Go Search

HumaPen LUXURA HD
Questions and Answers

HumaPen LUXURA HD

Below is information that may help you address some of the questions your patients with type 2 diabetes may have about using HumaPen® LUXURA HD. HumaPen LUXURA HD is for use only with Humalog 3 mL insulin cartridges.

Inserting the insulin cartridge

Why doesn’t the screw move out when there is no cartridge in the pen?
Inform patients that the screw may not move out when the injection button is pushed unless there is a cartridge in the pen. This feature of the pen allows patients to easily push the screw into the pen body when replacing a cartridge. Once a cartridge is inserted, the screw will move out when the injection button is pushed.
What should I do if I can’t attach the cartridge holder to the pen body?
Patients should be instructed to check that the insulin cartridge is fully inserted into the cartridge holder. They should then carefully line up the cartridge holder with the pen body and screw together until secure.

Priming

Why is it important to prime before every injection?
Advise patients on the importance of priming. If they do NOT prime, they may get too much or too little insulin. Priming helps to ensure that the pen and needle are working properly. Once the pen is properly primed, a stream of insulin will flow from the needle. Patients may need to prime several times before a stream of insulin is seen.
Why can it take several attempts to prime when a new cartridge is inserted?
Let patients know there may be a gap between the screw and the cartridge plunger. Repeating the priming steps will move the screw out to touch the cartridge plunger. Once the end of the screw pushes the cartridge plunger out, insulin will flow from the needle.

What should I do if I see an air bubble in the cartridge?
If an air bubble is seen in the cartridge, instruct patients to do the following:
  • Repeat the priming steps until a stream of insulin is seen
  • If patients are still unable to see a stream of insulin flow from the needle, refer to "Why should I prime to a stream...?" below
Why should I prime to a stream, and why isn’t the pen ready for use if I see a drop of insulin on the needle tip?
Inform patients that priming moves the screw into contact with the cartridge plunger and gets the air out of the cartridge. When priming the pen:
  • Patients may see a drop of insulin on the tip of the needle when it is first attached. This only shows that the needle is attached and not clogged. The pen must still be primed
  • Patients may also see no flow at all. This may be because the screw is moving forward to close a gap between the screw and the cartridge plunger
  • If there is air in the cartridge, the insulin may sputter or drip until all the air is removed
  • Insulin will flow as a stream only when the pen is properly primed
  • If the injection button is hard to push, the needle may be clogged. Patients should attach a new needle, and then repeat the priming steps until a stream of insulin is seen
If patients are still unable to see a stream of insulin out of the needle, they should NOT use the pen. Assist the patient or instruct them to contact The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979) for assistance or to obtain a replacement.
What should I do if I have an air bubble in the cartridge?
Let patients know that priming the pen will remove air. Instruct them to point the pen up, and tap the cartridge gently with their finger so any air bubbles can collect near the top. They should repeat the priming steps until a stream of insulin is seen. A small air bubble may remain in the cartridge after completion of the priming steps. If the pen has been properly primed, this small air bubble will not affect the insulin dose.

Injecting

Why is it difficult to push the injection button when I try to inject?
Let patients know this could be caused by the following:
  • The needle may be clogged. Instruct patients to try attaching a new needle, and then prime the pen
  • Pushing the injection button down quickly may make the button harder to push. Pushing the button more slowly may make it easier
  • The injection button may become harder to push if the inside of the pen gets dirty with insulin, food, drink, or other materials. Following the instructions in the "Care and storage" section below should prevent this

Using a larger diameter needle will make it easier to push the injection button during injection. Work with each patient to determine which needle is best for them.

If none of the above steps resolves the problem, the pen may need to be replaced.

Why doesn’t the dose knob go to zero when I inject my dose?
Inform patients that this can happen if the insulin cartridge does not have enough insulin left in it for the entire dose. Explain to patients that the number in the dose window is the amount they did NOT receive. To get the rest of their dose, patients should remove the needle, change the insulin cartridge, attach a new needle, and prime the pen. Then patients should complete their dose by dialing the amount that they did NOT receive and inject only this amount.

Care and storage

How and where should I store the pen?
Instruct patients to do the following:
  • Remove the needle after every use. Do not store the pen with the needle attached
  • Keep the pen away from moisture, dust, extreme hot or cold temperatures, and direct sunlight
  • Do not store the pen in a refrigerator
  • Do NOT store a cartridge that is being used in the refrigerator. Keep at room temperature below 86°F (30°C) for up to 28 days. Throw away a cartridge 28 days after first use, even if there is insulin left in the cartridge. For full insulin storage information, have patients refer to the Patient Information for Humalog >
Refer patients to the HumaPen LUXURA HD user manual for complete care and storage information for the pen.

Pens and needles are for single-patient use only and should not be shared, even in healthcare facilities, as infection or disease can be spread from one person to another.

Do not withdraw insulin from the pen cartridge.

Indication for Humalog, Humalog Mix75/25, and Humalog Mix50/50

Humalog® (insulin lispro injection, USP [rDNA origin]) is an insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus. Humalog® Mix75/25 (75% insulin lispro protamine suspension, 25% insulin lispro injection [rDNA origin]) and Humalog® Mix50/50 (50% insulin lispro protamine suspension, 50% insulin lispro injection [rDNA origin]) are indicated in the treatment of adults with diabetes mellitus for the control of hyperglycemia. Humalog, Humalog Mix75/25, and Humalog Mix50/50 contain 100 units/mL.

Important Safety Information for Humalog, Humalog Mix75/25, and Humalog Mix50/50

Contraindications

  • Humalog, Humalog Mix75/25, and Humalog Mix50/50 are contraindicated during episodes of hypoglycemia and in patients who are hypersensitive to insulin lispro or any excipients contained in the formulation.

Warnings and Precautions

  • Dose Adjustment, Monitoring, and Considerations: Closely monitor blood glucose in all patients treated with insulin. Change insulin regimens cautiously. Concomitant oral antidiabetic treatment may need to be adjusted. The time course of action for Humalog, Humalog Mix75/25, and Humalog Mix50/50 may vary in different individuals or at different times in the same individual and is dependent on many conditions, including the delivery site, local blood supply, or local temperature. Patients who change their level of physical activity or meal plan, or experience illness, emotional disturbances, or other stress may require insulin dose adjustment. Humalog differs from regular human insulin by its rapid onset of action and shorter duration of activity. Humalog should be given within 15 minutes before or immediately after a meal. Humalog Mix75/25 and Humalog Mix50/50 are intended only for subcutaneous administration and should be given within 15 minutes before a meal.
  • Hypoglycemia: Hypoglycemia is the most common adverse effect of Humalog, Humalog Mix75/25, and Humalog Mix50/50. The risk of hypoglycemia increases with tighter glycemic control. Educate patients to recognize and manage hypoglycemia. Hypoglycemia can happen suddenly and symptoms may vary for each person and may change over time. Early warning symptoms of hypoglycemia may be different or less pronounced under conditions such as long-standing diabetes, diabetic nerve disease, use of medications such as beta-blockers, or intensified diabetes control. These situations may result in severe hypoglycemia and possibly loss of consciousness prior to the patient’s awareness of hypoglycemia. Severe hypoglycemia may be life threatening and can cause seizures or death. Use caution in patients with hypoglycemia unawareness and who may be predisposed to hypoglycemia. The patient’s ability to concentrate and react may be impaired as a result of hypoglycemia. Rapid changes in serum glucose levels may induce symptoms similar to hypoglycemia in persons with diabetes, regardless of the glucose value. The timing of hypoglycemia usually reflects the time-action profile of the administered insulins. Other factors such as changes in food intake, injection site, exercise, and concomitant medications may also alter the risk of hypoglycemia.
  • Allergic Reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with Humalog, Humalog Mix75/25, and Humalog Mix50/50.
  • Hypokalemia: Humalog, Humalog Mix75/25, and Humalog Mix50/50 can cause hypokalemia, which, if untreated, may result in respiratory paralysis, ventricular arrhythmia, and death. Use caution in patients who may be at risk for hypokalemia (eg, patients using potassium-lowering medications or medications sensitive to serum potassium concentrations).
  • Renal or Hepatic Impairment: Frequent glucose monitoring and insulin dose reduction may be required in patients with renal or hepatic impairment.
  • Mixing of Insulins: Patients should be advised NOT to mix Humalog Mix75/25 or Humalog Mix50/50 with any other insulin. Humalog for subcutaneous injection should not be mixed with insulins other than NPH insulin. If Humalog is mixed with NPH insulin, Humalog should be drawn into the syringe first. Injection should occur immediately after mixing.
  • Humalog Use in a Subcutaneous Insulin Infusion Pump: Humalog should not be diluted or mixed when used in an external insulin pump. Change Humalog in the reservoir at least every 7 days. Change the infusion set and insertion site at least every 3 days. Malfunction of the insulin pump or infusion set or insulin degradation can rapidly lead to hyperglycemia and ketosis. Prompt correction of the cause of hyperglycemia or ketosis is necessary. Interim subcutaneous injections with Humalog may be required. Train patients using an insulin pump to administer insulin by injection and to have alternate insulin therapy available in case of pump failure.
  • Humalog Mix75/25 and Humalog Mix50/50 should never be used in a pump.
  • Drug Interactions: Some medications may alter glucose metabolism, insulin requirements, and the risk for hypoglycemia or hyperglycemia. The signs of hypoglycemia may be reduced or absent in patients taking anti-adrenergic drugs. Particularly close monitoring may be required.
  • Fluid Retention and Heart Failure with Concomitant Use of PPAR-gamma Agonists: Thiazolidinediones (TZDs), which are PPAR-gamma agonists, can cause dose-related fluid retention, particularly when used in combination with insulin, including Humalog, Humalog Mix75/25, or Humalog Mix50/50. Fluid retention may lead to or exacerbate heart failure. Observe patients for signs and symptoms of heart failure and consider discontinuation or dose reduction of the PPAR-gamma agonist.

Adverse Reactions

  • Adverse reactions associated with Humalog, Humalog Mix75/25, and Humalog Mix50/50 include hypoglycemia, hypokalemia, allergic reactions, injection-site reactions, lipodystrophy, pruritus, rash, weight gain, and peripheral edema.

Use in Specific Populations

  • Pediatrics: Humalog has not been studied in children with type 1 diabetes less than 3 years of age or in children with type 2 diabetes. Safety and effectiveness of Humalog Mix75/25 and Humalog Mix50/50 in patients less than 18 years of age have not been established.

Please click to access Full Prescribing Information for Humalog, Humalog Mix75/25, and Humalog Mix50/50.

Please see Instructions for Use that accompanies the pen.

HI BOI HCP ISI 29MAR2013

Important Safety Information for Glucagon

Contraindications

  • Glucagon is contraindicated in patients with known hypersensitivity to it or in patients with known pheochromocytoma.

Warnings

  • Glucagon should be administered cautiously to patients with a history suggestive of insulinoma, pheochromocytoma, or both. In patients with insulinoma, intravenous administration of Glucagon may produce an initial increase in blood glucose; however, because of Glucagon’s hyperglycemic effect the insulinoma may release insulin and cause subsequent hypoglycemia. A patient developing symptoms of hypoglycemia after a dose of Glucagon should be given glucose orally, intravenously, or by gavage, whichever is most appropriate.
  • Exogenous Glucagon also stimulates the release of catecholamines. In the presence of pheochromocytoma, Glucagon can cause the tumor to release catecholamines, which may result in a sudden and marked increase in blood pressure.
  • Generalized allergic reactions, including urticaria, respiratory distress, and hypotension, have been reported in patients who received Glucagon by injection.

Precautions

  • Glucagon is effective in treating hypoglycemia only if sufficient liver glycogen is present. Therefore, hypoglycemia associated with states of starvation, adrenal insufficiency, or chronic hypoglycemia should be treated with glucose.
  • Patients and family members should become familiar with the technique of preparing Glucagon before a severe hypoglycemic emergency arises.
  • To prevent severe hypoglycemia, patients and family members should be informed of the symptoms of mild hypoglycemia and how to treat it appropriately. Blood glucose determinations should be obtained to monitor the patient with hypoglycemia until patient is asymptomatic, and patients should be advised to inform their physician when hypoglycemic reactions occur.
  • One-half the adult dose should be used in pediatric patients weighing less than 44 lbs (20 kg). Any unused portion should be discarded.
  • Pregnancy Category B: There are no adequate and well-controlled clinical studies of the use of Glucagon in pregnant or nursing women.

Adverse Reactions

  • Severe adverse reactions are very rare, although nausea and vomiting may occur occasionally.

For more safety information, please click to access Information for the User and Information for the Physician.

HI GLUC HCP ISI 1NOV2013

Humalog® is a registered trademark of Eli Lilly and Company and is available by prescription only.

Humalog® and Humalog® KwikPen are registered trademarks of Eli Lilly and Company and are available by prescription only.

Humalog® Mix75/25, Humalog® Mix50/50, Humalog® Mix75/25 KwikPen, and Humalog® Mix50/50 KwikPen are trademarks of Eli Lilly and Company and are available by prescription only.

Humalog® Mix75/25, Humalog® Mix50/50, Humalog® Mix75/25 KwikPen, and Humalog® Mix50/50 KwikPen are trademarks of Eli Lilly and Company and are available by prescription only.

Humalog® Mix75/25, Humalog® Mix50/50, Humalog® Mix75/25 KwikPen, and Humalog® Mix50/50 KwikPen are trademarks of Eli Lilly and Company and are available by prescription only.

Humalog® Mix75/25, Humalog® Mix50/50, Humalog® Mix75/25 KwikPen, and Humalog® Mix50/50 KwikPen are trademarks of Eli Lilly and Company and are available by prescription only.

HumaPen® LUXURA is a registered trademark of Eli Lilly and Company. HumaPen® LUXURA HD is available by prescription only.

The Glucagon design is a trademark of Eli Lilly and Company. Glucagon is available by prescription only.

Managing Your Diabetes® is a registered trademark of Eli Lilly and Company.

BD, BD AutoShield, and BD Ultra-Fine are trademarks of Becton, Dickinson and Company.

BD and BD AutoShield are trademarks of Becton, Dickinson and Company.

BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company. © 2013 BD.

Apple®, the Apple logo®, iPad®, iPhone®, and iPod touch® are trademarks of Apple Inc., registered in the U.S. and other countries. App StoreSM is a service mark of Apple Inc.

iPhone® is a registered trademark of Apple Inc.