Difficulty getting new insulin pen

dancer

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I use the insulin pump but have an insulin pen in case of emergencies. Last week, I checked my pen to make sure it was still working. I dialled up 20 units and put it into the outer needle cover. The insulin barely filled a quarter of it. This was a Novo Junior Pen which I'd had for years. I contacted my nurse, as I couldn't remember the name of the Novo replacement for the Junior, and she told me to ask my GP for the Echo pen.

I contacted my practice and asked for a new pen, explaining that the one I'd been using was no longer manufactured and that I required a Novopen Echo. I received a phone call the next day (from a receptionist) asking me to explain exactly what I was asking for. I told her why I required the new pen and she asked who had told me to ask for the Echo. When I said it was my DSN, she said they would need a letter from my nurse as it was against protocol for them to prescribe a new pen.

I expressed my surprise at this, as they had prescribed the Junior Pen in the past, so surely they could prescribe its replacement. She said she would tell the doctor what I'd said but I would still probably need a letter from my DSN, before they could prescribe a new pen.

I received a call a few hours later and was told the doctor had agreed to prescribe the Echo pen but I would have to ask my nurse for a letter. It seems they are willing to prescribe cartridges for the pen but not the pen itself!

Today I went to Boots to collect my pen (having left plenty of time for them to order it) only to be told a batch of Echo pens had been recalled and their suppliers hadn't delivered my ordered pen. Boots will contact me asap to let me know when they expect a delivery. Who would have thought it would be so difficult to order a new insulin pen?
 

GrantGam

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Last week, I checked my pen to make sure it was still working. I dialled up 20 units and put it into the outer needle cover. The insulin barely filled a quarter of it.
What brand of needle cap did you use to test your pen? 20u will fill the lower part of a Novofine needle cap and also a BD one I think. I've noticed that other brands such as mylife penfine classics are a good bit larger, so the usual test isn't applicable as even when the pen works properly - it won't fill the lower part entirely.

It's possible there's nothing actually wrong with your pen:)
 
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TheBigNewt

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Sounds like your pen was probably expired if they don't even make it anymore. I use NovoLog (Novorapid in UK) Flexpens, which are disposable not cartridge pens you get there. I used to stash an almost finished one in my car for a spare just in case. What I found was it wouldn't eject any insulin if it went unused for awhile. Sounds like you found the same thing. What I recommend for emergencies is you get ahold of the VIAL of Novorapid not a pen. That way you know it will always be available. I know, I know, vials contain 1,000 units and pens only 300 units so it might cost more, but at least it'll work if you need it. Right? So ask nicely for a vial for emergencies instead. (You'll need a few syringes too of course). I used Lantus vials until recently and they're cheaper on a CC/CC basis probably because you don't get the extra hardware you get with the pens.
 
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I understand the need for backup pens when you are on a pump in case the pump fails.
It feels like a waste to have cartridges of insulin in my fridge (and taken on trips with me) never to be opened.
I wish there was an alternative but the best I have is a set of one use syringes which I can fill from the cartridge in my pump. It's convenient for short term fails but no good for basal: I can't imagine myself injecting every hour ... or more often ... especially during the night.
 
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TheBigNewt

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I understand the need for backup pens when you are on a pump in case the pump fails.
It feels like a waste to have cartridges of insulin in my fridge (and taken on trips with me) never to be opened.
I wish there was an alternative but the best I have is a set of one use syringes which I can fill from the cartridge in my pump. It's convenient for short term fails but no good for basal: I can't imagine myself injecting every hour ... or more often ... especially during the night.
Ask for a vial of Lantus. And maybe a vial of Novorapid too and a few syringes (you can use them over and over I did). A vial outta be good for a couple of years no matter what it says the expiration date is if it's in a fridge. It'll work fine. Compared to the cost of a pump and the supplies for it a couple vials of insulin are quite cheap.
 
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dancer

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What brand of needle cap did you use to test your pen? 20u will fill the lower part of a Novofine needle cap and also a BD one I think. I've noticed that other brands such as mylife penfine classics are a good bit larger, so the usual test isn't applicable as even when the pen works properly - it won't fill the lower part entirely.

It's possible there's nothing actually wrong with your pen:)
It was a Novofine needle cap, so there definitely was a problem with the pen.

@helensaramay when I started on the pump, I was prescribed Lantus disposable pens along with Novorapid cartridges (now Fiasp), for emergencies. I have never needed the Lantus, only the quick acting insulin.

I have also considered the cost of these insulins which are rarely, if ever used, and did think about asking about syringes, but I just couldn't go back to using syringes. If you use a pen in public, there's no problem but I think it's different with syringes.
 

TheBigNewt

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Whatever. Just remember if you start using a pen and let it sit for weeks without using it, don't count on it working again. Count on it freezing up on you. Then you throw it away.
 

himtoo

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I think this is one of the areas of us pumpers that needs a shake up with co-ordination between DSN's and Gps'
I get a replacement set of 5 cartridges of fast acting novorapid and lantus every 5 months -- the ( my ) GP don't have any pens to prescribe or hand out.
I phone my DSN to send me a replacement pen every couple of years to make sure I have a working back up pen.

to my mind it is yet another area of worry and concern that could be removed from us by better co-ordination between NHS departments so to speak.
 
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dancer

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I think this is one of the areas of us pumpers that needs a shake up with co-ordination between DSN's and Gps'
I get a replacement set of 5 cartridges of fast acting novorapid and lantus every 5 months -- the ( my ) GP don't have any pens to prescribe or hand out.
I phone my DSN to send me a replacement pen every couple of years to make sure I have a working back up pen.

to my mind it is yet another area of worry and concern that could be removed from us by better co-ordination between NHS departments so to speak.
My GP prescribed replacement pens before I started on the pump. It's now marked on my repeat list that I require Fiasp cartridges in case of emergency, so I can't see what the "protocol" problem is now.
 

himtoo

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I totally agree with you -- there should be no issue - however we know that in real life the dots don't always match up-- all I can say is well done you for fighting your corner
 
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donnellysdogs

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I understand the need for backup pens when you are on a pump in case the pump fails.
It feels like a waste to have cartridges of insulin in my fridge (and taken on trips with me) never to be opened.
I wish there was an alternative but the best I have is a set of one use syringes which I can fill from the cartridge in my pump. It's convenient for short term fails but no good for basal: I can't imagine myself injecting every hour ... or more often ... especially during the night.

With a pump failure you wouldnt go to injecting yourself every hour or more! Novorapid last 5 hours so eeven without a basal shot you would not be advised by any healthcare official to inject every hour or less.....
 
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With a pump failure you wouldnt go to injecting yourself every hour or more! Novorapid last 5 hours so eeven without a basal shot you would not be advised by any healthcare official to inject every hour or less.....
If I have no long acting insulin like Lantus, I would need to use Novarapid injected regularly as a basal. Just like the pump does.
 

TheBigNewt

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If I have no long acting insulin like Lantus, I would need to use Novarapid injected regularly as a basal. Just like the pump does.
How many units does your pump deliver at the basal rate in 24 hours, 24 or so? No boluses.
 

himtoo

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How many units does your pump deliver at the basal rate in 24 hours, 24 or so? No boluses.
basal rates on pumps vary widely for all of us -- there is no standard measure.
my own rates vary from 0.65unit per hour at 3pm to 1.7u per hour at 3AM

some pump users will be on a total of 12u in 24 hours , some will be on 30u in 24 hours .

we are all individual.
 
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TheBigNewt

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So some doctor figures that out for you and sets up the pump (using data from fingersticks of course)? You don't know how many units of insulin you get a day for your basal like I do?
 

GrantGam

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So some doctor figures that out for you and sets up the pump (using data from fingersticks of course)? You don't know how many units of insulin you get a day for your basal like I do?
"Some doctor (actually: diabetologist/endocrinologist/DSN) would set that up for you, initially. But not simply by themselves. It would be a joint decision of the diabetic and HCP through discussion of food diaries, BG logs, activity levels, lifestyle questions, routines, habits, occupations, etc, etc... and in a lot of cases CGM data; which goes to show that it's not a lottery of what your basal rates are.

Don't think for a second that pump users have their HCP's do everything for them - because the stark reality is that they do more work than those on MDI in getting their rates and radios worked out.

This book is a good one @TheBigNewt, I've read it as I'm perusing a pump - that's why I know it's more work (initially hopefully) than MDI:

http://www.diabetesnet.com/dmall/pumping-insulin

@noblehead, @Juicyj, @himtoo will be able to comment first hand however:)
 

tim2000s

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If I have no long acting insulin like Lantus, I would need to use Novarapid injected regularly as a basal. Just like the pump does.
Indeed, but having dropped my last bottle of Lantus onto a stone floor whilst awaiting the new prescription, I can confirm that a shot of Novorapid before bed and when you get up five hours later produces some surprisingly good results in terms of blood glucose excursions. I wouldn't recommend it but it's definitely manageable.

So some doctor figures that out for you and sets up the pump (using data from fingersticks of course)? You don't know how many units of insulin you get a day for your basal like I do?
Bit of a short sighted view really. It very much depends on the person. I went to the clinic and told the HCPs I saw what I was going to set up my pump with, providing them with a document that detailed what I thought the rates should be, ISF, carb factor, variation through the day of basal, ISF and CF and accounting for additional shots I was taking early am to counter DP. They said "Oh you don't need pump training, here's a pump". In addition, I know what my basal total looks like in the pump (22.6u - thanks for asking!), and remember what my Levemir split looked like before pumping (14u am and 10u pm, and no, it's not written down anywhere).

However, someone who is very dependent on calling the DSN every time they even consider changing basal insulin or carb ratio would have a very different point of view.
 
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So some doctor figures that out for you and sets up the pump (using data from fingersticks of course)? You don't know how many units of insulin you get a day for your basal like I do?
In my case, the DSN provided her best guess based on a loaned CGM. Since then, I have tweaked it based on results from a bought CGM.
Someone on MDI will know how much basal they take every day but, for me, a steady bolus 24x7 does not provide a steady BG. My pump has been invaluable to deal with the ups and downs of basal that my body needs throughout the day and throughout daily variations such as exercise, stressful meetings, headaches, ....