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Understanding Normal Insulin Secretion

In a person without diabetes, the pancreas releases insulin throughout the day (the
purple line) to keep the blood glucose values within a certain range. When meals are
eaten, more insulin is secreted by the pancreas to deal with the glucose load of the meal
(see the green peaks). So the pattern looks like this:1

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More About Insulin Medication Used to Treat Diabetes

As a patient with type 2 diabetes, you may require insulin to achieve glycaemic control
and remain controlled. The insulin preparations currently available in South Africa are
summarised in the table on page 2.2 They differ in the times that they take to start
working after injection (onset of action), the time to maximum peak effect, that they
continue to have an effect (duration of action) and whether they are human insulins or
analogue insulins.2 Human insulins are laboratory-made insulins (you would think they
come from humans, but they don’t).3 Analogue insulins are also made in a laboratory –
but are modified to affect how quickly or slowly they act.2

You may have either been prescribed a disposable device (SoloStar®)
OR a reusable device (ALLSTAR®)5,6

For Lantus® SoloStar® use click here
For Lantus® ALLSTAR® use click here

 

 

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How to Use Your Lantus®

These values are decided on by your prescribing doctor:

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When to Inject Lantus®

Inject Lantus® at any time during the day (choose a time that suits your lifestyle best), but then it must be injected at this time every day.4

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How to Initiate and Titrate Lantus®

STEP 1.  Initiate with 10 units or 0.2 U/kg in the morning or the evening, preferably at the same time every day4,7

STEP 2. Test fasting plasma glucose (FPG)7

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STEP 3. Adjust insulin dose as follows:

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Injection Techniques

The most common injection site is the abdomen (or stomach). The back of the upper
arms, the upper buttocks or hips, and the outer sides of the thighs are also used.9

These sites are the best to inject into for two reasons:9

  • They have a layer of fat just below the skin to absorb the insulin, but not many
    nerves – which means that injecting there will be more comfortable than injecting in other parts of your body.
  • They make it easier to inject into the subcutaneous tissue, where insulin injection
    is recommended.

If you inject insulin three or more times a day, it’s a good idea to rotate your injection
sites. Injecting in the same place repeatedly can cause hard lumps or extra fat deposits to develop. These lumps are not only unsightly; they can also change the way insulin is absorbed, making it more difficult to keep your blood glucose on target.10

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How to Use the SoloStar® Disposable Pen

Store between 2 °C and 8 °C, away from direct light. Do not freeze. Ensure that the container is not directly touching the freezer compartment or freezer packs.5

Once in use, the disposable pen may be stored at up to 25 °C for 4 weeks. The unused portion must be discarded.5

Remove the disposable pen from the fridge 1-2 hours before injecting, as cold insulin is painful when injected.5

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Important Information for the Use of SoloStar®:

  • Always attach a new needle before each use.
  • Only use BD Micro-Fine Pen needles.
  • Do not select dose and/or press injection button without a needle attached.
  • Always perform the safety test before each injection.
  • The pen is only for your use. Do not share it with anyone else.
  • If your injection is given to another person, special caution must be taken by this person to avoid accidental needle injury and transmission of infection.
  • Never use SoloStar® if it is damaged or if you are not sure that it is working properly.
  • Always have a spare SoloStar® in case your SoloStar® is lost or damaged.
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STEP 1. Check the Insulin

A. Check the label on your SoloStar® to make sure you have the correct insulin.
    The Lantus® SoloStar® is grey with a purple injection button.
B. Take off the pen cap.
C. Check the appearance of your insulin. Lantus® is a clear insulin.
    Do not use this SoloStar® if the insulin is cloudy, coloured or has particles.

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STEP 2. Attach the Needle

Always use a sterile needle for each injection. This helps prevent contamination and potential needle blocks.

A. Remove the protective seal from the new needle.
B. Line the needle up with the pen and keep it straight as you attach it.

  • If the needle is not kept straight while you attach it, it can damage the rubber seal
    and cause leakage, or break the needle.
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STEP 3. Perform a Safety Test

Always perform the safety test before each injection. This ensures that you get an
accurate dose by:

  • Ensuring that the pen and needle work properly, and
  • Removing air bubbles

A. Select a dose of 2 units by turning the dosage selector.

B. Take off the outer needle cap and keep it to remove the used needle after injection.        Take off the inner needle cap and discard it.

C. Hold the pen with the needle pointing upwards.

D. Tap the insulin reservoir so that any air bubbles rise up towards the needle.

E. Press the injection button all the way in. Check if the insulin comes out of the needle        tip.

You may have to perform the safety test several times before insulin is seen.

  • If no insulin comes out, check for air bubbles and repeat the safety test twice more to remove them.
  • If insulin still does not come out, the needle may be blocked.
    Change the needle and try again.
  • If no insulin comes out after changing the needle, your SoloStar® may be damaged.
    Do not use this SoloStar®.
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STEP 4. Select the Dose

You can set the dose in steps of 1 unit, from a minimum of 1 unit to a maximum of
80 units. If you need a dose greater than 80 units, you should take it as two or more injections.
A. Check that the dose window shows “0” following the safety test.
B. Select your required dose (in the example below, the selected dose is 30 units). If you turn past your dose, you can turn back down.

C. Do not push the injection button while turning, as insulin will come out.
D. You cannot turn the dosage selector past the number of units left in the pen.

Do not force the dosage selector to turn. In this case, either you can inject what is remaining in the pen and complete your dose with a new SoloStar® or use a new SoloStar® for your full dose.

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STEP 5. Inject the Dose

A. Use the injection method as instructed by your healthcare professional.
B. Insert the needle into the skin.
C. Deliver the dose by pressing the injection button in all the way. The number in the dose window will return to “0” as you inject.

D. Keep the injection button pressed all the way in. Slowly count to 10 before you withdraw the needle from the skin. This ensures that the full dose of insulin will be delivered

The pen plunger moves with each dose. The plunger will reach the end of the
cartridge when the total of 300 units of insulin have been used.

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STEP 6. Remove and Discard the Needle

Always remove the needle after each injection and store your SoloStar® without a needle attached.
This helps prevent:

  • Contamination and/or infection.
  • Entry of air into the insulin reservoir and leakage of insulin, which can cause inaccurate dosing.

A. Put the outer needle cap back on the needle and use it to unscrew the needle
from the pen. To reduce the risk of accidental needle injury, never replace the
inner needle cap.

  • If your injection is given by another person, or if you are giving an injection to another person, special caution must be taken when removing and disposing of the needle.

Follow recommended safety measures for removal and disposal of needles (e.g. contact your healthcare provider) in order to reduce the risk of accidental needle injury
and transmission of infectious diseases.

B. Dispose of the needle safely, as instructed by your healthcare professional.

C. Always put the pen cap back on the pen, then store the pen until your next injection.

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Maintenance:

  • Protect your SoloStar® from dust and dirt.
  • You can clean the outside of your SoloStar® by wiping it with a damp cloth.
  • Do not soak, wash or lubricate the pen as this may damage it.
  • Your SoloStar® is designed to work accurately and safely. It should be handled with
    care. Avoid situations where your SoloStar® might be damaged. If you are concerned that your SoloStar® may be damaged, use a new one.
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Points to remember before you start using the ALLSTAR® insulin pen:

  • ALLSTAR® is a reusable pen for the injection of insulin.6
  • Cold insulin is more painful to inject. If your insulin is in cold storage (e.g. refrigerator) take it out 1 to 2 hours before you inject.6
  • ALLSTAR® can only be used with Lantus® 3 ml (300 units) insulin cartridges
    (100 units per ml).6
  • ALLSTAR® has been designed to be used for up to 3 years after first use.6
  • Use ALLSTAR® for one person only – do not share.6
  • Never use ALLSTAR® if it is damaged or not working properly.6
  • Always have a back-up method for injecting your insulin.6
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STEP 1. Inserting a new insulin cartridge

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STEP 2. Check your insulin before every injection

Check your insulin cartridge.
Make sure you have the correct insulin. Using the wrong insulin may result in unwanted changes in your blood sugar levels that could be harmful to your health. Do not use an insulin cartridge if it is damaged or after the expiry date on the cartridge label.
Pull off the outer needle cap. Keep it safe to unscrew the needle after the injection.
Check the insulin:
Check the appearance of your insulin. Do not use the cartridge if the insulin is cloudy, coloured or has particles

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STEP 3. Attach a new sterile needle before every injection

IMPORTANT: Always attach a new sterile needle before each injection. Use needles from Artsana, Becton Dickinson and Company, Ypsomed and Owen-Mumford. These are the manufacturers whose needles have been approved
for use with ALLSTAR®.

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STEP 4. Perform a safety test before every injection

IMPORTANT: Always perform a safety test before each injection to make sure that you get the correct dose of insulin.

Select a dose of 2 units by turning the dose button.
The maximum dose you can dial is 80 units. If you need a dose greater than 80 units, you should take it as two or more injections.
Check that the dose window shows “0” following the safety test (see Step 4).

Holding the pen with the needle pointing upwards, tap the cartridge holder so that any air bubbles rise up towards the needle. Select your required dose by turning the dose button. If you turn past your dose, you can turn back in the reverse direction without losing insulin. Do not push the dose button while turning, as insulin will come out.

Press the dose button all the way in and hold it in for 10 seconds.

IMPORTANT: If insulin does not come out of the needle tip: the needle may be blocked. Remove the needle (Step 7) and replace with a new needle (Step 3). Check that the cartridge is properly inserted (Step 1) and is not damaged.
If it is damaged, use a new one (Step 1). After doing all this, repeat the safety test again (Step 4). If insulin still does not come out, do not use this ALLSTAR®. Contact your healthcare professional.

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STEP 5. Select your dose

The maximum dose you can dial is 80 units. If you need a dose greater than 80 units, you should take it as two or more injections. Check that the dose window shows “0”
following the safety test (see Step 4)

Select your required dose by turning the dose button. If you turn past your dose,
you can turn back in the reverse direction without losing insulin. Do not push the
dose button while turning, as insulin will come out.

IMPORTANT: If the dose button does not turn easily, do not force it.
ALLSTAR® will not let you select more units than what is left in the cartridge.
If you need more than what is left you can either:
– inject what is left (Steps 6-7), then replace the cartridge with a new one (Step 1) and complete your dose
(Steps 2-7).
– or discard what is left and use a new cartridge for your full dose (Steps 1-7).

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STEP 6. Inject your dose

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STEP 7. Remove the needle after every injection and dispose of it safely

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STEP 8. Store ALLSTAR® until your next injection

Replace the pen cap back on ALLSTAR® after use. Store the pen safely until your next injection.
IMPORTANT: You do not need to remove the cartridge after the injection unless it is empty or after the expiry date. Your ALLSTAR® should be stored with the insulin cartridge inserted, ready for your next injection. Do not store ALLSTAR® in the refrigerator. The pen and insulin can be safely stored at temperatures up to 25 °C for up to 28 days

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Storage and maintenance of ALLSTAR®

  • Keep ALLSTAR® out of the reach and sight of children.6
  • Protect ALLSTAR® from direct sunlight.6
  • Protect ALLSTAR® from high storage temperatures (e.g. do not store ALLSTAR® in a hot car).6
  • Protect your ALLSTAR® from dust and dirt.6
  • You can clean the outside of your ALLSTAR® by wiping it with a damp cloth. Do not soak, wash or lubricate ALLSTAR® as this may damage it. Your ALLSTAR® is designed to work accurately and safely. It should be handled with care.6
  • Avoid situations where ALLSTAR® might be damaged. Do not use excessive force
    when turning or pressing the dose button or when pushing the plunger back in. If your ALLSTAR® is damaged then it is no longer safe to use. If you are not sure whether or not your ALLSTAR® is damaged, contact your healthcare professional.6
  • Do not store ALLSTAR® in the refrigerator.6
  • Do not store ALLSTAR® with a needle attached. If your insulin cartridge is in cool storage (e.g. refrigerator), take it out 1 to 2 hours before you inject to allow it to warm up. Cold insulin is more painful to inject.6 The insulin cartridge can be used for multiple injections
    – do not remove it from ALLSTAR® between injections unless cartridge is empty or after expiry date.6 From when the cartridge is first used, it can be used for up to 28 days under normal carrying or storage conditions.6 See patient insert/leaflet supplied with the 3 ml insulin cartridge for further cartridge storage information.6 After 3 years of using the pen, dispose of the pen safely as instructed by your healthcare provider.6

Medical References

1. Polonsky KS, et al. Twenty-Four-Hour Profiles and Pulsatile Patterns of Insulin Secretion in Normal and Obese Subjects. Journal of Clinical
Investigation. Volume 81, February 1988. Pg 442-443. 2. The 2017 SEMSDA Guideline for the Management of Type 2 Diabetes. JEMDSA 2017,
Volume 21, Number 1 (Supplement 1). Pg. S1-S196. 3. Diabetes.co.uk. Insulin Types and Information. [updated 15 Jan 2019; accessed 18 March
2020]. Available from: https://www.diabetes.co.uk/insulin/insulin-types.html. 4. Package Insert. Lantus® solution for injection. 26 April 2018. 5.
Lantus® Solostar -Instructions for use. 6. Lantus® ALLSTAR® – Instructions for use. 7. Inzucchi S, Bergenstal R, Buse J, et al. Management of
Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach. Update to a Position Statement of the American Diabetes Association and
the European Association for the Study of Diabetes. Diabetes Care 2015;38:46. Available from: https://care.diabetesjournals.org/content/38/1/140.
8. Gerstein HC, Yale JF, Harris SB, Issa M, Stewart JA, Dempsey E. A randomized trial of adding insulin glargine vs. avoidance of insulin in people
with type 2 diabetes on either no oral glucose lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT
(Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study. Diabetic Medicine. 2006 Jul;23(7):736-42. 9. Becton,
Dickinson and Company. Injection Site Selection. [accessed 4/8/2019; cited 18/3/2020]. Available from: https://www.bd.com/en-ca/products/
diabetes-care/diabetes-learning-center/managing-diabetes-with-insulin/how-to-inject-insulin/injection-sites. 10. Becton, Dickinson and Company.
Rotating Injection Sites. [accessed 4/8/2019; cited 18/3/2020]. Available from: https://www. bd.com/en-ca/products/diabetes-care/diabeteslearning-
center/managing-diabetes-with-insulin/how-to-inject-insulin/rotating-injection-%E2%80%A61/3.

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