Filling Your Own Cartridges for a Reusable Insulin Pen

I've mentioned in a previous blog entry about how to refill the Lilly® brand of disposable pens.

As discussed, this method was based on the groundwork that was done by Eric, co-founder of the FUDiabetes online forum. You can read all about that original groundwork by visiting this link.

But, in addition to his excellent method on how to refill disposable pens, Eric has also provided all of us with an excellent method on how to fill your own cartridges for use with a reusable insulin pen, such as the Lilly® Luxura® and Luxura HD®.


Eric's idea was to re-use the original Humalog® 3ml cartridges, and refill them with Humalog®, Lantus®, Apidra®, or any other brand/type of insulin you might wish to be able use. The quite valid premise for wanting to do this is pretty simple. The most cost effect pricing on insulin is by purchasing in vials, but the most convenience is obtained when using a insulin dosing pen device and an appropriate cartridge.

So, once again, following up on Eric's excellent groundwork, I decided to see if I might be able to have similar success with refilling my own cartridges, but with a twist. I wanted to be able to use the supply of salvaged cartridges from the empty Lantus® Solostar® or empty Levemir® pens that I had on hand, instead of refilling a Humalog® cartridge. The big question is, would it work? 

The first step would be to place an order for some Lilly® Luxura HD® pens. Eric had mentioned that these reusable insulin dispensing pens were available, at very economical prices, from Canada Drugs in Winnipeg. So, not sure if my idea would even work, I made an order for one Luxura HD® pen. 

Now, right up front, I will admit that, even on my best of days, I am not too terribly patient on waiting for online purchases to arrive. I'll shamelessly blame that character trait on Amazon Prime and look anyone straight in the eye without flinching. This being said, when I still had not gotten a confirmation that the pen had been shipped 10 days after I placed the order, I impulsively placed another order for the same devices from Mike's Marine Pharmacy in Vancouver as well. 

The folks from MMP called me on the phone the same day that I placed the order, to confirm the details of the order, and a second call a few days later to tell me that the order had been sent to their shipping department. 2 days later I received a confirmation that the package had been shipped. Ironically, the very next day, I received the confirmation that the original order from Canada Drugs had also been shipped. So now, I had not just one, but FOUR Luxura HD® pens headed my way.  It was then that I decided that, if I could not get the Lantus® or Levemir® cartridges to work in the pens, I had already invested too much money into this endeavor to just walk away from it if the salvaged cartridges didn't fit. I would just have to ask my PCP to switch me over to the Humalog® brand of insulin, so that I could get some cartridges to use in those pens. Either that, or I would have to go the out of pocket route, and buy some Humalog cartridges from Mike's Marine Pharmacy, just to have something to refill.

When the pens arrived, it was time to get to work. In the picture above, you can see the two different cartridges that I had to work with. The one on the left, is from a Lantus® Solostar® pen, and the one on the right is from a Levemir® Flextouch® pen. Even a casual glance is all it takes to see that there are noticeable differences between the two cartridges. The Lantus® cartridge is shorter, and with a larger diameter. The Levemir® cartridge is a bit longer, and a slightly smaller diameter. It was as simple as trying to insert them both into the pen barrels to see which cartridge might be the correct size.

Despite the diameter differences, both cartridges will fit into the barrel, and the pen plunger will also fit inside either cartridge. But what about the length?

And that's where the final decision comes in. As you can see, on the Levemir® cartridge, the pen barrel will not screw down completely like it should. The cartridge is just too long to let that happen.
But the Lantus® cartridge fits just like it was made for this Luxura HD® pen. Apparently the cartridge used in the Solostar® pen is the same size as the Humalog® cartridge, or at least, close enough that they are interchangeable in the Luxura® pens.

And from that point, by following Eric's excellent instructions on how to clean, rinse, and fill the empty cartridges, it only takes a short while to set up two of the new Luxura HD® pens to dispense Lantus® and Novolog®, using insulin from a much more affordable vial instead. Which is a double bonus for those folks that have insurance that will not cover the disposable pen delivery devices for their insulin needs, but will cover insulin in a vial. In fact, even if you have no insurance, you could still use these same pens, and cartridges, and fill them with the very affordable Novolin R® and Novolin N® brands of insulin available at your nearest Walmart to get pen convenience without paying the obscene out of pocket costs of other brands of insulin!

In an upcoming blog post, I will share a similar method on how to refill your own Novolog® cartridges for use with the Novopen® Echo® device, as well as a way to put those Levemir® cartridges to good use in the Novopen® Echo®, making it every bit as flexible for dispensing whatever insulin you want to fill it with, just like the Humapen® Luxura® devices.

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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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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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.

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Diabetes and CPAP

Its no big secret that many of the things that lead us to developing diabetes also play a significant role in other health related issues as well. And one of those correlations is shown in how many diabetics are also affected by sleep apnea. In my own case, I was aware that I had, un-diagnosed and untreated, sleep apnea for many years prior to the onset of my type 2 diabetes. But escalating risks, with my diabetes, and cardiac issues, forced me to finally seek help for my sleep apnea, which resulted in my doctor putting me on a CPAP machine.

About a week into my CPAP usage, there was a problem. It wasn't a problem with the use of the machine, or nasal mask, or even dealing with nightly bathroom visits. In fact, I don't believe I have ever had a better night's sleep than these first nights, and I awoke more refreshed and more energized that ever before, with only minimal adjustment issues. So what was the problem you might ask?

The problem, was a software problem. It seems that the SleepMapper software for my Philips Respironics® CPAP machine is only supported for Windows or Mac computers. Which is fine, as long as you are a Philips customer, and own one of those types of computers. But in my case, my computer runs a LINUX operating system, and Philips wasted no time in letting me know that I was 'out of luck' as far as software support goes. (You can see more about this, and my rant about how corporate America treats LINUX users as if they are not important in this blog entry)

Because I do have a fundamental knowledge of computers, and enjoy a good challenge, I set out to attempt to find a solution to using the Philips SleepMapper software with LINUX. And along the way, not only did I discover a solution, I also discovered a much more comprehensive software solution for use with my Philips Respironics® CPAP machine called Sleepyhead. The solution that allows the Windows version of SleepMapper to run in LINUX also allows the Windows version of Sleepyhead to run in LINUX as well. If you are the owner of a Philips Respironics® CPAP machine, and are also the owner of a LINUX computer, feel free to check out my solution on this blog entry.

And if you are a diabetic, you probably already know how important it is to get an adequate amount of high quality of sleep each night. Are you taking the steps to insure that you are getting 8-9 hours of sleep every day? As a diabetic your body needs it's rest to help combat your diabetes. And if you have not been screened for sleep apnea, and have any of these symptoms, you owe it to yourself to seek the appropriate medical advice.

David Jarrett © 4/08/2015

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Premier Diabetes Site thinks we all should use iPhones?

Well over a year ago I contacted dLife and asked about the availability of an Android version of the dLife app, which was only available for the iPhone at that time. 

I received an email reply and was told by dLife that it was being worked on. 

Over a year later, there is still no Android version of the dLife app, and a current article on dLife about mobile apps for diabetes mentions ONLY iOS apps, NOTHING for Android.

So what's up dLife, are diabetics only supposed to be iPhone users?

BTW, for those Android using diabetics out there, there IS an excellent diabetes tracking app available from Medivo called OnTrack Diabetes.

It can be downloaded here on Google Play

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No Sugar Added Chunky Pasta Sauce

Easy No Sugar Added Chunky Pasta Sauce
-Ingredients-
4 Tbsp Olive Oil
3 Tbsp Minced Garlic
2 Tbsp Italian Seasoning
1 Medium Onion Coarsely chopped
1 can (or fresh) mushrooms (optional)
1 to 1-1/2 lbs meat of your choosing
2 28oz cans diced Tomatoes
1 28oz can crushed tomatoes
3 Tbsp Cream/Neufchatel Cheese (optional)

Into a 6 quart saucepan add the olive oil,
italian seasoning, minced garlic, chopped onion,
and meat. (In our house we like diced chicken the best!)
Saute until the meat is done through and through.
Add the diced tomatoes and crushed tomatoes, cover and
simmer on low heat until cooked through. If you prefer
more of a Vodka style saucee, add the Cream/Neufchatel
Cheese and blend in evenly.

Serve over your pasta of choice. For an extra low carb meal,
serve over spaghetti squash or a vegetti style pasta.

This recipe is approximately 1 carb serving per 3/4 cup of sauce.

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