I have 2x Novopen 4 pens. I was on Tresiba and Novorapid. For financial reasons. I moved onto Mixtard HM 30/70 10ml vials with syringes, and boy they hurt. So I’m trying to find middle ground.
I’d like to get a cartridge of Mixtard hm 30/70, refill it from the vial and use the more comfortable 32G needles.
While I saw the post about refilling other pens, I was unable to find confirmation for the viability of refilling novopen cartridges.
If you’ve tried it, can you share your experience?
My last option is to buy Biocon’s Insupen Pro. It seems to be compatible with empty peptide pen cartridges.
Afaik, there are no refillable pen cartridges. What is the problem with the syringes? Are the needles too painful? If so, you can get syringes in many different gauges and lengths, like pen needles.
You can buy 32G syringes. Just search for “32g syringe”. USD 25 for 100. Don’t sweat the difference between 30/31/32; it’s meaningless for the pain. The pain comes from what you hit and how far you insert the needle.
If it’s hard to find 32g syringes it is equally hard to find 32g pen needles.
The pain, and we all love the pain, comes from reusing the syringe or, indeed, the pen needle. This is something that many people on this list do; hey, why waste a needle/syringe, I’m saving the world!
A lot of us leave the needle on the pen and just keep on using it. It hurts, after a while, but it is so very convenient.
You do need to check very carefully what you are being prescribed. You are using a human insulin which is available everywhere. “Mixtard” is just a brand name. This link might help:
How you deal with this depends on where you are but Mixtard is not a requirement; any of the other competing manufacturers can supply the same thing but, maybe, at less cost.
The needles, well, that’s more difficult. If you have to re-use then, in my experience, one-per-day never caused too much pain. Of course I pretty much used one-per-pen, not because of money but because I simply did not want to carry all that stuff around.
You can buy 32G syringes. Just search for “32g syringe”. USD 25 for 100. Don’t sweat the difference between 30/31/32; it’s meaningless for the pain. The pain comes from what you hit and how far you insert the needle.
If it’s hard to find 32g syringes it is equally hard to find 32g pen needles.
32G syringes are impossible to find. 32G pen needles are commonplace. I’ve experienced 1/4th the pain with 32G pen needles and I’ve reused them a lot more without much pain.
I know. I’ve used a bunch of Human Insulin 30% + Insulin Isophane 70% solutions like Mixtard, Huminsulin etc.
The cartridges are expensive compared to the vials, hence the post. One option I’ve found is using empty peptide cartridges with Insupen Pro. This particular pen is used a bunch by the peptide community because it costs less than peptide pens and it takes generic peptide cartridges with a spacer.
i just hoped I didn’t have to buy a new pen and empty peptide cartridges. It’s an investment when you’re broke.
For reference, a 3ml cartridge costs 5.36 USD ($1.8/ml) while a 10ml vial costs 6.76 USD ($0.70/ml)
In the US insulin syringes cost between USD 0.10 and USD 0.25 each whereas a 10mL vial (regular or a mixture) costs USD25 and would last me about 20 days (0.5mL/day) were I injecting. The 32G syringes I found (HomeAide TrueComfortPro and EasyComfort) were .15 or .25 each so the actual costs of the syringes would match the cost of the insulin here, assuming I used 3-4 per day.
In the US a pen with reusable vials would cost more because the pen needles (including 32 gauge ones) I have used in the past cost .15 here (I use “Easy Touch” from Amazon, the Becton Dickinson (BD) ones are much more expensive.)
I did search for a pen with fillable vials some years ago but couldn’t find any that are insulin specific. A quick search again reveals these:
The first is for insulin and the second is for “peptides” and so uses different “units” (IU of peptide, not IU of insulin) but, in both cases, it’s important to convert the actual IU of the insulin used to the IU of the injection device; this happens automatically with pre-filled pens.
At $1 for a 3mL cartridge (most likely less in India if you can find them) the cost of the cartridges seems small compared to the cost of the needle (one per injection) and the insulin (10mL).
Then total cost of filling a cartridge adds up though because sterile components are required:
A sterile syringe with needle to fill the cartridge with insulin, preferably with a large gauge needle and a 3mL capacity.
A large gauge sterile needle to vent the cartridge. I’d probably use a larger gauge piercing needle; they are readily available and cheap.
The cartridge itself; they come sterilised.
If you really want to refill a novopen it’s possible but sooner or later it will break and, after first use, the inside of the cartridge cannot be guaranteed to be sterile any longer. I would happily do this for non-sterile applications, e.g. in this video the author is using a green liquid, but no so much for my insulin:
Since you have found the Biocon pen and the price, ₹1339.59, is about USD14 it seems to be reasonable compared to the disproportionately high cost of insulin cartridges you quote (2.6 times the vial cost per mL). With a 3mL disposable, unfilled, cartridge costing USD1 and filling supplies maybe bringing the per cartridge up to USD1.3 the extra cost for a 10mL vial is $4.3, but you still need the pen needles…
There’s the upfront investment for Biocon Insupen Pro (INR 1600) though.
My first refill would require me to put in 1600 + 20 + 651 + 100 = INR 2371 = 24.63 USD
Yes, I’ll be doing all conversions in ml instead of IU.
I’m not sure which cartridges you’re talking about. The pre-filled ones cost $5.36. The empty ones are imported by sellers and cost even more. What I plan on doing is getting government subsidized, generic ones (image below) at INR 100 with the same insulin formulation, rinse it with some insulin from my vial and then use it. Before you ask, the subsidized insulin vendors are infamous for not maintaining their cold storage in the supply chain which makes them ineffective in a country like mine.
Secondly for the syringes/needles, I can reuse the syringe for 2-3 jabs, while I can reuse pen needles for 10-15 jabs. Maybe it’s the quality of products that causes such a difference. Both come from BD. A syringe costs INR 10 and a pen needle costs INR 20. Pen needles are cheaper for me. If I had to move to one syringe/needle per jab, I would not be able to afford it.
@jbowler Thanks for the video. But I use the reusable Novopen 4. But yeah, after the calculations, I am going for the Biocon Insupen Pro. That’s the best option in the long run.
I was talking about the “peptide” pen in the second link I posted; that site advertises empty cartridges for $1 each.
When I was first diagnosed in 1972 I was sent home with a box of 5 18 gauge needles and a glass syringe for my U30 (IRC) insulin. My mother sterilised the needle and syringe between each use (once a day). I used the first needle for a long time.
With fine gauge needles I find the pain of reuse to be significant. The needle is much more prone to bend and I observed a noticeable tendency to form a little hook at the end. Of course I was doing a lot more injections - 3 or 4 a day - but all the same I think finer needles are less robust on reuse.
This study backs some but not all of my assumption:
With a syringe a single use requires two punctures; once in the vial, once in our skin. With pen needles a single use is just one puncture, our skin. It seems likely that the vial puncture, which occurs first, will significantly blunt the needle regardless of gauge and it’s possible that the rubber stopper on a vial causes much more damage to the needle than our skin.
I have reused both but I’m happier with more times with a pen needle; I rarely changed the needle on a pen. I just don’t like the mechanics of syringe reuse whereas with a pen it is even possible to carefully put the pen cap back on without the pen needle protective sleeve, though I always put the protective sleeve back on before the pen cap.
I never noticed! I feel so dumb.