FUDiabetes

Pen seems leaky?

I know there was a discussion somewhere recently about that extra drop of insulin on the needle after injecting with a pen (which was helpful to know about). What I’m experiencing is a bit more than that, though - started using my NovoPen Echo yesterday afternoon, and I noticed the drop; didn’t think much of it as I remembered that discussion. Well, I primed 2u this morning, a stream shot out, then it was just steadily forming bigger/new droplets as I held it needle angled down. If I angled it back up, it would stop “leaking.” This went on for a good 30 seconds or so before I finally got impatient with it and kept it upright for another 30 seconds or so before injecting my breakfast dose (hope I don’t regret that later :grimacing: ). Is it supposed to do that? Makes me concerned about the extra few seconds you’re supposed to leave it in your skin after injection - would it still be leaking like that into the skin, potentially giving you more insulin than the dose you chose?

ETA: I also realize the amount of “extra” insulin would be minimal if you leave it in the recommended 6 seconds. I’m mostly curious, not worried.

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First, a 2 unit prime seems really large. We used to prime with a 0.5 unit or 1 unit depending on the device. Just enough to see a drop so you know the needle is full. Second - Did you prime it facing upwards? If you did, my guess is a bunch of insulin ran down the side of the needle/pen and then when you inverted it, it “created” a drop on the end of the needle.

If you didn’t do this, then there could be something wrong with the pen.

It seemed large to me, too, but I tried a .5u prime yesterday and got nothing that I could see, so figured I’d try following the directions this morning. :laughing: I’m not sure what direction I had it to begin with - I’ll make sure to prime down this next time and see what happens.

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When we put a new needle in, we typically use a 1.5u or 2u prime also. If I prime and I cannot see a nice continuous stream coming out I prime again. I occasionally have failing 1.5 u primes, but it may well be that I am not able to see it well enough, for instance at night with only a flashlight.

I prime over a surface where I can clearly see insulin droplets when I can. I like to prime over a dry stainless sink for instance. This way I can make sure that the prime is good: it looks like a line with little hash marks.

Are you sure that you screwed in the dark insulin cartridge holder all the way in? We once left it loose, and the whole cartridge fell off and broke, thousands of miles from home: it was our last one…

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Yeah, I did see a stream, then just steady drops. I just re-screwed the cartridge holder on to make sure that wasn’t an issue - it WAS put together by the pharmacist and me, neither of whom knew what they were doing. :wink: My breakfast rise was within normal range, so I think I got at least close to what I thought I was dosing. I’ll update when I give my lunch dose here in a bit and see what happens.

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You need to feel a strong clicking when it cinches up. When we had that malfunction, early on, we had felt a mild click but we had not gone far enough.

Thanks - it was a strong click this time. When you prime 1u, how much generally comes out? I got a big droplet, not stream. Injected 1.5u, counted to 10, then there was the typical drop on the needle when I pulled out, wiped that, then another smaller drop formed.

It at least wasn’t leaking before injecting this time though!

I never changed needles when I experimented with pens - I would just put the cap on and put it aside till my next injection. So I would never prime except for the first injection - why waste the insulin was my theory? So the priming had absolutely nothing to do with why I would get “leakage”. And I would always get leakage - even if I kept the needle in for fifteen seconds. I think there is something about a pen (or the shorter needles) that makes it happen. Part of the reason I didn’t like pens and went back to syringes. I never get leakage with a syringe.

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Well, I often don’t get a perfect stream with less that 1.5U or 2U. And, and the videos, they always show the “right” priming as a good jet. I am a real cheapskate so I wanted to reduce the priming, which makes sense for us because we inject 1/2 or 1U doses many times per day, but I could not get a truly reproducible jet with 1U.

Do the drops keep forming? I typically never even wipe the drop, but put the pen right back in, so I would not have noticed the second one.

Ok, good.

They did after the initial prime this morning, but didn’t at all after priming for lunch, and only 2 drops after injection. So I think it must have been that the cartridge holder was loose - thanks! Hopefully things will go smoothly with it from here on out.

I got pens from a fellow t1 when my vial broke on accident, and I was so unsure seeing drops leaking (and it was the regular FlexPen, so I wasn’t able to dose in 1/2u increments), I went back to using syringes, too. I just thought I’d try the Echo pen to see if I liked it, as it would be easier for me than doing the vial/syringes. We’ll see how I feel once I get past all this user error. :wink:

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We love the pens, both the Echo pen and the ?? (metal) pen for Humalog! We started on syringes but switched to pens very quickly.

Why we like pens better:

  • more compact and less fragile

  • fully enclosed

  • don’t have to carry as much bulk (all these syringes)

  • when also carrying a needle clip, totally self contained system, have a look:

This has everything we need for a full week of fast-acting insulin (if need be):

  • echo pen and insulin
  • 7 needles (6 spares plus one on the pen)
  • one needle clipper (so no needle disposal problem)
  • 1/2 unit injecting capability

it is hard to beat the convenience!

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Yes! The less fragile makes me feel better with my toddler running around (she’s the one who accidentally broke my vial a while back - my fault for leaving it out, but still).

So do you re-use needles for an entire week then? I never re-used syringes, and I’m trying to decide just how comfortable I am re-using these needles (I do re-use lancets…couldn’t tell you when I last replaced mine, in fact…).

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We are not afraid to reuse needles. We often use only one per, but also often reuse them 2-3 times. More than that, and, in our experience, they become a bit duller – but I know many others reuse them a lot more.

If we were short needles, we would reuse them a lot more. We would have no problem using one per day as suggested above if we needed compacting our supplies. In fact, if we only had one, we would use it for as long as we need :slight_smile:

[EDIT] in the pic, btw, we have 7 needles, one on the pen that you can’t see and 6 in the net part of the case. This spare case is rigged as an emergency case for a week’s worth of supplies :slight_smile:

I use pen needles usually 4 times (2 days’ worth) and haven’t had much issue with leakage, HOWEVER, I have noticed that since I started storing the pen with needle in the fridge I am getting leakage and a bigger air bubble much faster. Is there an issue with it being cooler inside the cartridge causing some type of extra pressure? The reason I started storing in the fridge door is that I’m home during the day now and it’s ridiculously hot most days and I’m concerned I keep my house too warm to completely avoid it getting too warm. I’m going to leave it out of the fridge today and when I use it at dinner see what it does.

Beth

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Yes. A number of studies (such as this one from 2014) demonstrate that temperature changes and air pressure changes (which often go hand in hand) cause air bubbles in pen and pump cartridges, which may affect dosing.

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Thanks for the confirmation! I knew something weird was going on and I was getting way more insulin smell on my fingers after holding it so I knew something specific happened! Good to figure out stuff right away!

Beth

I believe storage with the needle on can contribute to air bubble growth, per my son’s reading of the pen instructions. I don’t worry about the bubbles, since they are normally in the high end of the pen when I inject. And I rarely change needles, only when I change or refill the cartridge, so I do get some bubbles.

BTW:. It seems like Levemir has less issues with leaking on the pen tip, and bubbles, compared to humalog. I think it’s thicker-also tends to clog needles quicker when unused for a while.

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Still trying to finish off this kwikpen - the air bubble has increased a bit but still plenty of insulin to get me through a few more days before it hits the trash. Did my usual shot this morning, it hurt a bit which isn’t normal, and sure as sh*t I hit a blood vessel AND it sucked in blood into the cartridge!!! The remaining insulin is now pink!!! WTF?? It’s annoying enough with the blood to clean up and knowing you didn’t get the full dose but it’s sucking blood IN now too? I’m furious.

It’s like Satan himself has invaded this thing.

Beth

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A thought for when a kwikpen is malfunctioning is you could always keep an old kwikpen around and move the insulin from the malfunctioning pen to the old pen and then use it there. No need to keep injecting with a pen that is malfunctioning. Additionally, you could always try and see if the pharmacy will replace. Finally, you can always use a separate syringe to remove the insulin you need and just inject it with a syringe without the pen.

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