How long can one keep Lantus?

You can keep Lantus for 28 AFTER you first puncture the vial read the box, the expiration date
on the box is IF you haven't opened it at all. should be a few years at least. but since you've
been using it, keep using it.. if you start to get weird results and loose control. toss the
vial it's gone bad.

I've had a vial of lantus go bad after 13 days of first using it, others i've had last well beyond
45 days. some right at the 30 day mark. just depends on the LOT #.

--
RK - t1 In tribute to the United States of America and the State of Israel, two bastions of strength
in a world filled with strife and terrorism.

"M. Pann" <[email hidden]> wrote in message "]news:[email hidden]...

Quoted message said:

I opened my first vial of Lantus a month ago, and kept it in my fridge. The manufacturer advices
to throw it away after 28 days after opened, but I think they mean it only if the vial was kept on
the shelf, not

cooled.

Quoted message said:

Is that correct?

By now, I've used less than a half of the lantus in the vial. Considering the price ($54.00), and
the fact that I'm retired on a fixed income, it seems almost a sin to throe it away.

What's your opinion, and experience?
---
Meir "Doubt everything. Find your own light." [Last words of Gautama Buddha, in Theravada
tradition]

Fri said:

I opened my first vial of Lantus a month ago, and kept it in my fridge. The manufacturer advices
to throw it away after 28 days after opened, but I think they mean it only if the vial was kept on
the shelf, not cooled.

Is that correct?

By now, I've used less than a half of the lantus in the vial. Considering the price ($54.00), and
the fact that I'm retired on a fixed income,

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Quoted message said:

it seems almost a sin to throe it away.

you mean you pay out of pocket for the whole 54 bucks?

what made you decide to use Lantus?

everything i know, suggests that "human"-UL is both better, cheaper, safer, more flexible, and much
more robust than Lantus

bill t1 since '57, ex 8-yr pumper, pork-L 2x, simple MDI/DAFNE

Meir,

None of our patients have experienced a problem from Lantus potency fading after 28 days, if it has
been refrigerated. The concern on the part of the manufacturer is whether the insulin is degrading
from one of many factors; heat , age, bacterial growth, skin/blood particles from needle reuse, pH
changes as more air is introduced into the vial, etc.

The Lantus pen will be out soon, and may be a better option for you since it will carry 300 units
instead of the 1000 in the vials.

We see sporadic problems from all the insulins right after using them, almost like you got an
inactive bottle. IMHO, it if probably from exposure to heat during shipping or storage at the
pharmacy rather than how the patient uses it. This problem has lessened over the last several years,
probably due to better packaging and shipping requirements by wholesalers.

You may see more problems with insulins that are less commonly used anymore, such as Lente or
Ultralente. They tend to stay on the shelf at the distributor and pharmacy longer. Ultralente is
always a quirky insulin to use, with a lot of inherent day to day variability. Much of that is a
mixing / resuspension issue which simply isn't a problem with a soluble long acting insulins like
Lantus or Levemir.

Best wishes, William C Biggs, MD

"M. Pann" <[email hidden]> wrote in message "]news:[email hidden]...

Quoted message said:

I opened my first vial of Lantus a month ago, and kept it in my fridge. The manufacturer advices
to throw it away after 28 days after opened, but I think they mean it only if the vial was kept on
the shelf, not

cooled.

Quoted message said:

Is that correct?

By now, I've used less than a half of the lantus in the vial. Considering the price ($54.00), and
the fact that I'm retired on a fixed income, it seems almost a sin to throe it away.

What's your opinion, and experience?
---
Meir "Doubt everything. Find your own light." [Last words of Gautama Buddha, in Theravada
tradition]

On Fri, 28 Nov 2003 12:36:02 -0500, "M. Pann" <[email hidden]>

Quoted message said:

I opened my first vial of Lantus a month ago, and kept it in my fridge. The manufacturer advices to
throw it away after 28 days after opened, but I think they mean it only if the vial was kept on the
shelf, not cooled.

Is that correct?

By now, I've used less than a half of the lantus in the vial. Considering the price ($54.00), and
the fact that I'm retired on a fixed income, it seems almost a sin to throe it away.

What's your opinion, and experience?
---
Meir "Doubt everything. Find your own light." [Last words of Gautama Buddha, in Theravada
tradition]

my experience is 28 days. Lantus has a very fragile Ph level if it changes the insulin loses it's
strength until it becomes useless. If after 28 days you see your BGs starting to creep up for no
reason change the lantus and see what happens over the next 3 to 4 days.

Close watch on your BGs is the only way to tell if there is a problem.

Mack Type 1 since 1975 alt-support-diabetes.orgalt-support-diabetes.orgOpen ↗ insulin-pumpers.orginsulin-pumpers.orgOpen ↗

In tribute to the United States of America and the State of Israel, two bastions of strength in a
world filled with strife and terrorism.

William C Biggs said:

Meir,

None of our patients have experienced a problem from Lantus potency fading after 28 days, if it
has been refrigerated. The concern on the part of the manufacturer is whether the insulin is
degrading from one of many factors; heat , age, bacterial growth, skin/blood particles from needle
reuse, pH changes as more air is introduced into the vial, etc.

Hi, Dr. Biggs, nice to here from you again. I've been away. I reuse the syringe, cap it and put it
in the fridge next to the vial, and am very careful not to touch the needle. However, (obviously) it
touches the skin on my belly... So, will that be a serious factor in degrading Lentus?

Quoted message said:

You may see more problems with insulins that are less commonly used anymore, such as Lente or
Ultralente. They tend to stay on the shelf at the distributor and pharmacy longer. Ultralente is
always a quirky insulin to use, with a lot of inherent day to day variability. Much of that is a
mixing / resuspension issue which simply isn't a problem with a soluble long acting insulins like
Lantus or Levemir.

I was advised, on another list, to switch from the expensive Lantus to U or L, which are much much
cheaper and have the added benefit of varying the nighttime and daytime amount. I was told that some
people differ by as much as X3 day/night amounts

However, if U or L are more problematical, would it not be a bad move?
--
Meir Pann "Management reorganizes the company whenever they need to create the illusion of
progress."

Meir,

I would suggest discussing this with your doc.

Lantus and Ultralente or L are not interchangable.

We haven't had any noticable Lantus degradation problems in our patients who reuse syringes. Most of
these companies err on the side of safety, and thus give you extremely conservative advice.

We use Lantus twice a day in about 15 % of our patients. Some of these people have an exagerrated
dawn phenomenon, and we can step up the Lantus in the evening to cover that if needed, just like you
are proposing with the UL or L. Some people find that Lantus fades out the last 4 - 6 hours, so they
need the twice a day coverage.

UL, L, and Levemir are all best used with at least twice a day dosing.

My approach would be to discuss the financial concerns about Lantus vs the lower cost of UL or L
with your doc. If cost is an overriding concern then UL or L are certainly an option. I expect the
cost of Levemir to be about the same as Lantus when it comes out early next year.

At this point we don't have many UL users left in our practice, since the vast majority of users
prefer Lantus over UL.

The pros / cons are:

UL: Quirky, sputtering, time release profile. At least twice a day dosing Poor day to day
consistency Can mix with other insulins, but blunts effect of short acting insulin. Availability
becoming spotty Better pricing No pen available

Lantus More predictable Smoother & flatter activity curves Once a day an option for most people No
mixing with other insulins Short 28 day dating on opened vials More expensive Pen available 1q 2004

Levemir Not available until 1q or 2q 2004 Regional availability initially will be spotty At least
twice a day dosing Even more consistent & predictable than Lantus Less weight gain Can mix with
other insulins (No information on interaction with other insulins available) More expensive Rumor is
that it will be available in pen form only, at launch. (Thus negating its biggest advantage over
Lantus....mixing)

Choosing an insulin is harder than it looks, eh ?

Good luck, William C Biggs, MD

"M. Pann" <[email hidden]> wrote in message "]news:[email hidden]...

Quoted message said:

William C Biggs said:

Meir,

None of our patients have experienced a problem from Lantus potency

fading

Quoted message said:

Quoted message said:

after 28 days, if it has been refrigerated. The concern on the part of

the

Quoted message said:

Quoted message said:

manufacturer is whether the insulin is degrading from one of many

factors;

Quoted message said:

Quoted message said:

heat , age, bacterial growth, skin/blood particles from needle reuse, pH changes as more air is
introduced into the vial, etc.

Hi, Dr. Biggs, nice to here from you again. I've been away. I reuse the syringe, cap it and put it
in the fridge next to the vial, and am very careful not to touch the needle. However, (obviously)
it touches the skin on my belly... So, will that be a serious factor in degrading Lentus?

Quoted message said:

You may see more problems with insulins that are less commonly used

anymore,

Quoted message said:

Quoted message said:

such as Lente or Ultralente. They tend to stay on the shelf at the distributor and pharmacy
longer. Ultralente is always a quirky insulin

to

Quoted message said:

Quoted message said:

use, with a lot of inherent day to day variability. Much of that is a

mixing

Quoted message said:

Quoted message said:

/ resuspension issue which simply isn't a problem with a soluble long

acting

Quoted message said:

Quoted message said:

insulins like Lantus or Levemir.

I was advised, on another list, to switch from the expensive Lantus to U or L, which are much much
cheaper and have the added benefit of varying the nighttime and daytime amount. I was told that
some people differ by as much as X3 day/night amounts

However, if U or L are more problematical, would it not be a bad move?
--
Meir Pann "Management reorganizes the company whenever they need to create the illusion of
progress."

Fri said:

UL, L, and Levemir are all best used with at least twice a day dosing.

by "UL" you mean "human"-UL, right?

beef-Lente is the one insulin that can be used with 1x dosing (coz it has 70% beef-UL in it) and is
*flat* at the 12-to-24 hour time period, with 1x dosing

Quoted message said:

My approach would be to discuss the financial concerns about Lantus vs the lower cost of UL or L
with your doc. If cost is an overriding concern then UL or L are certainly an option.

what he needs to do is to actually do it

in my 46 years of experience of using insulin, talking with doc about insulin is a waste of time

btw, Lilly Humulin-UL can be gotten from www.canadapharmacy.com at $18/1000u. 🙂

Quoted message said:

I expect the cost of Levemir to be about the same as Lantus when it comes out early next year.

At this point we don't have many UL users left in our practice,

i bet a doc named biggs is a big part of the reason for that at your practice (how many docs are in
the practice besides you?)

Quoted message said:

since the vast majority of users prefer Lantus over UL.

really?

what we can say for sure is that their belief system buys into believing it. yours too for
that matter

i also bet that if everyone in the world paid out of pocket for their insulin, that high priced
Lantus would be struggling

Quoted message said:

The pros / cons are:

UL: Quirky, sputtering, time release profile.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

not in my experience with beef-Lente (used with 1x dosing)

not in my experience with pork-Lente (used with 2x dosing)

with "human"-U, you keep harping on this "sputtering" thing. post some cites/sites that don't cost
money to see the full report

Quoted message said:

At least twice a day dosing Poor day to day consistency

not in my experience with beef-UL and pork-UL

Quoted message said:

Can mix with other insulins, but blunts effect of short acting insulin.

the blunting of the speed is a plus. if you don't want the blunting, then don't mix

Quoted message said:

Availability becoming spotty

my hunch is that Lilly will offer "human"-UL in the USA and Canada for at least another 5+ years

if/when Lilly pulls the plug on "human"-UL, one can always buy 5-to-15 years worth of it coz it is
very robust in the fridge (40+ years with 5% potency loss)

Quoted message said:

Better pricing

see above on canadapharmacy pricing. i think www.hocks.com in Ohio has Humulin-U at something in the
$20+ range

Quoted message said:

No pen available

Lantus More predictable

not when it dies early/unexpectedly

Quoted message said:

Smoother & flatter activity curves

doubtful

Quoted message said:

Once a day an option for most people

t1 charly coughran said that 2 of the top endos in San Diego have more than half of their t1s doing
2x with Lantus

hardly what was advertised

Quoted message said:

No mixing with other insulins Short 28 day dating on opened vials

^^^^^^^^^^^^^^^^^^^^^^

isn't this exactly where a lot of the Lantus potency problem(s) lie?

once the vial is used, more and more air gets into the vial and has a negative effect on the
extremely acid pH of Lantus

bill t1 since '57, ex 8-yr pumper, pork-L 2x, simple MDI/DAFNE

Quoted message said:

More expensive Pen available 1q 2004

William C Biggs, MD wrote in message ...
. . . .(snip). ..>

Quoted message said:

The pros / cons are:

UL: Quirky, sputtering, time release profile.
. . . . Poor day to day consistency

Before I retired, I spent a lot of time and Company money making, then analyzing particle size
spectra of polystyrene particles in the 10 to 100 micron range, i.e. similar to the too-easily
settling Ultralente particles. I learned, the hard way, how to get a representative sample of
obstinate particles out of a well-mixed vial. One part of the learning process was immediate
feedback, a print-out with a physically improbable size profile, whenever I sampled poorly.

I shoot U three times a day, ~1100 times a year, and I have never detected an anomalous
absorbence profile.

Every Diabetes professional I have encountered testifies to the same "quirky, sputtering profile" .
I think that the settling problem is a major part of the quirkiness and, unfortunately, shooting U
is an art.

(I note that I never had problems with anomalous absorbence by NPH either. I experienced
frustration because of its peakiness but the peaks did come at about the same time-after-
injection. )

Regards
Old Al

In article <[email hidden]>,

African Bios said:

In resposne to the original question Once open largine shelf life =1 month, the same applies for
all the new recombinant human insulin analogues ie lispo and novorapid

I have found no decline in the activity of refrigerated Humalog (lispro) for more than two months
after being opened. It is time we got honest information about the effect of different temperatures,
instead of giving it one month after opening, refrigerated or not.
--
This address is for information only. I do not claim that these views are those of the Statistics
Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University
[email hidden] Phone: (765)494-6054 FAX: (765)494-0558

oldal4865 said:

I learned, the hard way, how to get a representative sample of obstinate particles out of a well-
mixed vial.

And... ?

Colin Percival

Sat said:

Before I retired, I spent a lot of time and Company money making, then analyzing particle size
spectra of polystyrene particles in the 10 to 100 micron range, i.e. similar to the too-easily
settling Ultralente particles. I learned, the hard way, how to get a representative sample of
obstinate particles out of a well-mixed vial. One part of the learning process was immediate
feedback, a print-out with a physically improbable size profile, whenever I sampled poorly.

I shoot U three times a day, ~1100 times a year, and I have never detected an anomalous absorbence
profile.

Every Diabetes professional I have encountered testifies to the same "quirky, sputtering profile"
. I think that the settling problem is a major part of the quirkiness and, unfortunately, shooting
U is an art.

the only thing that i have noticed with my 5 years of 1x use of beef-Lente is that by the end of the
vial (u100 with 1000u in the vial), the 70% UL potency falls off, but not the 30% SL. it's
expecially noticable at the 24 hour mark when one doses 1x

this happens no matter how well i roll/shake the vial. (and like you, i make SURE that i rock and
roll with that vial before i use it. 🙂)

meaning that in the last half of the vial i have to start using more of the Lente. roughly 30% to
40% by the end of the vial

since you are using UL (and not Lente), have you noticed a similar falloff as you near the end
of the vial?

my own guess is that it is due to the heavy UL crystals falling to the end (where the needle is
sucking the insulin out) of the vial more quickly than the lighter SL does

bill t1 since '57, ex 8-yr pumper, pork-L 2x, simple MDI/DAFNE

[email hidden] (Herman Rubin) wrote in news:bqiccr
[email hidden]:

Quoted message said:

I have found no decline in the activity of refrigerated Humalog (lispro) for more than two months
after being opened. It is time we got honest information about the effect of different
temperatures, instead of giving it one month after opening, refrigerated or not.

Thanks for you observations I was only stating the Manufacturers recommendations as per this link
care.diabetesjournals.org2665Open ↗. What individual patients or users
choose to do is at thier own risk
--
Remove nyet / block or change dot to . to reply Thank you

Colin Andrew Percival wrote in message ...

Quoted message said:

oldal4865 said:

I learned, the hard way, how to get a representative sample of obstinate particles out of a well-
mixed vial.

And... ?

Colin Percival

and I never experience the well-publicized quirkiness or variable potency with Ultralente, an
insulin noted for containing obstinate particles which demand a well-mixed vial to obtain an
accurate dose.

Regards
Old Al

My experience with Lantus. I use less than 20 units of Lantus a day and I use the whole bottle.

I discarded one bottle since I started using Lantus and I started early when Charles Evans gave me
detailed info on it.

Today, I suspect that the discard was unnecessary but it was the worry from listening to all of the
posted info here.

I do use fairly careful procedures and have a very good way to see changes. Loss of basal is
signaled by the glucose rises and any increase of activity will show up in low morning readings.

There are many other things that cause problems and throw me. However I try to not let my biases
come into play. Enough other problems to worry about.

I receive a warning from "BD" on the reuse of syringes. I have noted that the most recent lot of
syringes has needles that bend very easy,

I have noted poor quality on alcohol pads for awhile. Appears to be quality control but there is an
a blurb on new pads. I have switch to generic pads.

As the fellow told me last week when discussing the medicare prescription situation, These are
private companies and may do what they want or charge what they want. Their right.

It is my responsibility to do as much as possible to negate their ability to operate in that mode.

Due to legal and marketing issues all medical goods are marked with very conservative numbers.

Know who is your friend and who smiles at you for money reasons.

Guy

willbill wrote in message ...

Quoted message said:

Sat, 29 Nov 2003 10:41:24 -0500, "oldal4865" wrote:

.

Quoted message said:

the only thing that i have noticed with my 5 years of 1x use of beef-Lente is that by the end of
the vial (u100 with 1000u in the vial), the 70% UL potency falls off, but not the 30% SL. it's
expecially noticable at the 24 hour mark when one doses 1x

this happens no matter how well i roll/shake the vial. (and like you, i make SURE that i rock and
roll with that vial before i use it. 🙂)

meaning that in the last half of the vial i have to start using more of the Lente. roughly 30% to
40% by the end of the vial

since you are using UL (and not Lente), have you noticed a similar falloff as you near the end of
the vial?

my own guess is that it is due to the heavy UL crystals falling to the end (where the needle is
sucking the insulin out) of the vial more quickly than the lighter SL does

bill t1 since '57, ex 8-yr pumper, pork-L 2x, simple MDI/DAFNE

That's exactly what happens. I experienced the reduction in potency with the first few vials then
figured out what was happening (Too soon old, too late smart Syndrome)

I didn't figure it out from first principles. I left a bottle out on the counter for some reason and
was amazed at how fast it settled to form a clear supernatent over a precipitate.

Regards
Old Al

African Bios <[email hidden]> wrote on 2 Dec 2003 18:58:29 GMT:

Quoted message said:

[email hidden] (Herman Rubin) wrote in news:bqiccr [email hidden]:

Quoted message said:

I have found no decline in the activity of refrigerated Humalog (lispro) for more than two months
after being opened. It is time we got honest information about the effect of different
temperatures, instead of giving it one month after opening, refrigerated or not.

Quoted message said:

Thanks for you observations I was only stating the Manufacturers recommendations as per this link
care.diabetesjournals.org2665Open ↗.

Quoted message said:

What individual patients or users choose to do is at thier own risk

Which kind of carries undertones of "and if they do so, they're stupid". In fact, it's the sort of
highly patronising insult you're likely to get from a manufacturer's "helpline" if you phone them up
and put this point to them.

Why 30°C (86°F) and why finish within 1 month of first use? These figures have been appearing on
insulin leaflets for a LONG time. The same for every insulin type, since (at least) the mid 1960s.

I read the answer somewhere (I can't remember where) that sometime in the middle ages some
international convention established a 2 year shelf life, 30°C and 1 month after opening as the
_MINIMUM_ acceptable durability of any insulin. As the unforseen result of this decision, the
manufactures withold all relevant information and we are made to restrict our lifestyles below this
minimum or get told we're stupid.

This is a bit like going to a garage to buy tyres for a car. You tell the salesman that you expect
to be driving over a lot of snow, and so want rugged winter tyres. The salesman replies with his
syrrupy smile "don't worry, SIR, all our tyres have at least 2mm tread on them, don't worry too much
about that, but we do recommend you avoid driving in snow as much as possible and keep your speed
right down when you do." Would you buy tyres from this place?

In actual fact, insulin (whether "human" or animal) will stand very high temperatures (well over
40°C (104°F)) without any problems. Their shelf life, when refrigerated, is measured in decades, not
months. The newer analogs do not have this durability. My own experience shows that Humalog is
destroyed in a few hours at a moderately high temperature (40°
- 45°) and others' experience here suggests that Lantus is dodgy stuff at any temperature.

--
Alan Mackenzie (Munich, Germany) Email: [email hidden]; to decode, wherever there is a repeated
letter (like "aa"😉, remove half of them (leaving, say, "a"😉.

Guy said this...

Quoted message said:

I have noted poor quality on alcohol pads for awhile. Appears to be quality control but there is
an a blurb on new pads. I have switch to generic pads.

British diabetics are instructed not to use them at all, as they cause more problems than
they solve.

Ratty
--
www.flyingrat.net

Sat said:

My experience with Lantus. I use less than 20 units of Lantus a day and I use the whole bottle.

lessee... using exact math, 19u per day would give you 52 days of use from a single 1000u
vial of Lantus

whereas 8u per day would give you 125 days

maybe 3 months of air exposure is enough to do in frail Lantus?

for certain i wouldn't want to be keeping a half open vial of Lantus around for a year or more
before finishing it off (i've done that with both beef-L and pork-L without problems, and beef-R and
pork-R and "human"-R also. and without the slightest problem too. 🙂)

Quoted message said:

I discarded one bottle since I started using Lantus and I started early when Charles Evans gave me
detailed info on it.

Today, I suspect that the discard was unnecessary but it was the worry from listening to all of
the posted info here.

not to worry. 🙂

tossing it early was likely the right thing to do

i'm not the one who coined the term "lantoss"

and RK isn't the only t1 who's used Lantus and not been too impressed with it's frailness

btw, i've thought biggs to be a pimp for Aventis/Lantus for the past year. coz if Lantus isn't
frail, then why do the pharma distributors in the USA keep having problems with it? biggs' answer is
that they had to learn how to treat Lantus with TLC??

doh!! that must be the problem. they handled Lantus like they do with all the other insulins that
are on the market

bill t1 since '57, ex 8-yr pumper, pork-L 2x, simple MDI/DAFNE

p.s. for alan m., TLC is Tender Loving Care. 🙂

oldal4865 said:

Colin Andrew Percival wrote in message ...

Quoted message said:

oldal4865 said:

I learned, the hard way, how to get a representative sample of obstinate particles out of a well-
mixed vial.

And... ?

and I never experience the well-publicized quirkiness or variable potency with Ultralente, an
insulin noted for containing obstinate particles which demand a well-mixed vial to obtain an
accurate dose.

You missed my question. Would you care to share your hard-learned wisdom about how to get a
representative sample of obstinate particles out of a well-mixed vial?

Colin Percival