Archive for DM Rx

What Is An Insulin Pen?

What Is An Insulin Pen?

At some point you may want to consider an insulin pen as part of your diabetes plan.
You will need to decide if you want a disposable or reusable pen. Disposable insulin pens are refrigerated before use and then may be kept at room temperature once you start to use. When you have used all the insulin in the pen, you just throw it away. Most disposable insulin pens contain 300 units of insulin.

Reusable insulin pens have replacement cartridges that are reloaded with a new insulin cartridge. With the reusable pen, cartridges are stored in the refrigerator, while the pen is never stored there. With both pens you just dial in the appropriate number of units and give yourself the subcutaneous injection. Cartridges usually contain either 150 or 300 units of insulin.

What Types Of Insulin Are Available In A Pen?

Nearly all types of insulin are available in a insulin pen.

  • Long Acting
    • Levemir by Novo Nordisk
    • Lantus Sanofi-Aventis
  • Rapid acting
    • Apidra by Sanofi-Aventis
    • Humalog by Eli Lilly and Company
    • NovoLog by Novo Nordisk

Advantages of Using An Insulin Pen

  • Portable, discreet, time saving
  • Dial in exact dose of insulin
  • Easier than syringe and bottle, especially if you have vision or problems with fine motor coordination
  • Better adherence
  • Less damage to injection site because there is less handling of the insulin, which may reduce risk of contamination or infection
  • Less hypoglycemia because correct dose is delivered more often

Disadvantages Of An Insulin Pen

  • Many companies design pens to only work with their insulin (Owen Mumford Inc makes an insulin pen that works with Eli Lilly insulin cartridges
  • More expensive
  • Not all insulin brands have a pen available
  • Pens can only be used by one person
  • Cannot mix regular and long acting insulin so you may need more injections

What Questions Do I Need To Ask?

  • Is my insulin available in a pen?
  • What increments can my pen deliver?
  • What are the smallest and largest doses my pen can deliver?
  • How do you know if you are about to run out of insulin in your pen?
  • Can you see and read the numbers on the insulin pen to dial in the correct dose?

Accessories For Your Insulin Pen

There are a number of different products that may make your diabetes plan a little easier.

Frio Wallet

A Frio Wallet may be just what you need to travel with your insulin pen. The wallets let you keep your insulin pen cool in warm temperatures. The Frio wallets are approved as a medical device by the FDA and have been extensively tested by the British Medical Devices Evaluation Unit .

It is important to note that the Frio is not an alternative to refrigeration, but will allow you to keep insulin or any other medication at room temperature. According to the Frio website insulin can be kept between 64.4–78.8°F for 45 hours minimum, even at environmental temperatures of 100°F. The wallet can be ‘re-activated’/’topped-up’ to provide continuous safe storage conditions for subsequent periods of 45 hours minimum for up to 28 days- the useable life of insulin that is in use.

Timesulin Cap

A Timesulin cap sits on top of your insulin pen and tells you exactly how long it has been since your last dose. This will alleviate any anxiety that you might have about whether or not you gave yourself your insulin dose.
Basically the device is a smart cap that starts counting after each actuation. You just restart the timer after each dose.


  1. Carl V. Aschea,b, Wenli Luoc,d, Mark Aagrene. Differences in rates of hypoglycemia and health care costs in patients treated with insulin aspart in pens versus vials. Current Medical Research and Opinion. October 2013, Vol. 29, No. 10 , Pages 1287–1296.
  2. Bastian MD, Wolters NE, Bright DR. Insulin Pens vs. Vials and Syringes: Differences in Clinical and Economic Outcomes. Consult Pharm. 2011 Jun;26(6):426–9.

Metformin- Indications, Uses, Precautions, and Side Effects of Metformin

Everything You Need To Know When You Take Metformin

Why Is Metformin Prescribed?

Metformin is usually the first medication prescribed after a new diagnosis of type 2 diabetes. Metformin helps lower your blood sugar through several different pathways. Metformin improves how your body utilizes insulin, decreases the amount of sugar your body absorbs from food, and also decreases the amount of sugar created by your liver.

Metformin is not used in the treatment of type 1 diabetes.

How Should I Use Metformin

Metformin is usually started once per day with either your morning or evening meal for 1-2 weeks. A second dose is generally added so that you take 1 pill with your morning meal and a 2nd dose with your evening meal. Alternatively, there is a long acting form of metformin that can be taken just once per day. There are also a number of different medications that combine metformin with other drugs.

Name Brands and Combination Metformin Products

Metformin brand names include:

  • Fortamet®
  • Glucophage®
  • Glumetza®
  • Riomet®

Metformin combination products include:

  • Actoplus Met® (Metformin + Pioglitazone)
  • Avandamet® (Metformin + Rosiglitazone)
  • Janumet® (Metformin + Sitagliptin)
  • Metaglip® (Glipizide + Metformin)

Are There Any Special Precautions With Metformin

  • Do not split, chew, or crush if you are taking a long acting or extended release form of metformin.
  • Metformin does not cure diabetes. To get benefit you must continue to take your metformin.
  • Metformin needs to be stopped before surgery or receiving contrast dye (e.g. getting a CT scan)

What Are The Side Effects of Metformin

While metformin is generally well tolerated, there is a risk for potential side effects with any medication. The most common side effects when beginning metformin are related to your gastrointestinal system. Diarrhea, bloating and abdominal discomfort are fairly common. To combat this, your doctor may start you on a low dose once per day and slowly increase the dose and frequency to twice a day dosing of metformin. Your body may adjust to the metformin after 1-2 weeks with an associated decrease in these gastrointestinal side effects. Additionally, a rare, but serious side effect of metformin is lactic acidosis. Build up of lactic acid in your system can lead to sever fatigue, muscle cramping, and shortness of breath.

If you experience any of the following side effects after starting metformin and they do not go away, worsen, or concern you discuss them with your doctor:

  • Constipation
  • Cough
  • Headache
  • Heartburn
  • Runny nose
  • Sneezing

While uncommon, metformin could cause hypoglycemia. If you develop any hypoglycemia symptoms, make sure you follow your doctor’s instructions about what to do.

Additionally, call your doctor if you have any of these symptoms of high blood sugar:

  • Dry mouth
  • Fast heart rate
  • Shortness of breath
  • Nausea
  • Vomiting
  • Fruity smelling breath
  • Altered mental status or decreased alertness

Other Metformin Uses Beside Diabetes

Your doctor may also use metformin for the following “off label” use?

  • Weight loss
  • Polycystic ovary syndrome
  • Gestational diabetes
  • HIV lipodystrophy syndrome.


National Diabetes Information Clearinghouse. Accessed November 4, 2010. What I need to know about Diabetes Medicines