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Insulin pens and 28-day rule

Discussion in 'Parents of Children with Type 1' started by momof2greatkids, May 22, 2011.

  1. momof2greatkids

    momof2greatkids Approved members

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    I've been curious about this for awhile. I've seen that often when your CWD is on a pump and needs a correction, several of you will give the correction with a syringe or pen. When you do this, do you have the insulin set out at room temperature prior to the injection, or do you pull it directly from the refrigerator? When you're using a pen occasionally for this type of correction, I'm assuming it goes back in the refrigerator. Do you keep the pen indefinitely, or once you've used it once, do you start counting down the 28 days and throw it away after that?

    Also, we have a Levemir pen that was used once in the hospital in December(we're on Lantus). They sent it home with us, and it's been in the butter compartment ever since. Would it be okay to use at this point if we had some reason to want to? If so, how long can we hang on to it?
     
  2. Catiesmom

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    We're on a pump now, the bottle of insulin stays in the frig util we fill the cartridge, then I warm it up a few minutes before filling the cartridge. Then it goes back in. I have syringes for it now if need be, I may or may not warm it up first. I know it doesn't need to be in the frig, but it's just a safe place for it.

    When we were on pens, I used them right from the frig without a problem. I used them up to 31 days without a problem too. We usually used them up before 30 days. Same for both my Novolog and Lantus pens. I would write the date we started using it on the pen in sharpie ink. After that toss it in the regular trash.

    I would toss that levemir pen, it's old.

    Catie age 10.5 dx 6/19/09 Animas Ping since 9/28/10 Novolog
     
  3. KatieJane'smom

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    We've used the pens straight out of the fridge. We've used them for longer than the 28 days when just using them occasionally for corrections. However, I do toss them once they have expired. Am I the only one that see dollar signs being thrown away when tossing out the insulin and such?
     
  4. MrsBadshoe

    MrsBadshoe Super Moderator

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    Two pump family here. Insulin that is in use is always on the counter. We don't use pens for corrections but my son likes to use syringes if he's high. I would think that if we used pens that they would stay in the fridge opened and use them as needed. We would probably waste insulin and have to throw them out at 28 days. So, the syringe works better for us.
     
  5. nanhsot

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    Vial comes out onto the counter the day that the pump needs to be refilled and sits on the counter to be used as needed, whether for pump or syringe. It lasts a little over a week. No pens anymore, other than a few samples of lantus we keep as backup. Basically we fill pump and use syringe from the same vial so there is never an issue of going bad as he goes through insulin pretty quickly these days.
     
  6. L101418

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    Anything used (pen or vial) we start the 28 day countdown whether it is stored on the counter or fridge.

    An unused pen I've thrown in my purse as back-up for the day goes back in the fridge and I would keep it until expiration. But if used I would toss it in 28 days.

    But I've had the same questions as you. If the vial is used but stored in the fridge isn't there a way to sqeak out a few more days. What starts the countdown clock? The "breaking of the seal" or the room temp or both?
     
  7. virgo39

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    When you're using a pen occasionally for this type of correction, I'm assuming it goes back in the refrigerator. Do you keep the pen indefinitely, or once you've used it once, do you start counting down the 28 days and throw it away after that?

    Also, we have a Levemir pen that was used once in the hospital in December(we're on Lantus). They sent it home with us, and it's been in the butter compartment ever since. Would it be okay to use at this point if we had some reason to want to? If so, how long can we hang on to it?

    We use pen cartridges to fill the pod. Once I pull a new cartridge out of the refrigerator, I keep it in our back up Novopen Jr. (so that if we are out and about for a longer time, I can toss it, with a few pen needles in DD's kit). I have a dry erase label on the pen and write the date that I removed it from the fridge on it. I would toss it after one month, but we go through 300 units in three pod changes.

    Once we remove insulin from the refrigerator, we leave it out at room temperature.
     
  8. Christopher

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    To the OP, some people find that injecting cold insulin hurts more than room temp insulin. Once it is opened, it normally does not last longer just because it is in the fridge. I personally don't like to use insulin longer than you are supposed to, mainly because of the uncertainty around its efficacy. However, I don't think a day or two over should make a big difference.
     
  9. KatieJane'smom

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    Never bothered my dd - just feels "cold"
     
  10. dejahthoris

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    Sorry if I am stating the obvious but from what I am gathering the question is, do you have to throw away insulin 28 from when it is opened, or 28 days after it has been allowed to reach room temp?


    I have always thrown it away 28 days from either one (or both). But I can see the reasoning of the question. Even tho it has been opened, as long as it has always been chilled, is it done for after 28 days or can you keep it until expiration?


    Great question and something I have wondered myself. Sorry If I am not getting this right. I am on one cup of coffee and multiple bg nite checks.
     
  11. Christopher

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    That is great :cwds:

    Many children find that it stings more.
     
  12. BrokenPancreas

    BrokenPancreas Banned

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    Hmmm.. My dd never complained about it being cold.
    She did complain about the Lantus (every day though)
     
  13. Becky Stevens mom

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    I have always used the cartridges in the pens longer then the 28 days. They do not lose much efficacy after this time but there is a greater chance of contamination the longer they are used. There have been studies done that have found that insulin loses only a small amount of its effectiveness after 30 days. But of course it is very important to follow the package insert carefully which recommends changing the cartridge every 28 days. Some CWD do find that cold lantus does sting, my son says that it does but that the humolog does not whether it is room temp or cold. As always, YDMV;)
     
  14. Kyra's Mom

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    We keep all insulin on the counter as Kyra complains when it is cold, so I counted down 28 days from when the pens were opened and threw them out on that day. I didn't think about using a sharpie but will begin to use that to write the date on the pen so we don't forget to throw them out after 28 days. Kyra still complains that the Lantus hurts when injected even at room temp but not the novalog.
     
  15. KatieJane'smom

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    I've heard MANY diabetics say that the Lantus hurts or stings as opposed to the short-acting insulins. Our poor kiddos have to endure so much...
     
  16. momof2greatkids

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    I was wondering about this. Even though we're using a new pen needle every time, could there be some breakdown of the insulin with each needle introduced. So even if a pen is used occasionally, once it's been compromised, does some sort of breakdown start, making it less effective after a month.

    It seems like if/when Audrey decides to move to a pump, we may want to use syringes for corrections instead of having a separate supply of pens to use on occasion as that could result in a lot of insulin/money we're throwing away if the pens were only used sometimes.

    I'm a little hesitant to use syringes - they just look so much more ominous than the pens. Before my husband had a pump, I would sometimes give him shots, and felt much more stressed using syringes then I do giving Audrey her Lantus with a pen.
     
  17. momof2greatkids

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    Our CDE said it was because the Lantus is acidic. I think that's why it can't be combined with other insulins, also. Audrey doesn't complain about it, but they said if it bothered her, we might want to move to Levemir because it doesn't sting like Lantus can.
     
  18. KatieJane'smom

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    The thing about using syringes is that you will be using the same vial of insulin to fill the pump cartridge and to draw up out of for corrections with the syringe - so, there is less "waste" that way. I absolutely LOVE the pens but, with pumping, we just don't use them enough to justify the cost of them. At least for us. The pens are just so much more convenient when you're away from home cause you can just grab one and go.
     
  19. Ellen

    Ellen Senior Member

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    Agree. We always try to bring insulin to room temperature before injecting for this reason.

    We don't use any long acting insulin, and we would use the fast acting in the pump next refill or as soon as necessary - but don't follow 28 day rule for fast acting insulins.
     
  20. swimmom

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    I don't think syringes hurt any more than pens (according to Lauren). Pens are nice for travel.
     

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