# Sanofi Aventis insulin pens



## Stephen Downie (Dec 29, 2012)

I just thought I would join this forum as I have had very concerning experiences with the insulin pens manufactured by Sanofi Aventis.

I am a type 1 diabetic - diagnosed in 1977 for my sins, but otherwise I am very well controlled and have had no complications.  I test my blood 4-5 times a day and use my general experience to control my diabetes, together with the appropriate medicine.

I had a cough a few weeks ago and was high in sugar (as usually occurs with infections) and thus monitored my blood sugar levels more closely.  However, the infection was gone after a short period but I continued to be high in sugar for the past couple of weeks.  I found myself administering large amounts of short term insulin (I usually require very little during the day) to keep a cap on my sugar levels, but found myself going high in sugar continously.

This morning I administered my Lanctus long-term daily insulin as usual.  However, upon injecting it and because of my ongoing high sugar levels, I became suspiscous and dialed about 10 units and pressed it into the sink.  Low and behold nothing came out and I then realised that although I had been administering this insulin daily, for perhaps at least 2-3 weeks the pen had been beguiling me and not putting any insulin into my body.

I realise that I should have noticed the insulin pen was not running out, but due to the amount I use a vial normally lasts me a month and so there was no reason to be concerned.  It is concerning that there is no failsafe device in the pen which can stop such problems ocurring (as in less capable diabetics this problem could continue for much longer giving doctors false symptoms of insulin resistance).

I wanted to find out - are there any more reliable pens than the Sanofi Aventis Clikstar?  This pen appears to be manufactured on a low cost basis and the internal parts seem to be of poor quality.  The pen I previously used (Optipen Pro 1) was much more robust and better made (although I usually had to count the units by the clicks as the digital measuring device often went) but they fazed that out a couple of years ago. 

If I could find anything out there that is betted quality, more reliable and robust (even if I have to buy them rather than use the NHS' generosity) I would be keen to know.

Please let me know if you know of any better products.

Thanks


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## Northerner (Dec 29, 2012)

Hi Stephen, welcome to the forum  I used to use an Autopen 24 for my lantus, but they are pretty shoddy as well. I'd always thought that the Clikstars were supposed to be much better! I find my novopens to be of much better quality (currently using a novopen Echo). I don't use lantus any more though. If you were to change to levemir for your long-acting then you would be able to use the novopens for it. I was tempted to change at one point because my lantus requirements were so low but there is no half-unit pen for lantus - the Echo is half-unit and also has lots of other good features.

Sorry, probably not much help if you want to stick with lantus. Do you do an airshot before injecting? I always dial up a couple of units just to check that the pen and needle are functioning correctly.


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## Homedaze (Dec 29, 2012)

The Lantus 3ml insulin cartridges fit the Lilly Humapen Luxura and Humapen Memoire pens.  

I always prime the pen with each new needle before every injection.


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## Pumper_Sue (Dec 29, 2012)

> This morning I administered my Lanctus long-term daily insulin as usual. However, upon injecting it and because of my ongoing high sugar levels, I became suspiscous and dialed about 10 units and pressed it into the sink. Low and behold nothing came out and I then realised that although I had been administering this insulin daily, for perhaps at least 2-3 weeks the pen had been beguiling me and not putting any insulin into my body.



Excuse my ignorance, as I have never used an insulin pen, do you not need to do an air shot before you inject? If so surely that would have shown the pen wasn't working?


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## Northerner (Dec 29, 2012)

Pumper_Sue said:


> Excuse my ignorance, as I have never used an insulin pen, do you not need to do an air shot before you inject? If so surely that would have shown the pen wasn't working?



We did have a thread about this recently and discovered that some people were told only to do an airshot when fitting a new cartridge  I was told to do it before every injection


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## Robster65 (Dec 29, 2012)

Homedaze said:


> The Lantus 3ml insulin cartridges fit the Lilly Humapen Luxura and Humapen Memoire pens.
> 
> I always prime the pen with each new needle before every injection.



Unfortunately they don't fit any of the lilly pens. 



> We did have a thread about this recently and discovered that some people were told only to do an airshot when fitting a new cartridge  I was told to do it before every injection



I was also urged to airshot 2u before each injection for this reason. Although I've never had a prob.

Have you checked to see if it was a needle or cartridge issue, rather than the pen?

I've been using the disposable Lantus Solostar pens for a year or so. They're very plasticy (being made of plastic! ) but I've had no problems with them so far.

Rob


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## Homedaze (Dec 29, 2012)

Robster65 said:


> Unfortunately they don't fit any of the lilly pens.
> 
> Rob



That's odd, because my Lantus cartridges do fit the Lilly Humapen!


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## Monkey (Dec 29, 2012)

I use the Solostar disposable ones. When I started using lantus, there was some question about the reliability of the cartridge ones (vague memory, sorry - it was a while ago!) and I've never swapped from these.

Saying that, I always, always do an airshot before injecting anything, even single units. Surely that'd at least give you an idea of whether it was an ongoing issue or a one off?


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## everydayupsanddowns (Dec 29, 2012)

I've certainly had issues with plunger and cartridge becoming separated, even in Novopens which have a very high build quality. Not sure what caused it, sometimes seemed to be temperature variation, other times just the pen being stored vertically. It convinced me that all the many airshots when nothing came out were worth the tiny number that showed any kind of delivery prob.


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## Robster65 (Dec 30, 2012)

Homedaze said:


> That's odd, because my Lantus cartridges do fit the Lilly Humapen!



I've been on lantus and humalog (via humapen) for a lot of years and I never knew this. If I had known it a couple of years ago, I'd probably have not gone for the solostar.

Flippin 'eck. It's amazing the things you can learn when you think you know it all!! 

Thanks for that, even if I'm a bit behind the times.

Rob


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## trophywench (Dec 30, 2012)

BUT whatever pen you use, disposable or re-usable, airshot every single time you use it (them) !


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## squeeze321 (Jan 2, 2013)

*Ohhhhh Lantusssssssssss*

I have had some problems too with Lantus Pens. The first Lantus pen I used was a yellow digital one which I did not trust and refused to use hahahah! So my GP for years had been prescribing 0.5ml syringes on repeat precription for me which I used to draw up the Lantus from the cartidge which worked marvelously. The needles were erm bigger than me but thats another post hahah. The only trouble was, I was made to feel like a complete plonker at the DAFNE course for using old archaic methods for injecting Lantus! Then they gave me a clickstar which I used for a few months and the clickstar started causing me bother, despite me religiously doing air shots in the air before injecting! One day I noticed the pen did not feel right so I dialled the dose and injected it into the sink when only a small amount of insulin came out. I thought, it's trying to kill me............... and went back to injecting Lantus with a syringe like I was before !!

Then there was light at the end of the Lantus tunnel.......I started on a pump!


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## pmailkeey (Jun 3, 2021)

I've just changed GPs - from the frying pan to the fire......

My first rpt Px to the new GP included SoloStar pens.........

......and the GP prescribed cartridges.

As I was out of insulin, the quick fix was to buy a refillable 'pen' - so I now have a ClickStar - which I've used successfully without reading the instructions - which are still in the box !

So, from this thread, it'll be interesting to see how long it works for  I'll certainly keep the receipt !

For info, I've never done 'air shots' but with every new one, I dial up a good twist of the knob and press the inject button to a measured pressure before I attach a needle. I typically get 3-4 clicks out of it and then it stops. I then attach a needle and expect to see a bead of insulin on the end of the needle or if I've pressed a bit hard, a drop falls off the end. This all says to me the device is working correctly - without excessive waste.

With the dose I'm on I can clearly see that the piston in the cartridge has moved. For anyone on a setting of less than 10, you're probably wasting it - unless you are injecting monkeys (YouTube: Michael Jamison or Jackie Smit) as it has such little effect.


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## helli (Jun 3, 2021)

Are the pens single use or reusable?
The reusable ones are always more robust. I think my reusable Lantus pen lasted 12 years whereas my NovoRapid one needed replacing after 8 years. 

And, yes, I was advised to do an airshot before injecting. I would only shoot one unit because I hate waste but that is enough.


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## Robin (Jun 3, 2021)

I always do an air shot before I inject because I have on occasion had a blocked needle, (so not the pen's fault). Like @helli, though, I find one unit is enough, not the two I was recommended by my DSN.
I can’t remember how long I’ve had my Novopen Echos, but the newer of them must be over 5 years old by now, and I know I’d had the other one some time before that.


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## pmailkeey (Jun 3, 2021)

Robin said:


> I always do an air shot before I inject because I have on occasion had a blocked needle, (so not the pen's fault). Like @helli, though, I find one unit is enough, not the two I was recommended by my DSN.
> I can’t remember how long I’ve had my Novopen Echos, but the newer of them must be over 5 years old by now, and I know I’d had the other one some time before that.


Blocked needle ? I've been suspecting that when the needles are attached to the pen, occasionally on inserting into the rubber tip, I think they can cut the rubber and a small pece of it goes into the needle - and then normally is intected into you along with the insulin ! A bit extra pressure will force it through !


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## Robin (Jun 3, 2021)

pmailkeey said:


> Blocked needle ? I've been suspecting that when the needles are attached to the pen, occasionally on inserting into the rubber tip, I think they can cut the rubber and a small pece of it goes into the needle - and then normally is intected into you along with the insulin ! A bit extra pressure will force it through !


I think it has more to do with the quality of the needles, I never had a problem in the ten years I was using BD Microfine, but our CCG has now put them on the Brown restricted list, and we get cheaper ones prescribed.


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## pmailkeey (Jun 3, 2021)

Robin said:


> I think it has more to do with the quality of the needles, I never had a problem in the ten years I was using BD Microfine, but our CCG has now put them on the Brown restricted list, and we get cheaper ones prescribed.


Cheaper - you mean GlucoRx CarePoint Ultra ?
I've not had a failed needle but these don't quite fit the threads on the pen and so are stiff to screw on properly !


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## JJay (Jun 4, 2021)

I used an Autopen 24 for my Lantus quite successfully until a new DSN said rather sniffily that it was "very old-fashioned", and prescribed a Sanofi Allstar Pro.  However, Boots could never manage to obtain one so I reverted to my Autopen, though it was admittedly a bit clunky and only did 2x units. Out of curiosity I got an Allstar Pro off Ebay. It honestly isn't that much better, although it does at least dispense in 1x units. It feels plasticy and flimsy and the mechanism seems stiff, but I have to say I have no reason to believe it isn't dispensing the right amount. But at the risk of being boring - yes, airshot EVERY time!


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## Robin (Jun 4, 2021)

pmailkeey said:


> Cheaper - you mean GlucoRx CarePoint Ultra ?
> I've not had a failed needle but these don't quite fit the threads on the pen and so are stiff to screw on properly !


No, a brand called Nipro 4sure. I've been using them for several yesrs now, and the failures have been few and far between. They do have a cheaper, less accurate thread though, so like yours, I find them stiffer to screw on and easier to get cross threaded, which may be what causes the problem.


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## pmailkeey (Jun 4, 2021)

Perhaps this is a good point to throw in some info from my engineering background !

When attaching needles to the pens to treat the process as precise engineering and get the pen and needle perfectly aligned before screwing it on. This will avoid damaging the part of the needle that pierces into the pen cartridge and avoid getting the thread crossed.


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## trophywench (Jun 4, 2021)

Good God! may be OK if you have an engineering background AND have rock steady hands all 5 times you attach a pen needle every single day of your life but if you're 7 or 87, perhaps not!  My husband is a retired engineer and still pretty cock-on with all things mechanical and electrical - but at 73 - his close eyesight, simply ain't!


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## Robin (Jun 4, 2021)

trophywench said:


> Good God! may be OK if you have an engineering background AND have rock steady hands all 5 times you attach a pen needle every single day of your life but if you're 7 or 87, perhaps not!  My husband is a retired engineer and still pretty cock-on with all things mechanical and electrical - but at 73 - his close eyesight, simply ain't!


...and if you’re my son, who is a Chartered Engineer, and still has to get his Mum to help him build his self assembly furniture because his fine motor control is about the level of permanently wearing boxing gloves, you’d have no chance!


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## Lucyr (Jun 4, 2021)

JJay said:


> I used an Autopen 24 for my Lantus quite successfully until a new DSN said rather sniffily that it was "very old-fashioned", and prescribed a Sanofi Allstar Pro.  However, Boots could never manage to obtain one so I reverted to my Autopen, though it was admittedly a bit clunky and only did 2x units. Out of curiosity I got an Allstar Pro off Ebay. It honestly isn't that much better, although it does at least dispense in 1x units. It feels plasticy and flimsy and the mechanism seems stiff, but I have to say I have no reason to believe it isn't dispensing the right amount. But at the risk of being boring - yes, airshot EVERY time!


The sanofi junior star is about a million times nicer than their other all star click star whatever pens. Though the rewind mechanism is a bit of a slow process unwinding it all the way back.


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## pmailkeey (Jun 5, 2021)

Jenny & Robin - a big thumbs up to you both !

Here's a possible answer for you - use refillable pens ! (E.G. CLICKSTAR - which comes with a useful plastic case)

The end of the pen that holds the cartridge unclips so you can replace the cartridge. After your dose, remove the needle as normal. Then remove the cartridge and store in the USEFUL plastic case and reassemble the pen. For the next dose, attach the needle easily as normal just onto the thread - STRAIGHT ! then dismantle the pen to reinsert the cartridge (the right way round !) and the needle will pierce the seal perfectly straight !

Is this too complicated ?


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## Robin (Jun 5, 2021)

pmailkeey said:


> Jenny & Robin - a big thumbs up to you both !
> 
> Here's a possible answer for you - use refillable pens ! (E.G. CLICKSTAR - which comes with a useful plastic case)
> 
> ...


Seems an awful lot of a palaver, when in fact what happens is, I start screwing the needle in, feel it’s not engaged the thread cleanly, give it a half twist in the opposite direction, and then proceed as normal and find it screws on cleanly. I do a lot of sewing, and it’s similar to threading a needle. If you miss the eye, you just backtrack and try again.
Edit: In the interests of scientific experiment, I just tried your method, and it won’t work, at least not on my Novopen Echo. The thread that the needle screws into is on the cartridge, not the pen.


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## everydayupsanddowns (Jun 6, 2021)

JJay said:


> I reverted to my Autopen, though it was admittedly a bit clunky and only did 2x units.



There are autopens that do 1u increments. I think it’s the green ones that are 1u and the blue ones that are 2u.

Never my favourite type of pen though. Those springs were always a bit ferocious!


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## JJay (Jun 6, 2021)

everydayupsanddowns said:


> There are autopens that do 1u increments. I think it’s the green ones that are 1u and the blue ones that are 2u.
> 
> Never my favourite type of pen though. Those springs were always a bit ferocious!


Yes! They're my "spare spares" now!


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## Robert459 (Jun 7, 2021)

Definitely perform airshot every time.  Why wouldn't you?  It clears any air from the system and lets you see that insulin comes out the needle


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## trophywench (Jun 8, 2021)

... and I use a pump although my GP point blank refuses to allow me to have re-usable pen insulin cartridges to keep as spares for when something goes awry and I need to inject with a pen - and insists on only prescribing ONE Flexpen at a time.  He's never been able to grasp that you can fill a pump reservoir from a cartridge which has never been in a pen ...........


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## pmailkeey (Jun 8, 2021)

Robert459 said:


> Definitely perform airshot every time.  Why wouldn't you?  It clears any air from the system and lets you see that insulin comes out the needle


I have no difficulty seeing the solution on the needle tip with out an 'airshot'. If I don't see any, a little pressure on the button usually encourages a bead to appear.


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## pmailkeey (Jun 8, 2021)

trophywench said:


> ... and I use a pump although my GP point blank refuses to allow me to have re-usable pen insulin cartridges to keep as spares for when something goes awry and I need to inject with a pen - and insists on only prescribing ONE Flexpen at a time.  He's never been able to grasp that you can fill a pump reservoir from a cartridge which has never been in a pen ...........


I have no objection to using refillables but that does leave me with the problem if the pen fails. Having 1 or more pens as an emergency source for a year - then use them and get a new set of backup pens would solve that one - so that your backup pens never go out of date.


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## Lucyr (Jun 8, 2021)

pmailkeey said:


> I have no objection to using refillables but that does leave me with the problem if the pen fails. Having 1 or more pens as an emergency source for a year - then use them and get a new set of backup pens would solve that one - so that your backup pens never go out of date.


From experience, the hospital keep spare pens and if your pen and your spare pen are both broken then a quick call to the diabetes department and they will leave you a new one at reception, or a call to the GP can get emergency disposable ones (i should probably learn from these past experiences and check my spare works)


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## trophywench (Jun 9, 2021)

I know mine works - needed to use it last night.


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## JJay (Jun 9, 2021)

I have spare pens. And spare spare pens. (And as I discovered today, spare spare spare pens: 2 Autopens I'd completely forgotten about but still functioning if absolutely necessary) Why use disposable (waste) plastic when I have plenty of it in the house?!


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## pmailkeey (Jun 9, 2021)

Lucyr said:


> From experience, the hospital keep spare pens and if your pen and your spare pen are both broken then a quick call to the diabetes department and they will leave you a new one at reception, or a call to the GP can get emergency disposable ones (i should probably learn from these past experiences and check my spare works)


It sounds like you live in a civilised world. I don't.

Have you got a good GP ?


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## Lucyr (Jun 9, 2021)

pmailkeey said:


> It sounds like you live in a civilised world. I don't.
> 
> Have you got a good GP ?


I haven’t spoken to my GP in years, an emergency prescription is a phone call to the receptionist for me and doesn’t need an appointment.


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## everydayupsanddowns (Jun 10, 2021)

I only ever used reusable pens when on MDI, one at a time. I always felt more comfortable with the solidity of a pen that was built to last  I never had a failure in more or less 20 years, and didn’t keep spares (perhaps a little reckless in hindsight?)

My fallback plan for pump failure is syringes. I can use the vials that I fill the reservoirs with... or even draw it up out of my ‘in use’ reservoir - though that would be trickier on the tSlim.


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## Gulshankim (Jun 19, 2021)

Robin said:


> ...and if you’re my son, who is a Chartered Engineer, and still has to get his Mum to help him build his self assembly furniture because his fine motor control is about the level of permanently wearing boxing gloves, you’d have no chance!


It's really hurt touching....


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