Patient tutorial shows how to use the original
Humalog & Humalog Mixtures Prefilled Pen.
Questions About the Original Prefilled Pen
- Do needles come with the Pen? What size should I recommend for my patients?
- Insulin does not come out of the needle. What should my patient do?
- My patient dialed the wrong dose (too high or too low). How do you correct the problem?
- My patient is not sure how much insulin remains in the cartridge. How do you determine this?
- Why must the injection button be held down for five seconds after the injection?
- My patient dialed below the zero or beyond the 60-unit mark. Is the Pen still usable?
- A small amount of insulin remains in the cartridge, but a dose cannot be dialed. Why?
- How many units of insulin are in the insulin cartridge?
- Why should my patient prime the Prefilled Pen?
- What is the approximate volume/amount of insulin used in the process of priming a Prefilled Pen?
- Are air bubble(s) in the Pen a problem?
- How do you remove and/or prevent air bubble(s)?
- The dose numbers are not centered in the window. Is this a problem?
- My patient's vial of insulin is "bubbling or foaming" more than usual. There are lots of bubbles. Is it safe to use?
Do needles come with the Pen? What size should I recommend for my patients?
The Prefilled Pens are suitable for use with Becton, Dickinson and Company's insulin pen needles (sold separately). There are a variety of pen needles currently available.
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Insulin does not come out of the needle. What should my patient do?
To obtain an accurate dose, you must always:
- Attach a new needle every time you inject
- Push in the injection button completely each time you inject (even if a 0 appears in the window) until a diamond or arrow is seen in the center of the dose window
- Prime the Pen prior to every injection and each time you use a new needle
My patient dialed the wrong dose (too high or too low). How do you correct the problem?
If you have not pushed in the injection button, simply turn the dose knob backward or forward to correct the dose.
If you have pressed the injection button and the dose was set too low, do not change the dose setting until the injection button has been fully depressed. After you have completed this injection, set a dose that is equal to the amount of insulin you did not receive and inject again.
If you have pressed the injection button and the dose was set too high, do not complete the injection. Remove the needle from your skin and dispense the remaining dose into an appropriate waste container.
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My patient is not sure how much insulin remains in the cartridge. How do you determine this?
Hold the Pen with the needle end pointing down. The scale on the clear cartridge holder (20 units between marks) shows an estimate of the number of insulin units remaining. These numbers must not be used for measuring the insulin dose. Always look at the number in the dose window to determine your exact dose. Remember, when you dial your dose, you will not be able to dial more insulin than remains in the Pen.
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Why must the injection button be held down for five seconds after the injection?
After the injection button is fully depressed, it takes a few seconds to completely expel the insulin dose, primarily due to the elasticity of the rubber plunger. As with all Lilly insulin pens, five seconds is recommended as the appropriate time needed to ensure full dose delivery.
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My patient dialed below the zero or beyond the 60-unit mark. Is the Pen still usable?
The Pen is broken. You will have to use a new Pen.
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A small amount of insulin remains in the cartridge, but a dose cannot be dialed. Why?
Even though the Pen has delivered 300 units, a small amount of insulin will remain in the cartridge. This insulin cannot be delivered, therefore a dose cannot be dialed.
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How many units of insulin are in the insulin cartridge?
There are approximately 320 units of insulin in the 3.0 mL insulin cartridge contained in a Pen. This includes 300 units of deliverable insulin, approximately 12 units of "overfill" (to ensure each cartridge is capable of delivering the claimed 300 units), and approximately 8 units of insulin that is undeliverable and will remain in the cartridge.
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Why should my patient prime the Prefilled Pen?
Priming the Pen is required to maintain dose accuracy, and consists of an initial priming of a new Pen and priming prior to each dose. Initial priming brings the lead screw in contact with the plunger, fills the needle with insulin, ensures a fluid path, and removes most air bubbles that may be present in a new cartridge. Priming prior to each dose maintains the contact between the lead screw and plunger, fills the new needle with insulin to ensure a fluid path, and removes any air that may have entered the cartridge during storage or installation of a new needle.
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What is the approximate volume/amount of insulin used in the process of priming a Prefilled Pen?
The approximate amount of insulin used in the process of priming a Prefilled Pen is 2 units. When using a new insulin cartridge or Pen, the priming step may need to be repeated multiple times.
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Are air bubble(s) in the Pen a problem?
A large air bubble or a cluster of bubbles may cause you to inject the wrong amount of insulin. However, a small air bubble is not a problem and will not affect the dose accuracy or injection time.
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How do you remove and/or prevent air bubble(s)?
Air bubbles should be removed by priming the Pen prior to injection. Priming is the most important step in making sure your insulin is delivered correctly and accurately. Priming ensures that:
- The needle is attached correctly
- The needle is not clogged, and insulin is flowing correctly
- The Pen is operating correctly
- Air bubbles are removed
In addition, needles should be removed from the Pen once the dose has been injected to prevent air bubbles from forming in the cartridge. Please refer to the Pen User Manual for further information.
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The dose numbers are not centered in the window. Is this a problem?
The Humalog, Humalog Mix75/25, and Humalog Mix50/50 Pen's dialing mechanism provides for a distinctive position as each unit is dialed. To get an accurate dose, you should attempt to center the numbers in the dose window before injection.
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My patient's vial of insulin is "bubbling or foaming" more than usual. There are lots of bubbles. Is it safe to use?
Insulin has surface activity; it behaves like a very diluted soap solution. Agitation causes foaming. During in-use studies that simulated patient dosing regimens, there has been no evidence that foaming affects the stability of the insulin. If the solution or suspension appears normal as described in the package insert, then it should be safe to use. Care should be taken not to inject air from the syringe (to equalize pressure) directly into the solution; inject the air before inverting the vial to take a dose. Injecting air directly into the solution could lead to bubble formation. Please refer to the Pen User Manual for further information.
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Important Safety Information
Humalog insulins are contraindicated during episodes of hypoglycemia and in patients sensitive to Humalog or one of its excipients. The safety and effectiveness of Humalog in patients less than 3 years of age have not been established. Safety and effectiveness of Humalog Mix75/25 and Humalog Mix50/50 in patients less than 18 years of age have not been established. There are no adequate and well-controlled clinical studies of the use of Humalog in pregnant or nursing mothers.
Potential side effects associated with the use of all insulins include hypoglycemia, weight gain, hypokalemia, lipodystrophy, and hypersensitivity. Because of the difference in action of Humalog, care should be taken in patients in whom these conditions may be clinically relevant (e.g., those who are fasting, have autonomic neuropathy or renal impairment, are using potassium-lowering drugs, or taking drugs sensitive to serum potassium level). Patients should be advised not to mix Humalog Mix75/25 or Humalog Mix50/50 with another insulin. Starting or changing insulin therapy should be done cautiously and only under medical supervision.
When used in an external insulin pump, Humalog should not be diluted or mixed with any other insulin. Humalog Mix75/25 and Humalog Mix50/50 are not indicated for use in external insulin pumps.
Humalog differs from regular human insulin by its rapid onset of action, as well as a shorter duration of activity. Therefore, Humalog and Humalog Mixtures should be given within 15 minutes before a meal. Humalog can also be given immediately after a meal. The short duration of action of Humalog means that patients such as those with type 1 diabetes, whose basal insulin levels are inadequate, will also require a longer-acting insulin to give optimal glucose control (except when using an insulin pump).
Clinical studies comparing Humalog Mix75/25 with human insulin mixtures did not show a difference in the overall rate of hypoglycemia between the two treatments. The overall rate of hypoglycemia did not differ between type 1 and type 2 patients treated with Humalog, as compared with regular human insulin. The lower rate of hypoglycemia with Humalog may be related to higher nocturnal blood glucose levels, as reflected by a small increase in the mean fasting blood glucose levels.
The clinical significance of improvement in postmeal hyperglycemia has not been established. In 12-month clinical studies, A1C did not differ between patients treated with regular human insulin and those treated with Humalog.
Humalog, Humalog Mix75/25, and Humalog Mix50/50 are available by prescription only.
For other important safety information and prescribing considerations, please see Humalog, Humalog Mix75/25, and Humalog Mix50/50 Prescribing Information.
Humalog is a registered trademark of Eli Lilly and Company. Humalog Mix75/25 and Humalog Mix50/50 are trademarks of Eli Lilly and Company.
Humalog insulins are contraindicated during episodes of hypoglycemia and in patients sensitive to Humalog or one of its excipients. The safety and effectiveness of Humalog in patients less than 3 years of age have not been established. Safety and effectiveness of Humalog Mix75/25 and Humalog Mix50/50 in patients less than 18 years of age have not been established. There are no adequate and well-controlled clinical studies of the use of Humalog in pregnant or nursing mothers.
Potential side effects associated with the use of all insulins include hypoglycemia, weight gain, hypokalemia, lipodystrophy, and hypersensitivity. Because of the difference in action of Humalog, care should be taken in patients in whom these conditions may be clinically relevant (e.g., those who are fasting, have autonomic neuropathy or renal impairment, are using potassium-lowering drugs, or taking drugs sensitive to serum potassium level). Patients should be advised not to mix Humalog Mix75/25 or Humalog Mix50/50 with another insulin. Starting or changing insulin therapy should be done cautiously and only under medical supervision.
When used in an external insulin pump, Humalog should not be diluted or mixed with any other insulin. Humalog Mix75/25 and Humalog Mix50/50 are not indicated for use in external insulin pumps.
Humalog differs from regular human insulin by its rapid onset of action, as well as a shorter duration of activity. Therefore, Humalog and Humalog Mixtures should be given within 15 minutes before a meal. Humalog can also be given immediately after a meal. The short duration of action of Humalog means that patients such as those with type 1 diabetes, whose basal insulin levels are inadequate, will also require a longer-acting insulin to give optimal glucose control (except when using an insulin pump).
Clinical studies comparing Humalog Mix75/25 with human insulin mixtures did not show a difference in the overall rate of hypoglycemia between the two treatments. The overall rate of hypoglycemia did not differ between type 1 and type 2 patients treated with Humalog, as compared with regular human insulin. The lower rate of hypoglycemia with Humalog may be related to higher nocturnal blood glucose levels, as reflected by a small increase in the mean fasting blood glucose levels.
The clinical significance of improvement in postmeal hyperglycemia has not been established. In 12-month clinical studies, A1C did not differ between patients treated with regular human insulin and those treated with Humalog.
Humalog, Humalog Mix75/25, and Humalog Mix50/50 are available by prescription only.
For other important safety information and prescribing considerations, please see Humalog, Humalog Mix75/25, and Humalog Mix50/50 Prescribing Information.
Humalog is a registered trademark of Eli Lilly and Company. Humalog Mix75/25 and Humalog Mix50/50 are trademarks of Eli Lilly and Company.
