Warning: Novopen 5 and Novopen Echo failure

[lifebynumbers]

Whoa! Where did that come from? 21.2 mmol/l ! Having injected and then eaten a meal some three hours before I was expecting a count between 6 and 8. Better take some corrective action, I thought, so injected 4 units of Novorapid waited for an hour and did another blood test exepcting it to be well on the way down. Nope, still at 21mmol/l. Panic began to ensue - had I become insulin resistant? Checked the insulin vial which was properly inserted and three-quarters full so nothing wrong there. Then I dismantled the body of the pen and found cracks in the plastic body - check out video on Youtube

Surely it should have not worked at all, I thought. So I reassembled the pen and tested it - with disturbing results. I dailled up 25 units and depressed the plunger suirting into an egg cup. Result - dry as a bone absolutley no insulin delivered but the dial indicator recording 25 units adminstered., https://www.youtube.com/watch?v=4fwWzja5ZGI.

Next step staight on the net googling Novopen 5 failures. It turns ou that there was a selective product recall via medical practitioners by Novo Nordisk on the grounds that certain (unspecified) cleaning materials can weaken the plastic leading to failure but only to certain batches of pens. Nordisk carried out a risk assessment and concluded that there was only a 0.1% (one in one thousand) chance of it leading to a case of hyperglycaemia. They sent a list of the batch numbers supposedly affected to medical practioners. The company has categorically stated that pens outside of these batch numbers are safe.
This week I experienced a second failure and I thought it prudent to share my concerens with others. Firstly I have never been contacted regarding a potential issue by my GP or anybody else. Secondly one pen was on the list of batch numbers but the other wasn't which might suggesst that the problem may be more widespread. I also showed one of the pens to my nephew who is a Senior Lecturer in engineering and his opinion was that it was a fault with the injection moulding process.
I would urge every user to check that their pens are functioning properly and to check the serial number against those published by the Nordisk (see attached copy).

 

[Thebearcametoo]

Good to know. Did you do an air shot before injecting?

 

[Kaylz]

This recall was quite some time ago I'm sure and it was well talked about at the time, my chemist even called me to make sure I'd checked my pens

As @Thebearcametoo has said but I'm assuming you can't have done an air shot, there are reasons we are told to do this before every injection, this being one of them
xx

 

[everydayupsanddowns]

How scary for you @lifebynumbers

If you are concerned about the issue being more widespread I guess you could ‘yellow card’ with MRHA?

Air shot was my first thought too though

I got very lazy with them in my last 5-10 years on MDI and mostly got away with it, but paid the price when I was well and truly out of the habit.

I had a couple of occasions when travelling where the plunger seemed to come away from the rubber bung a little, meaning that when I dosed and injected I’d get a frrrrp! before the dose actually started delivering, and whatever the distance had moved before that was ’no insulin‘. Except I had no way of knowing how much that was!

I tried to religiously air shot after those, and I did catch another when the airshot didn’t produce a droplet.

Some folks get blocked needles occasionally too.

Might be worth building that into your technique going forward?

 

[pm133]

I discovered another reason for always, religiously, performing a 2 unit airshot before every injection. When you screw the needle mechanism into the pen the needle part sticks out both sides. One side goes inside you and the other pierces the septum on the pen. If this part of the needle mechanism is either not there or doesn't pierce the septum, nothing will come out of the pen but your unit counter will go back to zero misleading you into thinking you've taken your dose when you haven't.

This happens to me once every 20 to 30 needles.

Always perform an airshot would be my advice.

 

[lifebynumbers]

Thanks for the advice and indeed a two unit test will pick up a pen that has already failed but not one that is in the process of failing which is what happened to me. The purpose of this post was to alert users to this issue.

 

[Kaylz]

but not one that is in the process of failing which is what happened to me.

but you state you dialed up 25 units and it was dry as a bone, not once have you said you performed air shots before administering your insulin so you can't guarentee it wouldn't have picked it up, I for one know what 2 units looks like, if it was in the process of giving up the ghost there would probably be a lack in the 2 units before it turned into no insulin being delivered so that would make me do another until it either ran as a 2 unit shot should or would have me check it

 

[rebrascora]

I have had quite a few needles fail recently (blocked etc) which I always spot when doing an air shot and I wonder if the pressure imposed on the pen by a large dose of insulin (25 is large to me) not emerging might be enough to break it.... particularly if you dialled up another 25 to test it. I know that the insulin has come out in a very powerful jet when only 3 or 4 units was dialled up and didn't emerge and then the needle changed.
Just an alternative thought to your thought that the pen was to blame.

 

[Lanny]

I’ve found that even a 2 unit air shot doesn’t always guarantee no blockages especially when getting a new pen straight from the fridge & do 2 or even 3 air shots until the insulin flows easily! I do like to take the new pen out before the old one runs out to warm up to room temperature but, sometimes needs must, especially when insulin doses need to be increased during times of sudden quick changes when I’m ill & I go through more at a faster rate!

Also, I remember someone posting before about it being important to check than pens dose correctly by doing a 20 unit shot with the outer plastic cup of the needle on & the volume should be at the top of the narrow part of the cap before it widens out! It did seem a little wasteful to me but, I DO sometimes do that with a new pen at times when my insulin doses are very high, when ill usually, as I could be using 60+ units anyway & I definitely don’t want THAT not being delivered properly!

 

[Lanny]

Oh. I better say I use Novofine 6mm needles but, was once changed to BD needles briefly, the whole practice sent out letters saying it was a cheaper cost measure but, they had to change everyone back due to the high volume of patients telling them of needle failures etc. In case other needle caps are different: BD ones looked pretty similar but, I don’t know about other brands!

 

[rebrascora]

I’ve found that even a 2 unit air shot doesn’t always guarantee no blockages especially when getting a new pen straight from the fridge & do 2 or even 3 air shots until the insulin flows easily! I do like to take the new pen out before the old one runs out to warm up to room temperature but, sometimes needs must, especially when insulin doses need to be increased during times of sudden quick changes when I’m ill & I go through more at a faster rate!

Also, I remember someone posting before about it being important to check than pens dose correctly by doing a 20 unit shot with the outer plastic cup of the needle on & the volume should be at the top of the narrow part of the cap before it widens out! It did seem a little wasteful to me but, I DO sometimes do that with a new pen at times when my insulin doses are very high, when ill usually, as I could be using 60+ units anyway & I definitely don’t want THAT not being delivered properly!

I love it when I learn something new! Thanks Lanny
That is 2 in 2 days from you what with this and the OJ yesterday.

 

[Lanny]

Tried searching extensively for the post but, no thread was found so, must have been someone posting when someone else had needle problems etc.

And I better be absolutely clear: either turn the pen with the needle attached or unscrew the needle & turn it upside down to check the volume of the 20 units that should come up to the top of the narrow bit of the cap!

 

[grovesy]

Oh. I better say I use Novofine 6mm needles but, was once changed to BD needles briefly, the whole practice sent out letters saying it was a cheaper cost measure but, they had to change everyone back due to the high volume of patients telling them of needle failures etc. In case other needle caps are different: BD ones looked pretty similar but, I don’t know about other brands!

BD are usally well thought of .

 

[rebrascora]

My BD needles have had a few duff ones, but I haven't had any other makes to compare them.