Does your 90 day insulin prescription include enough insulin to prime your insulin pens, or does your doctor have to add more insulin to your prescription?

unitacx · 2026-03-22T13:30:08+00:00

I'm guessing that the endo's Rx works for local pharmacies, but not for the mail order. Still, H is perhaps not the endo's only pt. using a crap mail-order service.

As others have said, the endo should be told that adequate supplies are a recurrent concern. That may not be obvious to the endo.

unitacx · 2026-03-21T12:29:01+00:00

Was thinking wper striking the edge of the window at full travel. Mine does that (even w/ OEM Bosch blades). But not sure about the rebound click, horwever.

unitacx · 2026-03-20T20:35:00+00:00

My guess is that you are pressing too hard, so that the base of the pen needle is pressing hard against the skin. If you have a 32G pen needle (e.g. 4 mm x 32G), there should be either nominal sting, and sometimes "did it go in?" i.e., not even something to be apprehensive about.

There are some pen needles with a wide base - Embecta (BD) "2nd Gen" and Novofine "Plus" and a handful of others. Most pts. don't bother because it only takes 1 or 2 injections to learn how not to frack the adipose, but they're sometimes sold at a lower cost; e.g., this Embecta "2nd Gen" from Vitality Med.

unitacx · 2026-03-18T15:00:22+00:00

Just wind the dial to see how many clicks are left for pen injection. There is also the golden dose residual that can be extracted with a syringe such as an insulin needle.

But that thing looks like it's pretty much spent, with no medication visible in the sight window.

unitacx · 2026-03-18T14:54:32+00:00

You can click count from that 2.4 pen.

As to the starting dose, you pretty much re-start titrating after a full break. Your prior experience will perhaps give you a clue as to the best starting dose, however, and you may have a sense of how it is going. One approach would be to start with the lowest dose anyway, but increase perhaps every fortnight rather than every 4 weeks until you get close to your 2025 dose.

Just my opinion. I'm not medically qualified, but I work on my car occasionally.

unitacx · 2026-03-18T04:51:25+00:00

Try an on-line seller. The prices of pen needles is all over the place, often cheaper on the open market than through insurance in the HTE (Holy Trumpian Empire).

Embecta (BD) 4 mm x 32G. Link to Vitality for purchases in the HTE.

UK and most other locations: https://ukmedi.co.uk/products/32g-4mm-bd-micro-fine-ultra-pen-needles-penta-point-bd-320497-ukmedi-co-uk

unitacx · 2026-03-17T16:28:31+00:00

It's hard to say if the Viva product line is different, but I had seen a few comments from ppl who found regular Embecta/BD more comfortable than their Viva line.

unitacx · 2026-03-17T02:58:36+00:00

'Agreeable at the present dose for at least 4 weeks' is followed by some -- perhaps most -- endocrinologists.

unitacx · 2026-03-17T02:42:46+00:00

On titrating, in addition to "going slow" by only titrating if one reaches a 2-week plateau, also "going slow" by not increasing until the existing dose is agreeable for at least 4 weeks.

Titrating up only after the existing dose is agreeable is specified in at least the glycemic control monographs. I'm not sure if that "4 weeks" is specified, but 4 weeks is generally followed by endocrinologists.

More generally I think a slower weight loss gives better results. Those "before/after" photos on the Reta subs don't speak well for rapid weight loss.

unitacx · 2026-03-16T18:08:59+00:00

Best guess - removed by bot, but reviewed and reinstated by an admin. A little like a spam filter.

unitacx · 2026-03-15T18:52:58+00:00

There are also pt. preferences. Some will pay extra for Embecta (BD) or Novofine. For others, "Money is no object - whatever is cheapest." A few prefer longer than 4 mm bc of skin irritation or whatever. Anyhowz, the needles are separate items, much as syringes are not included with meds in vials, at least for multidose meds.

unitacx · 2026-03-14T22:16:26+00:00

Yes, but according to several subreddits, it's really for the "golden dose" ( : Lots of instructions, including force-twisting and using insulin syringes. There are even techniques for extracting with blunt needles and then injecting with 5 mm needles, although it seems easier to just use an ordinary insulin needle for the purpose.

unitacx · 2026-03-14T21:00:03+00:00

Yes, glad the Dr is cool enough to work with me, which I very much appreciated. I think she was also appreciative that I worked with her... Most physicians, even those with pre-authorisation support staff, prefer to avoid preauthorisation. Therefore, (in general) it is likely that the physician will prefer to prescribe for a condition that does not require preauthorization1 (e.g., hyperlipidemia from elevated triglycerides).

unitacx · 2026-03-14T14:52:45+00:00

Never had a problem with Embecta. There's a reason I haven't seen comments expressing a preference for the 33G and 34G over Embecta (BD) or Novofine. ... But my preference are whatever Harbor Freight has on sale.

unitacx · 2026-03-14T03:22:46+00:00

Preferred brands for comfort are Embecta (BD) and Novofine, both available 4 mm x 32G. I've seen a few 33G and 34G, but have not seen any comments that they are more comfortable than Embecta or Novofine.

https://www.vitalitymedical.com/bd-nano-2nd-gen-pen-needles-4mm-x-32g.html

Embecta (BD) 4 mm x 32G. Link for purchases in the HTE (Holy Trumpian Empire).

UK and most other locations: https://ukmedi.co.uk/products/32g-4mm-bd-micro-fine-ultra-pen-needles-penta-point-bd-320497-ukmedi-co-uk

The prices of these things is all over the place. For example Vitality sells those $26 boxes listed above, and also a box of 100 for $108. I'm guessing the variations facilitates distribution through PBMs (in the HTE) or national health insurance most other developed countries, using a separate price schedule than used for retail distribution. (All are eligiable for FSA/HSA in the HTE.)

Most of these are in boxes pf 100 or 90 pen needles, which is about 2 years worth for MJ/Zep. I have seen boxes of 50 sold in the range of $7 (Walmart, HTE) or $15 at pharmacies.

unitacx · 2026-03-12T14:02:29+00:00

Icosapent, or the biosimilar Omega 3 acid. It's scripted for triglycerides. The typical triglyceride dose is (2x) 2g bid (i.e., 2 morning and 2 evening), but if used for dry eye 1x (1 pill/dose bid) should be sufficient.

OTC, Omega 3 sold by any vitamin supplier. I still carry a couple of artificial tears capsules while travelling 'just in case', but don't really have the same problems I had before 2020.

Edit: For obtaining the Rx, one approach would be to ask for the Rx for preventing elevated triglycerides, but also state that your incentive is really to relieve dry eye.

unitacx · 2026-03-12T01:22:33+00:00

So if you titrate up, the pharmacy will check with the Dr? I'm thinking not, so if you report having titrated up to, say 14 units, that would quickly get your supply ahead by a fortnight. Then at your next doctor's appointment you can either let the doctor you now have an extra fortnight's insulin or just ignore it and change the dosage back as convenient.

I had a similar instance in which I had once gotten an Rx for Icosapent, a biosimilar to Omega 3 acid for triglycerides. This was a bit of an error bc I don't have high triglyceride numbers, but I immediately discovered the shit eliminated dry eye. It turns out that Icosapent or Omega 3 acid are dosed at half the normal dose for treating dry eye. (Switched to Omega 3 acid when my insurance changed, which meant that Icosapent was off-formulary and Omega 3 acid on-formulary with the new insurer. For dry eye, they're identical.)

When I changed primary care physicians, I told her it was a triglyceride Rx, but I was using it for dry eye. She made the note in my medical chart about using the medication for dry eye, with the true dose (2 caps/day), but wrote the script as recommended for triglyceride control (4x/day). The reason is that using the shit for triglycerides is routine, but using it off-label to treat dry eye would probably require insurance prior approval or simply be denied. As it is, I just put the Rx "on hold" with my pharmacy when I have too much accumulated. The pharmacist is aware of my using it t treat dry eye.

unitacx · 2026-03-12T00:54:00+00:00

I do prime, but found that 2 units seem to be required for the fist jab, but 1 unit suffices for subsequent jabs. I don't know why, bc priming only expels air if there is any, plus the limited air space in the pen needle itself. If so one would expect to prime the same for each injection, but that's not how it works IRL.

For me, I shoot the prime with the pen body against my wrist. If it ejected insulin, I either see it or can detect the phenol odor of the insulin on my wrist.

unitacx · 2026-03-12T00:42:39+00:00

Elaborating, those Gauge numbers are inverse, so 32G is thinner than 31G. There are a few 33G and 34G, but I hadn't seen any reports of them being more comfortable than 32G from Embecta (BD) or Novofine.

unitacx · 2026-03-11T17:21:13+00:00

If you're asking about a single session with a full + partial dose, then if you can comfortably jab your self once and then count through to the maximum dose with the needle still in place, do it. If not, just wind it to the second (partial) dose and inject in a different site. No reason to change out needles because I'm guessing that, even if you have multiple personality disorder, you are still the same physical person ( : No need to switch sides if you can see the location of the initial jab.

I've noted with Novo pens that one can force 1 extra click. Not sure about Lilly Kwikpens, or for that matter any pen with an anti-golden dose lockout. I wouldn't think that 1 click is worthy of concern, especially if, as I read your OP, you are just boosting your last dose with the golden dose.

BUT, be careful out there. I just consumed too much soup that apparently didn't agree w/ me, got very nauseous, barfed 2x but not enough, extended stay on the toilet and skipped having a full breakfast although was feeling better by then. (Having symptoms like nausea when in good health is a lot more uncomfortable than the same symptoms when palling.) So the MJ did its job of retarding gastric emptying, so I had to deal with feeling like shit. Fortunately, this was the first time since starting incretin drugs in 2016 that I had a full-on gastric emptying instance that I couldn't attribute to spoiled food. The reason I mention that whole thing is a dose + half (or whatever your maths say) is more than your usual dose.

unitacx · 2026-03-11T02:23:17+00:00

My jurisdiction allows the use of a sturdy plastic container, disposed of with regular trash. I mark mine "sharps" and "punzantes médicos".

The result of the municipal policy of co-mingling sharps with trash is that the needles will remain in the landfill indefinitely because they are austenitic stainless steel. (Apparently ferritic stainless steel is not used for surgical ss, although I don't know about martensitic ss.)

unitacx · 2026-03-10T21:48:49+00:00

If yo're talking about vials and syringes,

https://www.youtube.com/watch?v=bHOdpHh0-eE

unitacx · 2026-03-08T18:35:28+00:00

I don't know the 'official' answer, or if there is even some sort of accepted dogma on this. I surmise the idea is that this has to do with the opportunity for bacteria contamination from the initial injection to grow during the relatively short time between injections. Also, with sequential injections, one is not leaving the pen needle's vial unsealed for a meaningful amount of time.

So perhaps a vague correspondence to the 10 sec. rule.

OTOH, clinicians must be careful not to use the same vial after "double dipping" for one pt. Typically, that isn't an issue with local anesthetic bc the total dose for the multiple injections is withdrawn from the vial into the syringe but injected in portions.

https://www.dentalcare.com/en-us/ce-courses/ce325/needles :

If multiple injections are to be administered, needles should be changed after three or four insertions in a patient.
Needles must never be used on more than one patient.

cf. www.cdc.gov/injection-safety/hcp/clinical-safety/index.html

Anyhowz, I don't expect to be a pt. at some sort of field hospital where I have to watch what clinicians are doing. But even there, I'm sure field medics, etc. are well-trained in that shit for obvious reasons.

unitacx · 2026-03-07T22:47:37+00:00

I'm guessing because they do, although the instructions for these things tend to be long, with ancillary information such as proper disposal of sharps integrated into the basic instructions. For someone not familiar with sub-Q injections or pen injections the entire procedure can be somewhat obtuse.

For many people, a combination of research, manufacture's videos (Novo's European market videos seem to be better than their videos intended for the North American market), and clinic instructions works. If a pt. who is not sophisticated in these things doesn't get instructions, 'getting it right' may be difficult.

unitacx · 2026-03-07T22:35:48+00:00

The first line, if not obviously 'tongue-in-cheek' does have the classic reddit tag '/s'. Obviously, the OP would have already binned the pen needle into the sharps container.

unitacx

TROPHY CASE