# "Priming" insulin pens - is this really practical?



## ollie1234 (Oct 3, 2011)

Hello,

I was looking on the Humalog site and came across this guide to using the an insulin pen. It talks about "priming" the pen before an injection, which means setting a 2u dose and firing it into the air, to ensure it's flowing smoothly.

While I can see how this is useful, it's very impractical as it would send insulin everywhere. At home I'd want to do this over a sink or bathtub, and in public, how could you actually do this in a restaurant without causing a scene?

In practice I have been doing a 1u prime for years, but I fire into the needle with the cap left on rather than into the air. I check there's some insulin when I take the cap off and I push a little harder on the plunger, which releases a drop or two from the syringe. 

I have not had a pen fail this priming test on me for as long as I can remember, but I find it reassuring to know I've tested it first.

Do you prime like this, or in a different way? What do you think of Humalog's  priming instructions - would you also find them impractical, especially in public?

Ollie


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## Robster65 (Oct 3, 2011)

Hi Ollie.

I never used to prime, but have started a couple of years ago and do a 2u airshot. I don't do it theatrically, as they might in a US medical drama but just aimed at the floor or some convenient place. It's sterile and, although it smells a little, I will used my shirt if need be. 2u is actually only 0.02ml so not really enough to worry about. And it soon evaporates.

Your method sounds fine though if you see insulin appear at the tip, it shows there's no air in the needle.

Rob


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## everydayupsanddowns (Oct 3, 2011)

I like to use 2u primes to see a good flow, as sometimes there's a little bit of insulin clinging to the end of the needle. 

Like Rob, I slipped into bad habits - for me it was around 15-18 years-in to D and stopped priming. Didn't even restart when I had more than one injection where the plunger and bung had become slightly separated so there was slack taken up and then I had a completely unknown reduced dose. Shudder to think about that now. 

I prime downwards, usually toward the floor, occasionally over jeans. If I'm worried about others' reactions/sensibilities I'll prime into my hand and then wash/wipe them after injecting.


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## Marc (Oct 3, 2011)

You really should always prime what do you think is in the needle before you prime it? I normally use 4u to get a good stream. Not up in the air normally under the table if in a Restaurant or into my kit bag spine thingie. Anybody moans I tell them to look the other way and mumble the DDA or something. 

Marc


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## ollie1234 (Oct 3, 2011)

Robster65 said:


> ...as they might in a US medical drama...



Laughed to read this. If I ever get the chance to do this, perhaps at a halloween party, it would be hilarious.


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## rachelha (Oct 3, 2011)

I have never had anyone comment on me priming my pen.  I always just do it on to the floor.  2 units is a very small amount.


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## SacredHeart (Oct 3, 2011)

I was never told to prime, so never did. I was told by my DSN to just press gently until I saw a small dot of insulin come through the end of the needle. Always worked fine


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## Northerner (Oct 3, 2011)

I have always primed 2 units, as I was instructed. It's only a tiny drop and soon evaporates - like Mike, when out I'd prime downwards. I remember a member posting here that his doctor had accused him of wasting valuable insulin by doing the airshot! 

Anyone remember the disgusted nurse from Birkenhead?

http://diabetespoetry.blogspot.com/2009/06/disgusted-nurse-gets-just-desserts.html


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## ollie1234 (Oct 3, 2011)

I am totally for priming, it just makes sense to do so. It's the practicalities I'm wondering about, the method in that manual is very dramatic.

There are two questions coming out of this thread for me - what's in your kit bags, and how do you handle other people's reactions? I would love to hear your answers to these.


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## FM001 (Oct 3, 2011)

Primed ever since using animal insulin in glass syringes, even now with the pens I do a 2u air shot to fill the empty needle with insulin.


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## everydayupsanddowns (Oct 3, 2011)

Hi Ollie!

Sorry if I confused you... I moved your earlier post to it's own thread, and was going to PM to explain, but you beat me to it!

New thread here: http://www.diabetessupport.co.uk/boards/showthread.php?t=21412

Thought it was a great question, and didn't want it to get lost!


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## D_G (Oct 3, 2011)

I dont do an air shot....i just point it at the ground to make sure the insulin is flowing 

With my demi pen, when i load a new insulin cartridge i have to prime it for ages before the stuff comes out!! at least 20 units until its flowing so i always do it just to make sure!


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## Vicsetter (Oct 4, 2011)

Its in the instructions for Levemir to prime with 2 units. With a new pen I found it sometimes has to be done a couple of times, also tap and prime if you see a bubble in the pen.  

It's strange that the Victoza pen seems to be the same construction but you only prime with the new pen, once youv'e done it the first time you don't do it again.


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## margie (Oct 4, 2011)

With a new cartridge it is essential that you prime the pen as there can be a gap between the cartridge and plunger. So you have to keep going till you know there is contact.

I prime my pen when I used it as others do I aim towards the floor. There have been a number of occaisions where this has revealed that the new needle is blocked so  I have had to change the needle and try again.


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## Copepod (Oct 4, 2011)

I leave needle in place between injections, and I have found that I only need to prime with 1 or 0.5 unit (in a half unit dose pen) to ensure the needle is full of insulin. Only when I change needles, do I prime with 2 units. Another saving of resources


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## imtrying (Oct 4, 2011)

wow I'd never heard of this before. I obviously prime when I start a new cartridge, but never knew we were 'supposed' to inbetween each injection! 

my days are full of learning things I am supposed to have known to have done! but never even had this one on my radar! I'm going to ask at DAFNE and see if they have any thoughts on this. 

so glad I'm on this site!!!


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## novorapidboi26 (Oct 4, 2011)

I always prime, about 4 units sometimes...............before each injection..

And it goes into the air, and I suppose onto the kitchen floor, carpets, etc.......its not doing any harm....

this, to me, is quite important, as ensuring I have received all the intended units enables me to confidently interpret my results and adjust the dose if needed.....


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## Phil65 (Oct 4, 2011)

novorapidboi26 said:


> I always prime, about 4 units sometimes...............before each injection..
> 
> And it goes into the air, and I suppose onto the kitchen floor, carpets, etc.......its not doing any harm....
> 
> this, to me, is quite important, as ensuring I have received all the intended units enables me to confidently interpret my results and adjust the dose if needed.....



Absolutely NRB!  

I always primed as once I had a blockage and didn't realise.... when my bs went up to 31 I realised why!  If anyone would have the cheek to criticize me for priming on the floor.....I'd ask 'would you like some?'


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## imtrying (Oct 4, 2011)

Phil65 said:


> If anyone would have the cheek to criticize me for priming on the floor.....I'd ask 'would you like some?'



hahahahahaha I'd love to see that!!


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## Monica (Oct 4, 2011)

On injections, we always primed. When out (please don't shoot me)Carol always went to the toilet to inject, so we didn't have the problem of priming in public.
But on the rare occasions she wore a skirt, I managed to persuade her to let me do it at the table (she wouldn't inject herself at that time). I simply primed it on the floor.

At home, the insulin went up in the air and eventually fell on the carpet.


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## AlisonM (Oct 4, 2011)

With my pen, I'm not on insulin of course and my pen is a fixed dose, I was told to dial a dose and expel it on first use. I usually do it over the sink, oh and I hate the way it smells, yeuch! 

The only time I've had a problem was when I had a needle with no hole in it, it took me ages to figure out what went wrond. I usually feel a wee sting from the Byetta when it goes in and there wasn't one that time.

I suppose you could aim it at a tissue if you were out and about, that would show a wee wet patch and you'd know it worked.


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## Ellie Jones (Oct 4, 2011)

When I was injecting with a pen (pump now) I always primmed my pen before injecting.

It's important to hold the pen up, so that when you are priming your are expelling any air bubbles that might have collected in the cartridge, more likely if you leave your needle on the pen either between use or ready for the next injection...  As air in the cartridge can cause a miss dosing of insulin..

when not in company I just use to squirt it, but anywhere else if you do it slowly then it just dribbles down the side of the needle


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## everydayupsanddowns (Oct 4, 2011)

I've never been very sure myself that you are likely to get any air out of a cartridge based on the direction you hold the pen when air-shotting (unless there is a *considerable* volume there). 

The needle inserted into the cartridge is very fine and inserts several mm into the insulin. In order to eject any air you would need the bubble to rise towards the top of the cart, but then sort of 'stick' to the part of the needle that has gone through the rubber seal and wait there to be pushed out be the insulin (and not slide off to the side).

I might be wrong, but it's never seemed very likely to me.

As far as I am aware small bubbles won't cause any problems, and even if they compressed a little on injection waiting for the 'regulation' count of 10 would allow the increased pressure to deliver the last micro droplets of dose as pressure equalised.


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