Insulin Concentration and Vial Size
Insulin Concentration: Long-acting, regular, and rapid insulin comes in a concentration of 100 units/ml. Some may come in 200 units/ml or 500 units/ml which would be reserved for people taking HUGE amounts of insulin per day.
Vial Size: A good average vial size is 10 ml. That means if the insulin has a concentration of 100 units/ml, one 10 ml vial will have 1,000 units in it.
Supplies that the diabetic patient needs
Monitoring supplies: The first 3 supplies (Glucometer, test strips, and lancets) are for monitoring blood sugars.
1) Glucometer – Refer patient to Durable Medical Equipment (DME) to get glucometer if their insurance covers for it.
2) Blood glucose test strips
2) Lancets (30 gauge)
If you need to write the prescription, do:
Glucometer. Disp # One. Ref # None
Blood glucose test strips. Re: Use twice daily as instructed. Disp#180. Ref# 1 (one)
Lancets (30 gauge). Re: Use twice daily as instructed. Disp#180. Ref# 1 (one)
Injection supplies: The last two (needles and syringes) are for injecting themselves with insulin.
1) Needles (30 gauge 1/2 inch needles) for injecting the insulin.
2) A syringe of the right size determined by the amount of insulin that will be injected. Choose from a 3/10ml, 1/2ml, or 1ml syringe as needed.
Syringe Size: Syringes come in three common sizes, 3/10ml, 1/2ml, and 1ml. See syringe sizes and how to chose the right size here.
Most often, the syringes come with the needles attached to them already and don’t have to be bought separately.
Sample Insulin Prescription
Lantus 100 units/ml
Sig: Take 10 units QHS
Disp: One 10ml vial or 1,000 units
Refill: 3
Add a note to the prescription saying, “Pharmacy may change lancet or needle gauge and size to suit patient desires or insurance recommendations”
** In the Sig for test strips, lancets, and needles, pharmacy (and insurance companies) want you to say how many times they should test the blood sugars or how many times they should inject the insulin. Insurance companies want to know how fast the patients will go through them so there is no wasting!
Related Article: Diabetes Drugs and their classes
Starting patient on Lantus
52 y/o M DM2 pt on Metformin 500 mg BID with HbA1c of 11, Cr. 1.47 and Microalbumin of 2338.2 and Microalbumin / Creat Ratio of 1980. Patient calls to ask, should he continue to take Metformin? Answer: No. Instead, start this patient on Lantus 15 units QHS and order syringes and needles with it as well. Also, make sure he/she has a meter to check blood sugars. **The resident MD didn’t know how to order needles and syringes and called the pharmacist! Call pharmacist when you need help!
The pharmacist told me that common syringe size they use for insulin is 0.3 ml syringe that can hold up to 30 units.
Syringe size:
– 0.3 ml syringe can hold up to 30 units.
– 0.5 ml syringe can hold up to 50 units.
– 1.0 ml syringe can hold up to 100 units.
They give the syringe size depending on the amount of insulin that the patient is injecting.
You can order insulin in the EHR and call the pharmacy to add syringes, needles and the strips for the meter. For meter, refer to Durable Medical Equipment (DME) from the EHR.
Questions
How long can an insulin vial last while it is being used?
An open bottle should be used for 28 days or less whether refrigerated or kept at room temperature. A refrigerated bottle that has not been opened would last three months or up to its expiration date, whichever is closer. Patients should always have an opened refrigerated bottle of each type of insulin they are using in reserve in case they need to use it.
Reference / Further Reading
http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7247
http://care.diabetesjournals.org/content/26/9/2665
http://www.medscape.com/viewarticle/822227
https://www.bd.com/us/diabetes/hcp/main.aspx?cat=3065&id=63268