Can anyone explain why the following would be problematic? We were moved to Humalog and have been moved back to Novolog. My first script I received recently was for Novolog vials. I’ve always preferred pens because if a pod fails and we have no backups, we can put a pen needle on top and administer manual Boluses from the pen. I received this message from the nurse who fixed our prescription.
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Well, trusting that you did indeed have a great day after those very firm orders I’ve mostly done what you do but for the opposite reason; I prefer the vial for the pod but carrying a vial and a pod around as a backup has multiple points of failure not least in the temperatures I’ve experienced in the past few weeks.
So I have prescriptions for vials and prescriptions for pods and, yep, it took my doc. some stern words (though perhaps not quite so insulting as the ones you quote) to get the pharmacist+insurance company dance team to skip up to those steps, but now I just get them no questions asked.
At times I was tempted to go to pens.
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I’m just trying to figure out why can’t you use a pen to fill a pods and as a pen for manual injections? That makes no sense to me. I stick the pod needle into the insulin pen to extract insulin for the pods but if pod fails and I don’t have a backup (which wouldn’t happen, but let’s say hypothetically two or three pods fail back to back), the pen serves as its own manual insulin injector by putting a pen cap on top of it. Either way the stopper of the pen is getting punctured by a needle so why’s it matter which needle punctures it.
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The whole Nursian diatribe made no sense, “[Y]ou should not use that pen as a pen moving forward”, duh, what? I have images in my mind but I simply do not know what was intended, most likely not the images in my mind but then, what?
What you are doing is less likely to cause problems than reusing a vial. We have to introduce air bacteria and virus akimbo into the vial to be able to remove the insulin. This introduces dangerous infectious material into the vial. A pen does not have this problem so long as the needle is removed ASAP after the injection (pod or body makes no difference).
Vials are a bad idea but so are pens that can’t deliver the dose required by a 'pod in one shot. Chose your fish.
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I was thinking it was for that reason - bacteria. But I don’t put air into the pen. I suck out insulin from the pen and any air in my syringe I flick until all the air bubbles are at the top of the needle and press the air out of the top of the needle.
I didn’t bother responding to her but I’ve been doing this for years and it works fine. I just don’t see a risk.
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You have many years of experience and the nurse some number of years dealing with “patients”; a word that somewhat ironically only equates with “patience” in the minds of doctors who get taught that equality.
So you are right and the nurse is out of depth.
I’ve found with the 'pods, so long as I remove the needle from the pen ASAP, that flicking is not necessary. I use one of @Eric 's very long pen needles (well 6mm or so) to inject the insulin into the pod, which requires two annoying steps because I have to dial back in a new does to get to the 125IU I require. After that I pull the pen, unscrew the needle and wait for the pod and my 'phone to do their black bluetooth magic.
The reason I normally use a vial is because I lack patience; I just want to suck the insulin up, squirt it in in one shot then spend the next tedious seconds while the 'phone and the 'pod get their act together swabbing my stomach so the adhesive sticks.
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Your use of it is fine. The nurse’s response is based on the “lowest common denominator” philosophy.
A person who is not really savvy with their manipulation of the pen and insulin and syringes and all of that would need to be cautioned because they might mess up the pen. If they pull insulin out of a pen, the plunger inside the pen cartridge moves down. But the mechanism that pushes the pen cartridge down with normal “pen” use would no longer be touching the plunger. So if they were to just try to do a normal pen dose, they would not get any insulin.
And the “lowest common denominator” philosophy means that the nurse must speak to you as if you are the person who has no clue about how a pen works, and would then be injecting nothing but air with their pen, because you have unwittingly moved the plunger inside the cartridge. Or you might not know you need to put a pen needle back on the pen! 
So you are not at risk. You know what you are doing. 
As perhaps an easier method, you could just inject straight from the pen into the pod. That would seem to be easier just because you are not needing to take the extra step of removing the insulin from the pen first. Why not just cut out the middle-man?
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Because there would still be an extra step…getting a pen needle cap, putting it on the pen then taking it off and disposing of it. It’s always been super fast and easy for me to just use the syringe that comes with each pod, then throw it in a sharps box. Plus, there is the dialing of the pen that would required.
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That is funny to hear, because I treat my pen needles like lancets. I keep them on all the time and use them for months!
But ya, that makes sense.
I use vials for filling anyway. I only use pens for injections at night when I don’t want Loop to know I got some secret insulin.
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I do the same, but the pen vial that I use to fill my pump, I don’t use that same pen vial for manual pen injections. I think the reason I received (it was a long time ago, and by a nurse not a doctor) is that the needle used for pumps created a much larger puncture hole in the pen vial as compared to the pen needle tips? I’m going by memory of over a decade ago, so could be wrong.
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That’s actually good info to have if there IS some good reason you shouldn’t use a pen for filling PODs and as manual injections…if it’s due to hole being bigger (and possibly allowing air/bacteria into the pen), then it makes sense to keep 2 pens in his pack and maybe keep them labeled…1 would be “manual injections” and 1 would be “POD fill-ups”. When the “POD fill-up” vial is empty, I could replace that pen with the “Manual injections” pen (it will never have been used as we haven’t had to do but maybe 3 manual injections ever since he’s started looping), then replace that manual injections pen with a new pen from the fridge and label that one as manual injections…so kind of rotating them out like that to avoid having one sitting in the pack for too long.
Thanks for the input everyone. At least now I’m kind of understanding the message I received and I definitely don’t ever want to take a chance at getting Liam sick, so it sounds like this is something I may want to implement immediately probably.
Again, the single pen I use really is NEVER used for manual injections anyway…but if we were out and the hypothetical situation occurred where multiple PODs failed, then we COULD need manual injections via the pen…so having a backup “manual injection” only pen may be something worth doing just to be on the safe side.
Thanks all!
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@ClaudnDaye I don’t get the rationale for the thinking. I’ve used my pens to fill my pods since I got started with the pods, for the same reasons you indicate: built in back-up means of delivery, portability with my kit. I take standard precautions (a new needle each time [can’t put the pen cap back on my Novolog pens with it still there], usually wipe the pen threaded end with alcohol wipe/cotton ball). My Endo agreed, my Insulet trainer agreed, its never been questioned by anyone else. We talked about here on FUD about a year+ ago with the only rationale not to do it is cost factor (vials to pens) depending on amounts used. Sounds like the nurse is thinking of pulling the insulin from the pen possibly with the needle/syringe that comes with the pod; if so, it is a substantially larger gauge and perhaps she’s thinking the potentially resulting hole provides a germ vector to the remaining insulin? “if you have used the pen as a pen, do not pull insulin out to then fill a pod” makes no sense to me.
Hey, let’s ask and see what logic she provides! The person with the closest answer gets a slice of chocolate cake! 
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If using a syringe to transfer from the pen to the pod, there apparently are two techniques: my trainer said don’t try “to suck it out” as there’s too much resistance; instead, hold the pen/syringe together and “push the insulin” into the syringe from the pen. Personally, I vote for eliminating the middleman and go directly from the pen to the pump, there’s a small extra cost for the pen needle and extra waste in the stream, but seems negligible in the grand scheme for many people.
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This is what we are doing. We use the Syringe/needle that comes with EACH POD for extracting the insulin from the Novolog Pens. We don’t use the Pen needles and inject from pen straight into POD…that’s more work imo. I use the Syringe/needle from each POD to suck insulin out of the Novolog pen. Not sure if you got that this was the process I am using or not.
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Sucking it out is extremely easy and I’ve never had a problem. Not one. It sucks out very easily as I pull back on the POD needle syringe handle…I pull that out, and it pulls insulin out of the pen everytime without any resistance and without messing up the pen at all.
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It’s not about the cost. I have thousands (probably tens of thousands by now) of those pen needle caps…it’s about the time it takes me to get a pen cap out, put it on top of the insulin pen, use the needle, twist it back off, put the top back on that pen, then throw it away. Why go through all that extra work when every POD comes with it’s own needle? I’m using the POD anyway, so there isn’t any extra work or “getting anything else” required on my part…I open POD, pull out needle, done. Instead of opening POD, going to closet or pack, finding/pulling out pen cap, putting it on pen, dialing in correct amount of insulin, bla bla bla…it’s waaaaaaay more work imo.
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If you “pull” the insulin out of the pen with a syringe, it’ll detach the rubber moving plug in the pen from the dosing micrometer type mechanism. Works fine, but renders the pen useless for using as a pen.
If you push the insulin from the pen into the syringe that comes with the pod… Everything is fine
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I use pen needles to fill my pods and to do injections. But they are kept in different spots. It’s easier to use a separate pen for shots and a different pen for the pods.
In my case because I have pod/site failures easy, I give myself a shot for larger doses sometimes, it depends on what pod day I’m on and the luck I’ve been having. So I have a pen in a kitchen drawer that I use for pods only, and a pen in my “back up” kit in my purse that I carry around that I also use for shots. I rotate the one in my purse to the drawer because the pod one is used much faster.
It seems easiest to carry one new pen, primed to go for a shot. And every 2 weeks or so, if it’s a “just in case” pen switch it out and then use it for pod filling. Or once it’s been used for a pod, switch it out for a new primed pen.
But I’ve been using pens for over 5 years, never vials, no issues.
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I’m new to the pump game, but I use cartridges to fill my pump (Tandem t-slim, I’m not sure if any of this differs with pods) and I was taught by my Tandem trainer and confirmed by my t-slim-using diabetes educator that I should use the pen and cartridges as my emergency backup.
When I was trained, I asked about syringes for a backup and was told I didn’t need syringes and was given a reusable pen. I assumed that this was to use for both filling reservoirs and for manual injections, but now that I think about it, that wasn’t explicitly said.
The way they taught me to fill my reservoir was to pull the insulin out of the cartridge with the syringe. I push it out by dialing up the units so the plunger stays in line with the stopper so I have the option of putting a pen needle on it.
I so rarely need to do a manual shot that I’m not worried about it. I can see the reasons why you shouldn’t do it, but it’s not something I’m going to change right now. If I ever started doing manual shots regularly, maybe I’ll pull out a new cartridge and rotate my pen cartridge and reservoir cartridge.
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Same. I’ve done manual shots only twice since he was diagnosed (once we were pumping that is). Going on 8 years.
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