Grudge Match: Pens Vs. Syringes
Taking insulin is a cornerstone of care for millions who have diabetes, and the most common method of insulin delivery in the U.S. is injection via needle and syringe. Roughly 20% of insulin users wear an insulin pump, 15% use insulin pens, and less than 1% use jet injectors. Insulin pumps can be expensive, with the average price hovering around $6,500, not including the disposable supplies that have to be replenished regularly, such as infusion sets, cartridges, and batteries. Although jet injectors may seem like a dream come true for patients who fear needles, they have been known to cause bruising and more pain than injections. The big question is why insulin pens are not more popular in the U.S., whereas in Europe and Japan, they comprise from 66% to 75% of insulin prescriptions. It’s not for lack of patient appreciation: In the November 2011 issue of the Journal of Diabetes Science and Technology, a review of 43 studies that compared patient- reported outcomes for insulin pen devices found that patients preferred pens over vial and syringe for myriad reasons, including ease of use, less pain, and greater perceived social acceptance. Indeed, patients are generally receptive to pen use — if their physicians bring it up. A study published in the March 2008 issue of Diabetes Care found that physician encouragement had a tremendous impact on pen use: Patients whose physicians discussed insulin pens were 100 times more likely to use an insulin pen than those whose physicians did not discuss pen use or who discouraged pen use. One reason pens have not caught on here may be payer reimbursement, says Maria J. Redondo, MD, PhD, MPH, assistant professor of pediatrics at Baylor College of Medicine in Houston and co-author of the 43-study review. “Pens are more expensive 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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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 >>
Insulin, Oh Insulin, Where For Art Thou, Insulin?
I can’t do it. I simply just can’t do it. I can’t bear to think that I’m throwing away as much insulin as I am with every cartridge change with Tandem’s insulin pump. It just doesn’t feel right. Not sure what I’m talking about? Let me give you a run-down. With any competitor pump out there, you can fill the cartridge and probably waste an average of 10 to 15 units filling the tubing and site during set up. From there, you can simply run the pump down to no insulin at all if you’d like, and only be losing that 10-15 units. Over a month (if you change out every 3 days), you’re looking at a grand total of 100 to 150 units per month that you’re losing due to the space in the tubing that needs to be filled. With *my* Tandem t:slim pump, because it’s made with a bag-design, the pump can’t read all of the units that are placed in the pump. (Emphasis on MY because apparently this is different for others. I must have gotten a dud or something) Take for instance, last night. I filled the cartridge with 160 units. The pump recognized only 115 units of that. That is a difference of 45 units that will not be usable unless after I use the cartridge, I draw it back out and re-use it in the next cartridge (which is TOTALLY not recommended). But if you were to follow everything by the letter, I am wasting a massive average if 45-55u per cartridge. That doesn’t even account for the extra 10 units that it takes to fill the tubing on top of the already standard 10-15 units. So, overall, 55-60 u per change out… every three days. That’s 550-600u per month. That’s a half of a bottle of insulin or more per month that I’m throwing in the trash can, never to be used. Just since starting back on it, in ONE week, I’m down a half-vial. I’ve NEVER used that much Continue reading >>
Insulin Pens: Improving Adherence And Reducing Costs
The advantages offered by insulin pens may help improve patient adherence. Currently 8.3% of the United States adult population, or 25.8 million people, have diabetes. Of these cases, more than 90% are cases of type 2 diabetes mellitus (T2DM) and at least 1 million are estimated to be cases of type 1 diabetes mellitus (T1DM). Although a variety of oral medications are available for patients with diabetes, insulins remain an important component of treatment.1,2 Insulins are the standard therapy in patients with T1DM and are ultimately used in patients with T2DM who do not respond adequately to other treatment modalities. Although in some settings insulins may be administered intravenously (eg, with an insulin pump), the vast majority of insulin administrations are subcutaneous injections.1,2 Available Forms and Administration In the United States, 2 types of insulins are available: recombinant human insulins and insulin analogs. Recombinant human insulin is available from 2 manufacturers (Humulin by Eli Lilly and Novolin by Novo Nordisk); each of these is available in a regular form and in a longer-acting neutral protamine hagedorn (NPH) form. Unlike recombinant human insulins, insulin analogs are structurally modified forms of insulin that are designed to either lower blood sugar rapidly or maintain low blood sugar levels over time. These insulin analogs may be classified as rapid-acting and long-acting insulins. Rapid-acting insulins include insulin lispro, insulin aspart, and insulin glulisine, and long-acting insulins include insulin glargine and insulin detemir. Premixed formulations of insulin are also available.1,2 Regardless of the differences between insulin formulations, all conventional types of insulin can be administered subcutaneously. Subcutaneous injectio Continue reading >>
9.6 Ml
Liquid Dosage Calculations The concentration of medication in a liquid solution or suspension is expressed in mass/volume (such as milligrams per milliliter) . Orders for liquid medication, however, are expressed in mass (milligrams, for example). Suppose the dosage ordered is 500 mg and the available concentration is 2.50 mg/ml. Our usual set-up for dosage calculations would be: The problem that the dosage on hand is expressed as a concentration — mg/ml. But we need to flip over the expression. That is why the boxes above show instead of . So the procedure is correctly expressed with the Dosage on Hand term flipped over. And now the mg labels cancel out perfectly: 200 ml is required. Note The previous example shows how proper dimension-analysis procedures can tell you when you are making a set-up error. This feature helps prevent math errors. It can save your reputation ... and even a life. Example Complete the math: Result: 21.4 ml Cancel the labels: Complete the math: Result: 0.08 ml or 80 mcg Here is how you would actually work such problems for exams or on the job. Dosage Ordered: 400 mg Stock Available: 500 mg/L Answer: 0.8 L or 800 ml Liquid Dosage Drill Work with this drill routine until you can consistently answer the questions correctly. You should have no need for a calculator. [ ** Interactive 020301 here **] Real-World Examples 1. You are to give the patient Ampicillin 250 mg PO q 6h. The suspension on hand contains 125 mg per 5 ml. How many ml will the patient receive per dose? ______ Ans: 10 ml 2. The order is to give Dilantin 100 mg PO t.i.d. The available suspension contains 30 mg per 5 ml. How many ml. will you give? ______ Ans: 16.7 ml 3. The physician has ordered Tetracycline syrup 500 mg q 6h PO The available medication contains 125 mg per 5 ml. H Continue reading >>
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 >>
Price Tag On Old Insulin Skyrockets
Retired nurse Mary Smith was having trouble controlling her type 2 diabetes on her regular insulin regimen, so her doctor decided to put her on something stronger. Amber Taylor, MD, director of The Diabetes Center at Mercy Medical Center in Baltimore, wrote Smith a prescription for Humulin U-500 insulin, a much more concentrated form of the drug. It could deliver far more active ingredient at far less overall volume, which was important since Smith's insulin doses were getting high. But when Smith showed up at the pharmacy, she was told she'd have to shell out $900 for a vial. "There was no way I could afford that," Smith told MedPage Today as she recalled the pharmacy visit, which happened about a year ago. And the price has gone up since then: Now a single bottle of highly concentrated Humulin U-500 insulin that lasts a diabetes patient about one month costs $1,200 wholesale -- more than five times the $220 it cost in 2007. Those increases have far surpassed those for the less concentrated Humulin U-100, which only rose three times during that period, at a rate comparable to the rest of the insulin market, a MedPage Today analysis found. Although less than 5% of all diabetes patients are taking U-500, Taylor and other clinicians are wondering why an old insulin that had been on the market for many years and had remained relatively cheap suddenly became a valued commodity. "I've had patients with a $2,500 deductible who can't put down $1,200 for a bottle of insulin," Taylor told MedPage Today. "For them, it's pay the mortgage or buy my insulin -- what do you want me to do?" An Old Drug With a High Price Tag Insulin is an old drug. Eli Lilly first put it on the market in 1923, and its more concentrated U-500 formulation, which was made from beef pancreas, appeared in 19 Continue reading >>
Ptce Quiz 6 Review
How many days will it take a patient injecting 23 units of Humulin R insulin daily to complete a 10 ml vial? A. 30 days B. 23 days C. 43 days D. 14 days C. 43 days Which size needle and syringe would a very thin patient use if injecting 23 units of insulin daily? A. 1cc short 25 gauge B. 1/3 cc short 30 gauge C. ½ cc long 30 gauge D. 1/3 cc long 25 gauge B. 1/3 cc short 30 gauge Glucagon is used: A. When a patient has high blood sugar (hyperglycemia) B. As a substitute for sugar in their diets. C. When a patient has low blood sugar (hypoglycemia) D. daily with insulin injections to prevent hypoglycemia. C. For low blood sugar Type 1 diabetics would not use which medication? A. Lantus B. Glucagon C. Glucotrol D. Lispro C. Glucotrol Which insulin is cloudy? A. Humulin R B. Humulin N C. Lantus D. All the drugs listed are cloudy B. Humulin N Which statement is true regarding insulin and refrigeration? A. Insulin should never be refrigerated. B. Insulin should never be left outside of the refrigerator. C. Insulin is good for approximately 28 days outside of refrigeration. D. Insulin burns more when injected at room temperature. C. Which statement is true regarding Type 2 diabetes? A. Usually diagnosed during pregnancy. B. Only use insulin. C. Can use both insulin and oral medications. D. All of the answers are correct. C. Can use both insulin and oral medications. Type 1 diabetics can increase their pancreatic output of insulin by changing their diet and exercise. A. True B. False B. False Which insulin comes in an inhalation dosage form? A. Exubera B. Lantus C. Humalog D. Humulin 70/30 mix A. Exubera Which insulin can be given IV? A. Humulin R B. Humulin N C. Lantus D. Humalog mix 75/25 A. Humulin R What is the proper temperature for insulin storage? A. 10-20 degrees Fah Continue reading >>
Successful Treatment Of Your Diabetic Dog
Your pet has been diagnosed by your veterinarian with diabetes mellitus (sugar diabetes)!Now what? The following is some basic information you should know to successfully treat your dog’s diabetes. Diabetes can be a difficult and unpredictable disease to manage.By employing the techniques below the treatment can be made less frustrating. Most dogs are Type 1 diabetics.This means that special cells in a gland called the pancreas are no longer producing insulin.Insulin is necessary to facilitate the use of the fuel, glucose, by the body’s cells. It is necessary for survival and must be given by injection.Insulin needs to be refrigerated; always be aware of the expiration date on the vial. TYPES OF INSULIN: Humulin-N®:this is a human insulin available without prescription at local pharmacies. Humulin® is a U-100 product meaning there are 100 units of insulin per milliliter (ml) or cubic centimeter(cc). So there are 1000 units in a 10 cc vial.Prices vary considerably so shop around.There are few, if any, mom’n’pop pharmacies anymore, but we checked some of the big guys and the prices ranged from $47.99 to $124.89 per vial.Syringes used must be calibrated for U-100 insulin.The syringes should have a 29 or 31 gauge, ½” ultra-fine needle – ½” to be certain of injecting under the dog’s skin.Humulin-N® should be administered every 12 hours. Vetsulin®:This is insulin made for dogs and available only from your veterinarian.Vetsulin® is a U-40 product (40 units per cc) meaning there are 400 units in a 10 cc vial.If your veterinarian opts for this insulin make sure he or she provides syringes calibrated for U-40.Like Humulin®, Vetsulin® should be given every 12 hours. THE PROCESS: Regulation:This refers to the process performed by your vet involving the chec Continue reading >>
Math Calculations With Lantus Insulin
www.TakeRx.com Calculate the total quantity and the total days supply for the following Rx: Lantus 100U/ML 25 units sq qam (1 month supply) ------------------------------------------------------------ The days supply is 30 days as stated by the doctor. The sig says: inject 25 units subcutaneously every morning Now, we need to convert 25 units (U) into mL The insulin ratio is 100 units per 1 mL, that is, 1 mL per 100 units x / 25 U = 1 mL / 100 U x = (25 * 1) / 100 x = 0.25 mL So, the patient will inject 0.25 mL per day. Then, the quantity will be 0.25mL * 30 days which is 7.5mL But, the pharmacist will have to dispense a 10mL vial of Lantus insulin. In other words, one bottle of Lantus insulin has 10mL So, the total quantity to be dispensed is 10 mL Calculate the total quantity and the total days supply for the following Rx: Lantus insulin 30U sq am 20 days ------------------------------------------------------------ The doctor has prescribed Lantus 100U/mL insulin injection. The total days supply is 20 days as stated by the doctor. The sig says: inject 30 units subcutaneously in the morning Now, we need to convert 30 units into mL The insulin ratio is 100 units per 1 mL, that is, 1 mL per 100 units x / 30 U = 1 mL / 100 U x = (30 * 1) / 100 x = 0.3 mL The patient will inject 0.3 mL per day. Then, the total quantity will be 0.3 mL * 20 days which is 6 mL But, one bottle of Lantus insulin has 10 mL and therefore the pharmacist will dispense a 10mL vial of Lantus insulin. So, the total quantity to be dispensed is 10 mL Calculate the total quantity and the total days supply for the following Rx: Lantus 100U/ML cartridge sig: 30 units qam ------------------------------------------------------------ The box has 5 cartridges and each cartridge has 3 mL of insulin. So, if 1 ca Continue reading >>
Actrapid 100 International Units/ml, Solution For Injection In A Vial
Package leaflet: Information for the user Actrapid® 100 IU/ml (international units/ml) solution for injection in vial Read all of this leaflet carefully before you start using this medicine because it contains important information for you. Keep this leaflet. You may need to read it again. If you have any further questions, ask your doctor, pharmacist or nurse. This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4. Go to top of the page 1. What Actrapid® is and what it is used for Actrapid® is human insulin with a fast-acting effect. Actrapid® is used to reduce the high blood sugar level in patients with diabetes mellitus (diabetes). Diabetes is a disease where your body does not produce enough insulin to control the level of your blood sugar. Treatment with Actrapid® helps to prevent complications from your diabetes. Actrapid® will start to lower your blood sugar about half an hour after you inject it, and the effect will last for approximately 8 hours. Actrapid® is often given in combination with intermediate-acting or long-acting insulin preparations. Go to top of the page 2. What you need to know before you use Actrapid® Do not use Actrapid® If you are allergic to human insulin or any of the other ingredients in this medicine, see section 6. If you suspect hypoglycaemia (low blood sugar) is starting, see Summary of serious and very common side effects in section 4. In insulin infusion pumps. If the protective cap is loose or missing. Each vial has a protective, tamper-proof plastic cap. If it is not in perfect con Continue reading >>
Insulin: How To Give A Shot
Many people with diabetes need to take insulin to keep their blood glucose in a good range. This can be scary for some people, especially for the first time. The truth is that insulin shots are not painful because the needles are short and thin and the insulin shots are placed into fatty tissue below the skin. This is called a subcutaneous (sub-kyu-TAY-nee-us) injection. The following instructions are for using a vial and syringe. For instructions on how to use an insulin pen, ask your doctor or diabetes educator. What You Will Need Before you give the shot, you will need the following: Insulin (This comes in a small bottle or vial.) Alcohol swab, or cotton ball moistened with alcohol Syringe with needle (You will need a prescription to buy syringes from a pharmacy. Check with your pharmacist to be sure the syringe size you are using is correct for your dose.) Hard plastic or metal container with a screw-on or tightly-secured lid Parts of a Syringe and Needle You will use a syringe and needle to give the shot. The parts are labeled below. Wash the work area (where you will set the insulin and syringe) well with soap and water. Wash your hands. Check the drug label to be sure it is what your doctor prescribed. Check the expiration date on the vial. Do not use a drug that is past the expiration date. Look at the insulin. Short or rapid-acting insulin (Regular, Humalog, NovoLog, Apidra) and Lantus or Levemir should appear clear. Do not use it if the drug appears to have pieces in it or is discolored. Intermediate or mixed insulin (NPH, 75/25, 70/30, or 50/50) will appear cloudy and white. This type of insulin should be gently mixed before use. To do this, roll the vial between your hands. You also can turn it gently. Remove the lid from the top of the insulin vial. (After Continue reading >>
Product Label
Go to site For Pet Owners NADA 141-236, Approved by FDA PRODUCT INFORMATION CAUTION Federal law restricts this drug to use by or on the order of a licensed veterinarian. DESCRIPTION vetsulin® is a sterile aqueous zinc suspension of purified porcine insulin. Each mL contains: Purified porcine insulin 40 IU (35% amorphous and 65% crystalline) Zinc (as chloride) 0.08 mg Sodium acetate trihydrate 1.36 mg Sodium chloride 7.0 mg Methylparaben (preservative) 1.0 mg pH is adjusted with hydrochloric acid and/or sodium hydroxide. INDICATION vetsulin® (porcine insulin zinc suspension) is indicated for the reduction of hyperglycemia and hyperglycemia-associated clinical signs in dogs and cats with diabetes mellitus. DOSAGE AND ADMINISTRATION USE OF A SYRINGE OTHER THAN A U-40 SYRINGE WILL RESULT IN INCORRECT DOSING. FOR SUBCUTANEOUS INJECTION IN DOGS AND CATS ONLY Shake the vial thoroughly until a homogeneous, uniformly milky suspension is obtained. Foam on the surface of the suspension formed during shaking should be allowed to disperse before the product is used and, if required, the product should be gently mixed to maintain a homogeneous, uniformly milky suspension before use. Clumps or white particles can form in insulin suspensions: do not use the product if visible clumps or white particles persist after shaking thoroughly. Using a U-40 insulin syringe, the injection should be administered subcutaneously, 2 to 5 cm (3/4 to 2 in) from the dorsal midline, varying from behind the scapulae to the mid-lumbar region and alternating sides. Always provide the Owner Information Sheet with each prescription. Dogs The initial recommended vetsulin® dose is 0.5 IU insulin/kg body weight. Initially, this dose should be given once daily concurrently with, or right after a meal. Twice da Continue reading >>
Dosage & Calc
Sort An adult has a prescription for: Epogen (epoetin alfa) 15,000 units subcut q day. The vial strength is: Epogen 10,000 units/mL. Which is the best method to teach him to administer these injections to himself? 1. Use two syringes, draw up 0.75 mL in each syringe, and administer in two different abdominal sites. 2. Draw up 15 mL of the medication and administer it through his intravenous site. 3. Draw up 1.5 mL of the medication in a syringe and administer it into the upper arm adipose tissue. 4. Draw up 1.5 mL of the medication in one syringe and administer it in one vastus lateralis site. 1. Use two syringes, draw up 0.75 mL in each syringe, and administer in two different abdominal sites. The nurse wants to select the most potent solution available to clean a wound. Which of the following solutions is the most potent? 1. 5:100 millitlers 2. 1:20 millitlers 3. 1:100 millitlers 4. 1:10 millitlers 1 : 10 mL The student nurse is learning how to write decimals to prevent medication errors. According to national health care standards, which of the following examples is expressed correctly? 1. 00.0125 milligrams 2. .0125 milligrams 3. 0.01250 milligrams 4. 0.0125 milligrams 4. 0.0125 milligrams The nurse is comparing a medication that is available in different amounts. Which of the following medications has the most medication? 1. 0.08 milligrams 2. 0.206 milligrams 3. 0.5 milligrams 4. 0.35 milligrams 3. 0.5 milligrams There are 4 patients receiving dextrose in their intravenous fluids. Which patient is receiving the most dextrose? 1. 10% dextrose solution 2. 1% dextrose solution 3. 5% dextrose solution 4. 50% dextrose solution 4. 50% dextrose solution The nursing student is reviewing rules of the metric system. Which of the following notations is acceptable? 1. 400 cc Continue reading >>
