throw out your old FlexPen® and start fresh with a new one. Each NovoLog® FlexPen® package has 5 disposable insulin pens, for a total of 1500 units of NovoLog® insulin. Saving on NovoLog® FlexPen® NovoLog® FlexPen® is covered by most health care and Medicare prescription plans. You can get NovoLog® FlexPen® for about the same co Continue reading >>
Math Calculations With Diabetes Insulin
www.TakeRx.com Calculate the total quantity and the total days supply for the following Rx: Humalog 75/25 30U sq am/pm #3 vials ------------------------------------------------------------ The doctor has prescribed 3 vials of Humalog Mix 75/25 Each vial of Humalog Mix has 10 mL of insulin 1 vial = 10 mL and then 3 vials = 30 mL So, the total quantity to be dispensed will be 30 mL The sig says: inject 30 units subcutaneously in the morning and in the evening In other words, the patient will inject 60 units per day. Now, we need to convert 60 units into mL We know that the ratio is 1mL/100U x / 60U = 1mL / 100U x = (60 * 1) / 100 x = 0.6 mL So, the patient will inject 0.6 mL per day. Now, the total days supply will be 30mL divided by 0.6mL which is 50 days. Calculate the total quantity and the total days supply for the following Rx: Levemir insulin qty: 1 inj 60 units sc qd ------------------------------------------------------------ The doctor has prescribed the brand-name drug Levemir insulin. The doctor wants the pharmacist to dispense one vial. One vial has 10 mL of insulin. So, the total quantity to be dispensed is 10mL The sig says: inject 60 units subcutaneously every day The ratio for the insulin is 1 mL per 100 units. We need to convert 60 units into mL x / 60 U = 1 mL / 100 U x = (60U * 1mL) / 100U x = 60 / 100 x = 0.6 mL In turn, the patient will use 0.6 mL per day. Now, the total days supply will be 10 mL divided by 0.6 mL which is 16 days. Calculate the total quantity and the total days supply for the following Rx: Levemir flexpen #15 mL 70 U qd ------------------------------------------------------------ The doctor has prescribed Levemir flexpen injection (U-100) 5X3mL prefilled pens. The package has 5 pens and each pen has 3mL and, thus, we can say the pack Continue reading >>
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Pet Syringe How To’s
I get many questions from owners of pets with diabetes. This month, I address pet insulin syringes. Dear Dr. Gary, My dog has been getting 5 units of insulin with U-40 syringes, but I ran out of syringes and I all have are U-100 syringes. Is 1 unit of insulin in a U-40 syringe equal to 1 unit in a U-100 syringe? George For George and other pet owners, I’m sure it gets confusing at times. Let’s back up a moment so I can explain the difference between U-40 and U-100. Always discuss your pet’s health with your veterinarian before administering any medication. A vial of insulin contains a sterile solution and an insulin source. The amount of insulin your dog or cat needs is measured in units. Veterinary insulin is available in different concentrations, commonly known as U-40 or U-100 vials. The “U” is an abbreviation of unit and the number after the unit represents the concentration, i.e. how many units (‘pieces of insulin’) are in one milliliter (mL). A U-40 syringe has 40 units (‘pieces of insulin’) per mL and a U-100 syringes has 100 units (‘pieces of insulin’) per mL. This means there is approximately 2.5 times more insulin (‘pieces’) in a unit of U-100 insulin compared to U-40 insulin or to put it another way the same amount of U-100 insulin is 2.5 times stronger than the U-40. U-40 and U-100 are the common insulin concentrations and syringe types used to treat dogs and cats. To give insulin to your animal, there are two types of syringes available, U-40 and U-100. A 1 mL syringe is universal, but the difference is a U-40 syringe has unit increments up to 40, whereas a U-100 syringe has markings up to 100. Looking at a ½ mL of insulin in each syringe, a U-40 will have 20 units and a U-100 will contain 50 units of insulin. It is essential for Continue reading >>
Math Calculations With Humulin Insulin
www.TakeRx.com Calculate the total quantity and the total days supply for the following drug: Humulin N (U-100); #10 mL vial; Sig: 18 units AM and 26 units PM ------------------------------------------------------------ The total quantity to be dispensed is 10 mL as stated by the doctor. The sig says: inject 18 units in the morning and 26 units in the evening 18 units + 26 units = 44 units per day Now, we need to convert 44 units (U) into milliliters (mL) The insulin ratio is 100 units per 1 mL, that is, 1 mL per 100 units x / 44 U = 1 mL/100 U x = (44 U * 1 mL) / 100 U x = 0.44 mL So, the patient injects 0.44 mL per day. The total days supply will be 10 mL divided by 0.44 mL which is 22 days. It is worth noting that Humulin insulin is an over-the-counter insulin. If the patient is just paying with cash, then the patient does not really need a prescription from the doctor. But, if the insurance company is going to be billed for Humulin insulin, then a prescription from the doctor is required. What are the total quantity and the total days supply for the following drug: Humulin N (U-100); #10 mL vial; Sig: 25 units AM and 30 units PM for 30 days ------------------------------------------------------------ The total days supply is 30 days as stated by the doctor. In this case, the pharmacist will have to dispense enough insulin to last 30 days. The sig says: inject 25 units in the morning and 30 units in the evening for 30 days 25 units + 30 units = 55 units per day Now, we need to convert 55 units (U) into milliliters (mL) The insulin ratio is 100 units per 1 mL, that is, 1 mL per 100 units x / 55 U = 1 mL/100 U x = (55 U * 1 mL) / 100 U x = 0.55 mL So, the patient injects 0.55mL per day. In turn, 30 days * 0.55 mL = 16.5 mL The patient will inject 16.5 mL per month. But Continue reading >>
