For Hospitalized Patients With Diabetes
Consider a basal-prandial approach instead of SSI.
In the RABBIT 2 study
A basal-prandial regimen significantly reduced BG vs SSI monotherapy.
HOST (NANCY MEYER) AKA SANDY
Hello. My name is Sandy, and I’d like to welcome you to the Guide to Administering Lantus Using the Lantus SoloSTAR Pen demonstration video.
This video will provide you with some basic information about Lantus and teach you the proper technique for injecting Lantus with the Lantus SoloSTAR pen.
But before we begin, let’s review some important safety information for Lantus.
Indications and Usage for Lantus
Lantus is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus should be administered once a day at the same time every day.
Important Limitations of Use: Lantus is not recommended for the treatment of diabetic ketoacidosis.
Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients.
Warnings and Precautions
Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles.
Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment.
Do not dilute or mix Lantus with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus via an insulin pump or intravenously because severe hypoglycemia can occur.
Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus, and may be life-threatening.
Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus, monitor and treat if indicated.
A reduction in the Lantus dose may be required in patients with renal or hepatic impairment.
(Warnings and Precautions, contd)
As with all insulins, Lantus® use can lead to life-threatening hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Closely monitor potassium levels in patients at risk of hypokalemia and treat if indicated.
Fluid retention, which may lead to or exacerbate heart failure, can occur with concomitant use of thiazolidinediones (TZDs) with insulin. These patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of TZD must be considered.
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and close monitoring of blood glucose. The signs of hypoglycemia may be reduced in patients taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine).
Adverse reactions commonly associated with Lantus include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema and weight gain.
Lantus SoloSTAR is a disposable prefilled insulin pen. To help ensure an accurate dose each time, patients should follow all steps in the Instruction Leaflet accompanying the pen; otherwise they may not get the correct amount of insulin, which may affect their blood glucose.
OPENING PART II
Now that we’ve reviewed the Important Safety Information, I’d like to share a brief description of Lantus.
It is administered once daily, subcutaneously at the same time every day. Its slow release and 24-hour duration closely resemble the physiologic constant secretion of endogenous basal insulin that is typically present in patients without diabetes. The dosage of Lantus must be individualized based on clinical response, frequent monitoring of blood glucose essential. It is important to remember Lantus must not be diluted or mixed with any other insulin or solution, which may alter the onset of action or time to peak effect in an unpredictable manner.
Now, I’ll turn things over to Nancy, who will guide you through a demonstration of how to administer Lantus with the Lantus SoloSTAR pen.
NURSE (JULIA KELLEY) AKA NANCY
Hello. I’m Nancy, and I’m going to teach you the proper technique for injecting Lantus with the Lantus SoloSTAR pen.
Let’s begin by reviewing the key components of the Lantus SoloSTAR pen.
The Lantus SoloSTAR pen is a prefilled, disposable insulin pen that contains 300 Units of insulin glargine.
The pen body consists of a rubber seal at the tip, an insulin reservoir, a dose window, the dosage selector, and the injection button.
The dose can be selected by adjusting the dosage selector dial from 1 to 80 Units.
The Lantus SoloSTAR pen uses disposable, single-use needles that are either pushed or screwed onto threads located at the tip of the pen body.
Needles are not provided with the Lantus SoloSTAR pen.
During today’s injection demonstration, I’ll be using the BD AutoShield™ Duo pen needle, the only pen needle that covers the front and back needles, helping to minimize exposure after use. If your facility does not use BD pen needles, please refer to the needle manufacturer’s instructions.
Now let’s take a look at the components of the AutoShield Duo needle.
The AutoShield Duo is a 30 gauge, 5 millimeter, very short and thin needle designed as a single-use product. It is the only pen needle that fits every diabetes pen, to get the highest level of protection.
You’ll see there are colored shields, which help to provide a visual confirmation of safety, on both the front and back ends of the needle.
The shield is also designed to facilitate 90 degree insertion and to help prevent accidental needle stick injuries. During injection, the shield retracts to allow the needle to penetrate the skin at the appropriate depth and has an auto-lock system to prevent re-use.
It’s important to note that a sterile, new needle must be used each time you deliver a dose.
Now that you’re familiar with the key components of the pen and needle, let’s go through the 6 steps for preparing and injecting Lantus with the Lantus SoloSTAR pen.
After a pen is opened, it can be used for 28 days.
Check the label on the insulin pen to ensure you are using the correct insulin. Lantus SoloSTAR is grey and has a flat, smooth button. It contains a long-acting insulin, Lantus.
After removing the pen cap, check the insulin reservoir on the pen. Lantus should be clear. Don’t use the Lantus SoloSTAR pen if the insulin is cloudy, colored, or has particles in it. In addition to verifying that the insulin is correct, you also need to ensure that the pen device is the one labeled and intended for that specific patient.
You should attach a new needle each time you use the Lantus SoloSTAR pen.
Examine the tamper evident label on the AutoShield Duo. Discard the needle if the label is damaged or missing.
Peel away the foil tamper evident tab from the pen needle and discard. Do not touch the clear shield at any point prior to the injection.
Next, swab the rubber seal on the end of the pen with an alcohol swab prior to attaching the pen needle.
Now, push and twist the pen needle hub onto the Lantus SoloSTAR pen in a clockwise direction until you feel resistance. Keep the needle straight as you attach it. Do not over tighten.
Pull only the outer cover straight off. The needle will remain covered by the clear plastic Outer Shield.
The next step is performing an air shot also called a safety test. This is necessary immediately before administering injections with Lantus SoloSTAR pens to eliminate air bubbles and check that the pen is working correctly.
To perform the air shot, select a dose of 2 units using the dosage selector dial. Make sure the dosage window is facing you. Pull the needle cover straight off.
Now hold the pen with the needle pointing upward.
Tap the insulin reservoir gently so any air bubbles rise toward the needle.
Keeping the needle pointing upward and using the palmar grip, press the injection button all the way in.
Check to be sure that insulin comes out of the needle tip. If no insulin comes out, check for air bubbles and repeat the air shot 2 more times to remove them. If still no insulin comes out, the needle may be blocked. Change the needle and try again. If no insulin comes out after changing the needle, the Lantus SoloSTAR pen may be damaged and should not be used.
After the air shot, check to make sure that the dose window shows zero. Also, make sure you’re not holding the pen so that the dose window is upside down. This will ensure that you can properly read the numbers in the dose window. Then select the required dose.
A dose of 1 to 80 units can be set on the dial. Doses larger than 80 units should be given as 2 or more injections. The dial can be turned in either direction when selecting the dose. Be sure to avoid pushing the injection button while adjusting the dial. The Lantus SoloSTAR pen is designed so that the dosage selector cannot be turned past the number of units remaining in the pen. If the amount remaining in the pen is less than the units needed for the patient’s injection, simply inject the partial dose and use a second pen dialed to the number of units needed to complete the dose.
Now we’re ready to inject the dose. This step involves 2 distinct actions: first insert the needle, then inject the insulin.
Lantus may be injected in the abdomen, upper arm, or thigh. Remember to rotate injection sites.
The abdomen is the preferred injection site for the AutoShield Duo. This location facilitates proper injection technique—such as keeping the pen at the proper 90 degree angle. Be sure to rotate injection sites.
Make sure to clean the area at the injection site with rubbing alcohol.
Now comes part 1 of the injection process: inserting the needle. The proper way to hold the pen during the injection is to grip the pen in the palm of your hand using the palmar grip.
The standard injection technique is to use one continuous motion to insert the needle straight on at a 90 degree angle to the flat skin of the abdomen.
Be sure to go in at 90 degrees, as a 45 degree angle may result in the needle reemerging from the skin and a needle stick injury
As you press down, the clear plastic shield retracts, allowing the needle to penetrate into the subcutaneous layer of fat. The needle has fully penetrated the skin when the clear needle shield retracts and the white sleeve is flush with the skin.
Now that the needle is fully inserted, we move to part 2 of the injection process: injecting the insulin. Maintaining constant pressure against the skin, deliver the dose by pressing the injection button all the way down. The number in the dose window will return to zero as you inject.
Keeping the injection button pressed, slowly count to 10 before withdrawing the needle from the skin. Waiting 10 seconds is important to make sure you deliver the full dose.
(Comparative presentation with correct technique showing large amount of insulin on the skin)
If the needle is removed before the dose is completely delivered, drops of insulin may appear on the patient's skin.
(Comparative presentation with correct technique showing needle being pulled out with insulin dripping from needle)
Insulin may also appear dripping from the needle. If you see drops of insulin on the skin, it’s likely the patient has not received the full dose.
Once the dose has been delivered, lift the pen away.
The safety shield will automatically lock into place. The appearance of a red indicator band confirms that it is locked and that the needle cannot be reactivated or used for another patient.
Press down on the area with a cotton ball or gauze. Do not rub the area.
Let’s take a closer look at what happens while injecting using this clear injection dome. As we showed earlier, after you swab the injection site, this is a 2 part process: first you insert the needle, then you inject the insulin. Again, you insert the needle straight on at a 90-degree angle to the flat skin of the abdomen. The needle has fully penetrated the skin when the clear needle shield retracts and the white sleeve is flush with the skin. Next, with the needle fully inserted, maintain a constant pressure against the skin and deliver the dose by pressing the injection button all the way down.
Slowly count to 10 while you keep the injection button pressed before withdrawing the needle from the skin. A full 10 seconds is needed to assure you deliver the full dose.
As you can see in this demonstration using a clear dome, the insulin is being administered over the full 10 second time span with only a small drop of insulin remaining on the skin. When using a needle with a protective, plastic safety shield, you will be prevented from actually seeing the insulin being administered. The shield is a safety feature to protect you from needle stick injuries.
To remove the AutoShield Duo, hold it by the clear hub and twist the pen counterclockwise. The orange shield will deploy to protect the pen connection end of the needle. Do not place your fingers on the activated shields.
Between injections, the Lantus SoloSTAR pen should be stored with its cap on and no needle attached. Once it has been used, it should not be refrigerated.
Finally, safely dispose of the needle in an appropriate sharps container.
Then with the AutoShield Duo removed, replace the cap on the Lantus SoloSTAR pen.
Return the patient’s individually labeled insulin pen to the patient’s medication storage drawer or the location approved by your facility’s pharmacy. It is important to remember, pens are for single patient use only.
Remember, each Lantus SoloSTAR pen is a multidose pen and can continue to be used for the same patient until the insulin in the pen is gone, or up until 28 days after the pen was first used, whichever comes first.
That covers the 6 steps for preparing and injecting Lantus with the Lantus SoloSTAR pen.
Let’s do a quick review: Step 1: Prepare for an injection; Step 2: Attach a new needle; Step 3: Perform an air shot or safety test; Step 4: Select the dose; Step 5: Inject the dose; Step 6: Remove the needle.
HOST (NANCY MEYER) AKA SANDY VIDEO CLOSING
Thank you, Nancy.
Now, let’s go over a few important points to keep in mind. First is delivering a full dose.
When you get toward the end of the insulin reservoir, there may not be enough insulin for the patient’s daily dose.
If you can’t turn to the dose you want, don’t force it. The pen prevents selection of doses greater than the amount of insulin left in the reservoir.
As Nancy mentioned, you can either inject what’s remaining in this Lantus SoloSTAR pen and complete the dose with a new pen, or you can use a new pen for the full dose. Please be sure to follow your hospital’s recommendations or policy.
Next let’s discuss storing the Lantus SoloSTAR pen.
After 28 days, throw away a used pen that still has insulin in it.
Do not use any pen after the expiration date on the label or individual patient label.
This concludes our demonstration.
If you have any questions about the Lantus SoloSTAR pen, call 1-800-633-1610 to talk to a Lantus SoloSTAR expert.
Thank you for watching. I hope you found this demonstration helpful and have a better understanding of how to administer Lantus using the Lantus SoloSTAR pen.
See how Lantus® provides effective, improved glycemic control in diabetes patients.†
†Lantus® Prescribing Information. August 2015.
Lantus® is a once-daily, long-acting insulin.**
**Lantus® Prescribing Information. August 2015.
Lantus® is a basal insulin with demonstrated long-term CV safety data††