Saturday, March 31, 2018

Refilling LIlly Disposable Insulin Pens

As promised, here is the blog entry on how to refill the Lilly brand disposable insulin pens, for those of us that prefer the convenience of a pen vs. a traditional insulin vial and syringe, but may have issues with the increased cost of these units when compared to the much lower pricing of insulin in a vial.

Right up front, I want to acknowledge that I did not personally originate this concept. That credit goes to a diabetes forum user named Eric, who is a co-founder of the FUDiabetes forum. Eric originally worked up a method for refilling the Lilly produced Kwikpen®, which is a disposable insulin pen which contains either Humalog®, or Humilin® insulin. Eric demonstrated a method whereby one of the Lilly Kwikpen® devices could be refilled with insulin from a vial, and re-used numerous times, which results in a substantial cost savings over purchasing the Kwikpen® and then tossing them away, and buying new ones. This cost savings is particularly significant for folks that are in the dreaded "doughnut hole" on their prescription coverage, or for folks like me, whose insurance will not cover the more convenient Kwikpen®, or it's Novo Nordisk equivalent, the Novolog® FlexPen® for their daily insulin needs. 
Rather than detail those steps on how this process is accomplished, I will refer you to Eric's excellent write up on how this can be done. You can find that solution by visiting his original forum post at FUDiabetes by following this link: Refilling the Lilly Kwikpen disposable pen



 So what, you might ask, did I add to Eric's excellent idea? Basically that boils down to two things:

1) On the FUDiabetes forum where this procedure was discussed, there were numerous inquiries and speculations as to whether or not it would be possible to do the same refill process on other brands of disposable insulin pens. Since I did have access to several of these devices, from personal use, or from empty donor units from family members, I began to experiment with trying to do the same refill process with those pens, instead of a Lilly Kwikpen®. For my experiments, I used several Lantus® Solostar® disposable pens, a couple of Levemir® FlexTouch® pens, and a Novolog® Flexpen®.





And try as I might, even resorting to attempts to completely disassemble and reassemble them, I could not, in any way shape or form, get these disposable pens to permit anything other than the single use application they were engineered to deliver. There is something in the internal workings of each of these pens that absolutely will not reset the way that the Lilly Kwikpen® units will permit. At best case, the only thing that I was able to do with these disposable pens was to scavenge the emptied dispensing vials from the pens, on the off chance that they could be converted for use in a non-disposable insulin dispensing pen device. More on that in a future blog entry!


2) I did, however, manage to successfully refill a couple of the newly released, Lilly produced Basaglar® KwikPen® units. 





To be honest, I did this project as a proof of concept more than anything else, plus the fact that I had two Basaglar pens on hand that my PCP supplied, but inadvertently gave me pens that were 4 months past the expiration date on the pens. Since his office advised me to not use them, I first ejected some of the contents, and tried turning them backwards as described in Eric's post on refilling the Humalog® disposable pens. Once I determined that this could be done, I finished emptying them out, syringed out the residual, flushed a bit with the new insulin, and then refilled them both completely, one with Lantus®, the other with Novolog®, both of which I had on hand in vials, since my insurance company refuses to cover these medications in a disposable pen.

I do plan to use some colored tape on each, blue for the Novolog®, and red for the Lantus®, around the body, to make it glaringly obvious which is which.

And when my current supply of Lantus® in a vial is used up, my PCP has me switching over to the Basaglar® pens anyway. Hopefully by that time the Lilly Luxura® and Luxura HD® pens that I have ordered from Canada will have arrived, which I plan to use for my Novolog® going forward. I also plan to have these reusable pens set up for use with the OTC available insulins, Relion® Novolin R® and Relion® Novolin N®, in the case of an insulin supply shortfall, which can, and does, happen when my insurance company decides to implement one of their arbitrary "re-certification" paperwork pushing sessions with my PCP. When this happens, it can sometimes take weeks to restore their approval for coverage of my insulin. Now that I am no longer using a combination of oral meds and insulin, and am completely dependent upon insulin for treatment of my diabetes, not having the insulin I need can become quite deadly, to put it bluntly. It was the ability to use this alternate source for insulin that helped me in my decision to agree to the use of an insulin only therapy, since I know from experience that it's not a matter of IF my insurance company will do this, it's only a matter of WHEN.

At this point, with the success of these efforts, I’ll be more than happy if the one Novolog® refilled pen is all I need to get me by until I can start using the reusable pens with refillable cartridges instead.
But until that time, it’s nice to know that these pens, like the Humalog® disposables, can be refilled, if that is what you have to work with. Certainly a less costly option than the proposed alternative of purchasing a box of Humalog® disposable pens out of pocket, simply to gain some refillable pen options for those of us that have insurance companies that won’t cover the disposables.

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Friday, March 30, 2018

Easing Myself Into the New Routine Takes More Time Than I Anticipated

I am starting to suspect that my PCP made the changes from oral meds to insulin therapy because they FORCE me to become much more actively involved in dealing with my diabetes.

And, if so, then kudos to him, because it's working!

I've just finished my second week of switching from oral meds / insulin to only insulin for treatment of my diabetes. A couple of obvious facts over this initial phase.

a) Switching from a somewhat lackadaisical glucose testing routine to a consistent, tightly regulated testing schedule 7-8 times a day is, quite literally, a pain. There are only so many times a day you can draw blood from your fingertips before you absolutely must start researching alternate site testing methods, and implementing them

b) Trying to make sense of the different insulin medications, the various delivery device options for each, plus wading through page after page after page of conflicting info on what the insurance company will or will not cover is, quite literally, mind numbing.

c) Despite tons of guidelines on dosage ranges for every conceivable situation, the bottom line is, proper dosing is at best, a guessing game, due to the wide range of variations on how any one individual's body reacts to insulin, as well as carbohydrate consumption. It takes a ton of trial and error, as well as meticulous notes, to work up an effective individual dosing range.

d) Surprisingly enough, the glucose testing is almost always more painful than the subsequent insulin shot, about 80-85% of the time.

e) Doing my glucose testing, as well as subsequent insulin shots, in front of a curious group of Cub Scouts and their parents, explaining what I am doing and why, is turning out to be a great way to deal with my initial self consciousness on doing these activities in public


f) At this initial stage of things, it seems like testing, dosing, testing, dosing, over and over again, is taking over my entire life. Ironically, this is pretty much the same effect as when I was first diagnosed, and was using oral meds and diet as a therapy regimen.

g) It's patently obvious that, although I am starting to get a feel for how many units of insulin I need for carb coverage, as well as the number of units I need to use to deal with high glucose levels, I really need to address the testing routines needed to determine the correct basal insulin dose levels.
My plan is to follow the steps for basal insulin testing using the method, guidelines, and using this tracking form from Acu-Check. Testing a Basal Rate Technically, these are instructions for basal rate testing for pump users, but I suspect that the same method can be used to help my PCP determine the correct basal dosing for Manual Daily Injection (MDI) therapy.

h) My first change to my approach to basal insulin dosing is to go back to my previous dosing schedule that I used when pairing Lantus® with oral meds. I had switched to a 7:30am / 7:30pm schedule when the change to insulin only therapy started, but find I have consistent high fasting glucose levels. I've long suspected that Lantus® does not last the entire 24 hours in my system, which was one of the reasons I originally went to a 2 X day dosing schedule. If true, then that 7:30am dose is not longer helping to keep those fasting glucose levels where they need to be. So, with that in mind, I'm going to revert back to a 10am / 10pm dosing schedule, which, even if I'm not getting a full 24 hours from Lantus®, should provide extra coverage for fasting glucoses levels, as well as additional dinnertime coverage. Any possible lags in coverage at breakfast, or in the evening before bedtime, can be adjusted using the routine Novolog® injections.

Next up, the promised blog entry on how you can refill certain brands of disposable pens, using insulin from a vial, to save money, or simply because, like me, your insurance won't pay for the disposable pens. Here's a sneak peek:




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Thursday, March 29, 2018

Big Changes in Diabetes Therapy for This Guy

It's been quite some time since I've made any entries on this blog, but recent changes definitely call for a update.

After having a long talk with my PCP about my ever increasing blood sugar levels, and the fact that the progression from Metformin/diet, Metformin/Januvia®/diet, Metformin/Januvia®/Lantus®/diet, and even Metformin/Januvia®/Lantus® 2X daily/diet over the years still delivering HbA1C levels in the 9-10 ranges, we needed to take a good hard look at making substantial changes in my diabetes therapy. Added to these poor results, my insurance company had decided to "push back" against escalating insulin costs by dropping coverage for the Lantus®. At first, it was only for the Solostar® pens, and it appears that in 2018, they won't even cover Lantus® in the vial any more. And to further complicate things, they were also dropping Januvia® from the 2018 Formulary

So the decision was made to go off the oral meds entirely, and go to an all insulin therapy approach. In my mind, this, in effect moves me into that "insulin dependent" Type 2 diabetic category.

So my PCP gave me some sample pens of Novolog® and Basaglar®, a dosing chart, and some new prescriptions, and it was decided that the best approach would be to just jump in headfirst, and paddle like mad. And so I did.

Right off the bat, there was a problem with the Kwikpen® script for the Novolog®. Apparently in conjunction with the push back on rising insulin costs, any sort of disposable insulin pen is only covered if you are a juvenile. This meant an immediate change in my prescription to Novolog® vials and insulin needle/syringes was required. So about a week into the change, when my sample Novolog® pen is all used up, it's time to do my fast acting insulin dosing the old fashioned way, with vial and needle.



Not nearly as convenient as it was to use one of the Lantus® Solostar® pens or the Novolog® Kwikpen®, and don't get me started on the debacle of trying to choose between 1ml, .5ml, or, .3ml syringes!



As luck would have it, I ran across a couple of articles about using refill cartridges and reusable insulin pens, which are a big deal in countries like Canada and all over Europe. And as it turns out, it does appear that the Novolog® refill cartridges are on the Formulary list on my insurance. It's not really clear if the pen itself is covered, so the the current plan is to send in a script for Novolog® refill cartridges and a reusable dispensing pen next month when it's time to refill my insulin prescription.

And it may be that the script may have to be changed to a different brand, Humalog® vs Novolog® as well. Both refills are listed on the Formulary, and the Humalog® Luxura HD® reusable pen can be purchased for less than $11 from www.canadadrugs.com. So even if the insurance company won't cover the cost of the dispensing pen, purchasing one or two at this price would definitely be an option. Not so much buying a Novopen® over the counter with no insurance here in the US, which can easily run over $100 or more. Adding in the cost of a pen to a backup pen, and that's some serious money around my household!

More on how it all works out next month when the new scripts go into the pharmacy!

And, in the meantime, I'm working up a new blog entry on how to refill your own insulin cartridges, and some disposable pens, thanks to the excellent DIY efforts from some awesome folks at FUDiabetes.

All logos, trade names, trade marks, and photos of the same belong to their respective owners. The use of such material in this article falls under the Fair Use provisions of intellectual property laws.