Pens

richard64

Member
Messages
6
It is clear that insulin keeps me alive. But the delivery mechanism is also important. We need pens to be accurate and robust. If they are not accurate, then it becomes immaterial what insulin dose we have, because without accuracy you cannot guarantee that you are taking it. Similar with robustness - if a pen will break after a few months then our treatment is adversely affected.

A few years ago I was moved to Humalin S and the HumaPen. This was a cheap tacky device, of the type of quality that you would expect from a toy in a Christmas cracker. Lilly say you should change them every three years, but two failed for me in two years. After the second one I went to get a prescription from my doctor to get a replacement and she refused to write the prescription (that's another story). So I bought a new one online, only to find that the cheap tacky plastic pen had been replaced with a metal pen because Lilly admitted that there was a design fault with the plastic one (but said that it was still safe, I beg to differ).

I use a Novopen for my basal insulin. The pen I use is is the silver NovoPen Classic and this has a maximum dose of 70 units. I take the maximum dose. Today I checked the currently available pens for Novo insulins. The most recent pen is NovoPen 4. The maximum dose is 60. Novo no longer make a pen that will deliver 70 units. Novo have lost those extra 10 units somewhere and it appears that when I need to replace my current pen, I will have to lose 10 units too. (I am not quite sure how I will do that.)

I really cannot see how we, as patients, are getting the best out of this ludicrous situation. If all the manufacturers standardised on the same cartridge shape, we could use the same pen whatever insulin we used. Then the pen manufacturing companies could compete on the pen design: some would sell the cheap tacky ones that only last a year, others would sell robust designs that would last 5 years. Some would sell pens for low doses, others for high doses. In fact, if the cartridge was standardised and offered licence free, companies other than the insulin manufacturers would sell pens. The NHS would chose the pens that they preferred, or if we preferred some other feature (different colour, say) we could buy our own.

In my case, it appears that the pen determines my treatment, so that when I need to replace my basal insulin pen it will, in effect, force my doctor to change how he thinks it is best to treat my diabetes. Should a pharmaceutical company be allowed to do that?

Richard
 

Stuboy

Well-Known Member
Messages
451
Dislikes
Crowds. Being high. Being Hypo.
Hi Richard,

As far as im aware, the novopen4 isn't available in the UK yet, so you should be able to get another novopen3 on prescription.

I've never needed to replace a novopen... but i do have different colours for my insulins so i dont end up injecting the wrong one.

I've had my silver pen for 2.5 years and it's never failed me. Novopens in my opinion are the 'Mercedes' of insulin pens. Compared to the Autopen for Lantus at least! That thing is shocking.

I have a novopen3 on my REPEAT prescription, so you shouldn't have any trouble getting one. If your DR wont prescribe one, ask him how he/she expects you to inject your insulin without a working insulin pen!

Good luck!
 

Stuboy

Well-Known Member
Messages
451
Dislikes
Crowds. Being high. Being Hypo.
another thought...

i could be wrong, so im sure someone will correct me if i am, but you can get different concentrations of insulin... widely used is the 100u insulin, if you are taking huge doses at a time and the pens can't give you the dose you need, it might be worth trying to find out about a *stronger* concentration of insulin, like u500 or something, so you can take smaller doses.

It's worth researching, i dont know much about it, im just throughing it out there!
 

richard64

Member
Messages
6
Hi Stuboy,

Stuboy said:
As far as im aware, the novopen4 isn't available in the UK yet, so you should be able to get another novopen3 on prescription.

Apparently Nova have said that Novapen 3 will be withdrawn and replaced with Novopen 4. As you say, that has not quite happened, and it is a case of "while stocks last". I really don't think this is a good situation, but what can I do?

I've never needed to replace a novopen... but i do have different colours for my insulins so i dont end up injecting the wrong one. I've had my silver pen for 2.5 years and it's never failed me. Novopens in my opinion are the 'Mercedes' of insulin pens.

I have been using Nova insulins for 30 years, and pens for about 20. The first one I used did not have a dial, it was like a ballpoint pen, with each click delivering one unit*. I have used the metal Novopen (which you dial the dose) since it was released, that must have been 16 or 17 years. I have had four or five in that time, and at one point I was using two Nova insulins. They don't last forever, but I agree that the metal ones are well built.

[*] It suddenly occurred to me that the clicking pen has no maximum dose, but then I realised that it does not take 3ml cartridges and also that counting over 60 clicks is prone to errors.

Compared to the Autopen for Lantus at least! That thing is shocking.

Sorry to hear that (and lucky for me, because I was almost put on Lantus, but couldn't because the pen would not deliver a big enough dose). The Humapen (not the current one) was appalling, it had a design fault that meant that you could insert the cartridge in such a way that the plunger would not deliver enough insulin. Lilly said it was safe, but replaced the model anyway.

It is worrying how badly designed some of the pens are. I swear that some of them have never been market tested, because when I come to use them they are so fiddly. I remember one plastic Novopen I used, you had to dial the dose and then twist the barrel before you could press the plunger. So many times I would dial the dose, push the needle in and then I could not deliver the dose because I had not twisted the barrel - meaning I had to pull it out of me so that I could twist the barrel and start again.

I have a novopen3 on my REPEAT prescription, so you shouldn't have any trouble getting one. If your DR wont prescribe one, ask him how he/she expects you to inject your insulin without a working insulin pen!

Yes, me too. But to be honest, since it keeps me alive I am willing to pay the 40 quid or so they cost (you have to consider how much good health is worth to you). I may even consider getting two or three while they are still available.

it might be worth trying to find out about a *stronger* concentration of insulin, like u500 or something, so you can take smaller doses.

Yes, I guess so, that is something that I'll have to ask about at my next hospital appointment.

The odd thing is that I have been on more or less the same dose for 20 years. It has crept up a little because as I have approached middle age I have put on weight (not excessively, just a bit more than when I was an active young man). But recently (like two months ago) my morning blood sugars have gone through the roof for no reason at all. I've sought medical opinion and I have been told "raise your basal insulin" but now I am on the buffers, so to speak, of what I can inject. Then couple this with Novopen 4 delivering a *smaller* maximum dose and I start to wonder how I could possibly get a balance again :( .

Richard
 

jopar

Well-Known Member
Messages
2,222
I am surprised by what you say about the pens..

There is only 3 different bottle/vials that are supplied in the is conuntry,

10ml standard vial for using with syringes
1.5ml cartridge but his is only supplied by certain companies
3mil cartridge this is the most common one used for insulin pens and supplied by all companies

Most pens use a dose incrediment of 1 unit of insulin, there is a couple of juninor pens that come in a 0.5 incrediment and then a couple that offer a 2 unit dose...

As to reliability, I've never had a real problem most of my pens have been replaced due to not being able to see the numbers due to wear.. I've used both lilley and novo pens..

To check if your pen is dosing accuratly, here's a little tip, it doesn't matter what side of needle you put on your pen as all the outer sterile sealed covers have be designed the same...

If you look at this outer cover you will notice that the need end that this is stright until it gets to the top of this section where it widens for the body of the needle holder, if you dail up 20 units on your insulin pen, squirt it into the bottom of the outer holder it will be level with the needle part neck.. if lower or higher, you pen is not accurate dosing... Works well when you've dropped your pen

I'm surprised that you paid £40 for your pen as they only cost £26 pounds to buy? I have never had a problem with supply with the excetion of when I first started to use them and I could only get them from my diabetic clinic at the hospital, but since I've been able to get them on prescription, I now always have a spare of each type in my cupboard..

Your concerns that the new Novo pens will have a smaller cartridge to them is wrong, it will still be the 3ml cartridge... The only other cartridge that is avaiable is the 1.5ml (in the main used for childrens insulin pens) but most companies are now looking to discontinuaing these cartridges and standarize cartridge at 3ml...
 

fergus

Well-Known Member
Messages
1,439
Type of diabetes
Type 1
Hi Richard and welcome to the forum.

I'm surprised that you can't get a Novopen4. I changed from Lantus to Levemir recently and received a swanky new Novopen4 at the time (pre-Xmas). So it might be worth persisting.

Now I have a Novopen for basal and a Humapen for bolus. The Novopen feels slim and sturdy, but I was a wee bit alarmed at the 'one-shot' action where the dose is delivered without the plunger counting it down, as the Humapen does. I may just have been lucky, but I've never had a problem with the Humapen at all (I have the ones which deliver half unit doses, the Luxura HD, not a kid's pen!).

If you can't get your doses up Richard, could you reduce the dose you need instead? Can I ask what your diet is like?

All the best,

fergus