Levemir Clogging Pen Needle Tips

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othytim

othytim

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Type 1
Hiya, I was for a long time using Lantus, but have more recently been moved onto Levemir.
My problem with Levemir is that I am forced to put a new needle on the pen immediately before I use it. I cannot plan ahead and put a fresh needle on in the morning that I'll then use in the evening, because it will be clogged up by then. I find this particularly annoying if I'm out and about in the evening, like wild camping, or at a festival. Levemir seems to always clog the needle tips and this means a lot more faffing about and that's not always convenient. With Lantus I could put a fresh needle on the pen in advance and I knew that it would be fine when I needed to take it later in the evening. I can't do this with Levemir and I find it flipping inconvenient. Okay, rant done. I guess I just wanted to get that off my chest.
 
This is interesting as I was just thinking about this situation a couple of mornings ago when I was injecting my Levemir. I am a bit naughty and don't use a new needle every time 😱 and I used to frequently but not everytime, find that my Levemir clogged and took several air shots to clear it. The reason I was thinking of this recently is that it no longer happens and hasn't for ages and I am now wondering if perhaps it reacts with the coating on some brands of needles, because I have been using GlucoRx Carepoint Ultra needles for a couple of years now and it doesn't seem to happen anymore. Just to be clear, it didn't happen every time before and I can't remember the brand of needles I was using before, but it definitely doesn't happen now with the Carepoints and that is the only possible factor that I can think of which might impact it. Certainly the needles I have are the same size and gauge as my previous ones, so that can't be it, but I know that different manufacturers do use different coatings to make the needle glide is easily, so maybe the coating is the issue.
I am going to tag @eggyg as I have a recollection of discussing this issue with her a few years ago. Not sure if it has resolved for her too or if she is still having the same problem.... or if I am imagining that conversation and she never had this issue in the first place or perhaps it was someone else.
 
You’re right Barbara. I always have to put a new needle on for my Levemir. I must admit I’ve never tried putting one on in advance, I’m too old for festivals etc! Definitely clogs up if I sometimes have a brain block and try injecting with an old needle on. I am puzzled by this because, to me, it doesn’t look any thicker than my NovoRapid and I use the same needle all day for that.One of life’s little mysteries I’m afraid. I use BD Viva 4mm needles and have done for years. Sorry @othytim that I don’t have any solutions, except maybe see if they’ll let you try different needles, but I don’t suppose you’re wild camping or going to festivals everyday so like a lot of things with diabetes we’ve just gotta do what we gotta do! 😉
 
Think it must be a levemir thing cos I’ve noticed on the times I thought it would be helpful to preset up my levemir that the needles blocked up so I don’t bother now.
 
I'm naughty like @rebrascora , I use a fresh needle every evening, but I leave it in overnight and reuse in the morning. I very occasionally have a problem with it blocking, but only about once a month, or possibly less. I had one the other day, and was taken by surprise, it hadn’t happened for so long. I usually get Nipro 4 Sure needles dispensed, (though it can vary depending on what stock the pharmacy has, my prescription is a generic one).
 
Well this is an interesting thread, and A New Diabetes Thing I have learned today. I never got to try Levemir (I was considering switching to it at the same time as I was considering a pump, and in the end, the pump won).

I’d never heard this about Levemir, but will put it into the archives in case this issue ever arises again.

My first thought was that it was more likely to just be the needle, but that doesn’t seem entirely the case.

Thanks @othytim
 
Many thanks for all the replies. It's really appreciated. I was having a bit of a moan I guess. Yes, it's more that I'm out doing stuff in this nice weather at the moment which makes this inconvenient. I'm not normally wild camping/festivaling all year round!

I did not get this problem with Lantus or NovoRapid, and I don't have this problem with Trurapi. It's just with Levemir and it's very consistently happening. The act of putting a fresh needle tip on the Levemir pen and leaving it until I need to take it that evening (while I'm out and about), will mean that it's completely clogged-up and cannot clear, despite air-shots to try to unblock it.

Looking at my repeat prescription list in the NHS app, the pen/needle tips I get are:
  • Microdot Max hypodermic insulin needles for pre-filled / reusable pen injectors screw on 4mm/32gauge
 
Looks like we all use different needles so it’s definitely a Levemir thing. Weird.
 
Might be worth trying the GlucoRx Carepoint Ultra as I am definitely not having problems with them and they are 4mm 32G, so the same size as you are using.
I am really, really naughty and just change my needles twice a week and have done since diagnosis so I have had plenty of opportunity to test this with Levemir and often I need an evening dose so the needle can go from one day to the next before I use it again and I am no longer experiencing blockages now with these needles. As you say, other insulins don't do it, just Levemir which makes the air shot really important to ensure that insulin is flowing freely when you inject.

Personally I absolutely love Levemir and this is/was a small blemish in it's otherwise very attractive features, but yes it was a bit frustrating. I could sometimes force it out with more air shots. I generally just use half a unit with reusing needles and as long as I see a bead of insulin at the tip of the needle that is enough but sometimes with Levemir it would take 2 or 3 x2 units or sometimes I got anxious that it might put too much pressure on the pen or cartridge and then found that I could run it under a tap to dissolve it.... not convenient.... or a bit of saliva between my fingers and rubbed on the needle tip. You could possibly dip it in vodka or something at a festival if you wanted to be more scrupulous about it being sterile! 🙄
 
I understand there is a certain convenience to having a pen with a needle already fitted, but I can't help wondering (since you now know this is a potential problem sometimes) could you not have a single spare needle in a few places as an Urgent reserve? Also are you priming the pen and needle when you first fit that needle and thereby leaving a residue of Lantus on and in the needle which is more likely to clog? If no air shot was done until you need the dose (which would be a safe routine anyway) and the pen lid was in place (as basic protection) with the pen kept needle upwards in a pocket or bag - would this reduce clogging to a very unlikely likelihood?
 
I only use one needle each day which is fine for me and saves the NHS a lot of money but I always try to do my Levemir before the Novorapid as the Levemir does block the needle but not the Novorapid.
 
Proud to be erratic said:
I understand there is a certain convenience to having a pen with a needle already fitted, but I can't help wondering (since you now know this is a potential problem sometimes) could you not have a single spare needle in a few places as an Urgent reserve? Also are you priming the pen and needle when you first fit that needle and thereby leaving a residue of Lantus on and in the needle which is more likely to clog? If no air shot was done until you need the dose (which would be a safe routine anyway) and the pen lid was in place (as basic protection) with the pen kept needle upwards in a pocket or bag - would this reduce clogging to a very unlikely likelihood?
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Yup. Due to this issue I have to have spare needles on me. It can't work otherwise! Sorry if I was unclear about that.
The clog is just that small amount of insulin that flows into the needle when I put a fresh needle tip on. I guess there is always going to be a small amount of pressure. It makes no difference if the pen is pointed up.
So yes, I always carry needle tips to put on my Levemir at the moment I need to take it, because if I do it in advance it clogs. It's just the inconvenience of the moment that I find er... inconvenient. It sounds like this issue may not occur with another brand of needle tips, which was mentioned above, so I will see if my GPs are happy to switch me to that.
 
After 25ish years of re-using needles and the history of blunt hedgestakes (cos nobody could tell me how to get them sharpened where I lived) followed by having to buy my own disposables for some time then only having 2 packets (so 20 syringes) per month so less than 1 per day now - I suddenly noticed in the mirror when dressed in my M&S short legged thermal leggings cos I'm only just over 5ft and everyone else only made them for taller people, ready to go somewhere on the pillion of one or other of husband's motorbikes (obv after I'd donned leathers etc etc on top) I suddenly saw I had ruddy great hollows on the outer area of the top of each thigh. OOps, those bits won't absorb well then ..... and parts of my tum don't either, neither do parts of my backside. This is the VERY reason I instantly tell everybody I hear does it to STOP THIS VERY INSTANT. Please!🙂

I don't wish this non absorbency issue on my worst enemy cos it's still a nightmare 25+ years later.
 
DaveB said:
I only use one needle each day which is fine for me and saves the NHS a lot of money but I always try to do my Levemir before the Novorapid as the Levemir does block the needle but not the Novorapid.
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Are you saying that you use one needle a day and transfer it from your Levemir pen to your NR pen and then back to Levemir for your evening dose? For some reason I am less comfortable about doing that than using one new needle on my Levemir every 3 or 4 days and another on my Fiasp every 3-4 days. I don't know why I am concerned about swapping a needle back and forth. Perhaps the concern that the 2 insulins may contaminate or impact their performance in some way. Probably negligible risk but just feel less comfortable about it.
I wouldn't say there is a huge saving to the NHS but there is some saving and there is also a slight saving to the environment. A box of needles is probably about £8. If I use 4 needles a week I am going to use just over 200 a year. If I inject a minimum of 5 injections a day (generally I need several more) and use a new needle every time, I am up to 1825 needles a year minimum if I change it every time but more likely over 2000 with corrections etc, so a factor of 10 difference..... plus the extra Sharpsafe boxes plus disposal of them which will all cost someone money be it NHS or council.... I guess it mounts up quite a bit when you actually do the maths. My 1 litre Sharpsafe generally lasts 2-3 years.
Of course you have to also consider the risks of damaging your sites and perhaps even timescales involved in that. ie I was diagnosed late in life and will be unlikely to make it to 100, so not going to have 50 or 60 years injecting and the tiny modern needles are far less damaging than the old reusable needles that many long term diabetics started out using and modern insulins may well also be less damaging. If my fingers cope perfectly well with using the same lancet for a year without harm I am sure my injection sites can cope with reused needles and my experience to date demonstrates that it is OK for me, but I am not advocating others do it.
 
I have never been the most puritanical about anything and definitely not diabetes (looks around to check that no one is listening) and when using pens, i certainly used a needle more than once. However, that was mostly to avoid throwing one out when I was away from home/sharps containers. The time taken to screw a needle on to a pen was negligible and 'the cost of a new needle each day is nothing compared to the cost of insulin.
I will happily use a lancet for months but those pictures of blunt needles (and the bruises on my torso) haunted me enough to minimise needle reuse.
So, I am definitely missing something here about the need to put the needle on the pen before heading out. Or to change the needle when at home near the sharps bin.
 
helli said:
I have never been the most puritanical about anything and definitely not diabetes (looks around to check that no one is listening) and when using pens, i certainly used a needle more than once. However, that was mostly to avoid throwing one out when I was away from home/sharps containers. The time taken to screw a needle on to a pen was negligible and 'the cost of a new needle each day is nothing compared to the cost of insulin.
I will happily use a lancet for months but those pictures of blunt needles (and the bruises on my torso) haunted me enough to minimise needle reuse.
So, I am definitely missing something here about the need to put the needle on the pen before heading out. Or to change the needle when at home near the sharps bin.
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Sheer laziness on my part. The first thing I do when I get into bed at night is inject my Levemir, before reading for half an hour, and the first thing I do after my cup of tea and a look at the news headlines and the forum, before getting out of bed next morning is inject again.
 
Mine is a dislike of the amount of waste plastic they generate and the cost. Plus if I wake up in the night and need a correction I can just get my pen out dial it up and jab it and go back to sleep within a few minutes tops, whereas if I had to faff on finding and fitting a needle before I jabbed I would probably be awake a lot longer before I got back to sleep. Same with finger pricking. I know my own body and Libre well enough now to know how much correction I need from my Libre. In fact I find it incredible that I can wake, scan my level calculate my correction, inject it and be back to sleep in 2-3 mins without putting the light on or even fully waking up. It really is quite amazing how the brain can learn to work on autopilot even mid sleep!
 
othytim said:
Hiya, I was for a long time using Lantus, but have more recently been moved onto Levemir.
My problem with Levemir is that I am forced to put a new needle on the pen immediately before I use it. I cannot plan ahead and put a fresh needle on in the morning that I'll then use in the evening, because it will be clogged up by then. I find this particularly annoying if I'm out and about in the evening, like wild camping, or at a festival. Levemir seems to always clog the needle tips and this means a lot more faffing about and that's not always convenient. With Lantus I could put a fresh needle on the pen in advance and I knew that it would be fine when I needed to take it later in the evening. I can't do this with Levemir and I find it flipping inconvenient. Okay, rant done. I guess I just wanted to get that off my chest.
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Hi!! I was told it's the needles that cause an issue sometimes but....as a fairly new diabetic my diabetes nurse told me to use same needle for both doses amd use the same needle for the 4 tests I do on my blood sugars!! Is this not the done thing? I did think the needles would be blunt!!??
 
Georgie491 said:
Hi!! I was told it's the needles that cause an issue sometimes but....as a fairly new diabetic my diabetes nurse told me to use same needle for both doses amd use the same needle for the 4 tests I do on my blood sugars!! Is this not the done thing? I did think the needles would be blunt!!??
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Really surprised that the nurse told you to reuse a needle or a lancet. Both are supposed to be single use although most of us reuse finger prick lancets multiple times and some of us hardened testers are signed up members of the St Swithin's day club, where we change our lancet annually on St Swithin's day (July 15th) so you have missed it for this year I am afraid which for those of us dedicated club members means you have to go another full year with the same lancet!! I am jesting to a certain extend of course but I do genuinely use the same lancet for a full year in each of my lancing devices. I think I have 3 though, but one almost never gets used and often gets forgotten on St Swithins day..

I get (friendly) grief from my nurse every time I see her about reusing needles 🙄 , because I refuse to lie when she says "You do use a new needle every time you inject, don't you?" and I say "No, I change my needles Sunday and Wednesday, like I have always done!".... well since about 5 years ago when I compromised from changing it weekly, just to make her feel better!!
The official line is that you use a new needle every time, so don't be lead astray by us naughties who reuse.
 
rebrascora said:
Really surprised that the nurse told you to reuse a needle or a lancet. Both are supposed to be single use although most of us reuse finger prick lancets multiple times and some of us hardened testers are signed up members of the St Swithin's day club, where we change our lancet annually on St Swithin's day (July 15th) so you have missed it for this year I am afraid which for those of us dedicated club members means you have to go another full year with the same lancet!! I am jesting to a certain extend of course but I do genuinely use the same lancet for a full year in each of my lancing devices. I think I have 3 though, but one almost never gets used and often gets forgotten on St Swithins day..

I get (friendly) grief from my nurse every time I see her about reusing needles 🙄 , because I refuse to lie when she says "You do use a new needle every time you inject, don't you?" and I say "No, I change my needles Sunday and Wednesday, like I have always done!".... well since about 5 years ago when I compromised from changing it weekly, just to make her feel better!!
The official line is that you use a new needle every time, so don't be lead astray by us naughties who reuse.
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Nothing surprises me tbh with treatment I've had!! I would rather use a new one each time so will start from now on. I was diagnosed in Feb but didn't actually see a diabetic nurse at the GP until end of July! They said they were only told in may I was diabetic despite the GP prescribing insulin?! I was diagnosed in hospital after a medical emergency. Honestly you couldn't write it what happened. I'm now awaiting two ops,I have a huge cyst on my pancreas that needs draining before they will do anything. It's 15.5 cm by 7.5cm and hasn't reduced in size at all. Been ill since 9th jan,feel like it's never ending:( you made me smile tho thank you!!
 
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