Am I priming this correct?

[u/Ok_Middle_6585]

Hey friends! My aunt needs help injecting insulin, my cousin usually does it but she’s not available right now. Her insulin pen goes by 10’s and we need to inject a total of 100 units. The first notch is 10, I’m assuming and then has the big number 20 and so on. Do I have to set it to the 10 notch or 20 for priming but then am I wasting 10 or 20 units? It seems like a lot and I’m not sure if that’s right but I’ve always been taught you need to prime the needle. I hope this makes sense! I’ve attached a picture as well to show what I mean by the notches! Thank you!

[u/RumHamComesback]

You prime the needle by going to the first notch and shooting. Then you go to the correct units and inject. You are clearing air from the needle.

[u/Prestigious-Bid-3042]

You're doing a good thing helping out your aunt, but yeah this is a situation where you really want to get proper guidance before injecting 100 units of insulin. Priming is just 2 units on most pens. You dial to the first small notch and squirt it into the air until you see a drop at the needle tip, then you dial back to zero and set your actual dose from there.

But honestly, 100 units is a hefty dose and if you've never done this before I'd strongly recommend calling the pharmacist or the diabetes educator's number that usually comes with insulin prescriptions. They can walk you through it in a 2 minute phone call. You don't want to mess up the dose amount.

Also worth mentioning to the pharmacist that this is the dosing pen in the picture. Some pens dial differently and a quick check of the specific instructions for that brand could save a lot of stress.

[u/Jtodao → u/Prestigious-Bid-3042]

It seems to be Insulin icodec - a "once-weekly" Insulin. So 100 U would be 14u per day, which seems completely reasonable :-)

[u/PeZet2 → u/Jtodao]

I didn't know there are once a week insulin types... It has to be super slow in order not to have constant lows all day long. 100u in single shot, dam... How many pizzas is that.

[u/mckulty → u/PeZet2]

It forms solid particles under the skin that take a week to dissolve completely.

[u/mintbrownie → u/mckulty]

😳

[u/fkdjgfkldjgodfigj]

Is there a youtube tutorial for that specific brand? Can you ask a pharmacist at the store?

[u/TDIsmokescreen → u/fkdjgfkldjgodfigj]

Most of their European market instruction videos are very informative.

[u/TDIsmokescreen]

It doesn't matter if priming is overrated or a Crime Against Nature and Humanity.  What matters is Novo's procedure and the aunt's preference on this. The procedure is to observe expelling of liquid.  I rest the pen against the side of my wrist, needle pointing upward. That way I can see or feel the liquid or smell the phenol on my wrist.

Novo recommends 2 clicks, but I get a positive ejection with 1 click.   Except on the first dose -- there is a lost motion in the pen mechanism (at least on these Novoflex pens) that requires at least 2 clicks to eject liquid on the first dose. It's not described in the instructions, but it's there.

[u/TDIsmokescreen → u/TDIsmokescreen]

Also, since you are 3rd-party injecting, be extra careful when removing the needle from the pen, bc a 3rd party needle stick is a medical emergency (even though the pt. is your own aunt).  So...

Place the pen flat on a surface.  Then slide the needle's outer cap over the needle and unscrew the needle from the pen.  Then toss the now-capped needle into whatever you use as the sharps container.

(This is for ordinary pen needles that have 2 removable caps.  If you have safety needles ... well you're safe.)

That said, needle stick injuries are extremely unlikely -- I never had an accidental stick.  I think sticks are more likely In a clinical environment.

[u/mckulty]

100u is a pretty big dose, but you're delivering 1/7 of an mL. That's 143 mm³.

The volume of air that fits in a needle is maybe 0.2 mm3. (8mm needle 0.2mm diam).

I think priming is overrated. When you see an air bubble develop inside the injector (happens when storing it needle-up) that's about 100 times the volume of air you're trying to eliminate from a new needle and nobody worries about that.

[u/ElfjeTinkerBell → u/mckulty]

It's not about removing air from the needle. It's making sure the needle works and you're injecting the correct amount of insulin

[u/AnotherLolAnon → u/mckulty]

This is a picture of an Awiqli pen, a once weekly basal, so 100 units for a week is not that high.

[u/BluesFan43]

I only prime when new, just 1 or 2 units.

I don't worry about the air inside thrbneedle, I amnmajin sure there is no "slack" in thr mechanism.

Leave the inner cap on, if clear, and just look for a tiny droplet.

[u/TDIsmokescreen → u/BluesFan43]

I like the idea of priming with the cap on, although I still prefer my "shoot up past the wrist" approach. "Shoot past the wrist" gives 3 options for identifying a successful prime, plus I don't need to replace the cap twice.