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ForumsOff-TopicDoes anyone else talk to their syringe or just me — anyone have experience?

Does anyone else talk to their syringe or just me — anyone have experience?

emily_PDX Sun, Oct 6, 2024 at 10:22 PM 14 replies 1,804 viewsPage 1 of 3
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emily_PDX
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Oct 6, 2024 at 10:22 PM#1

Collecting this in one place because it comes up every few weeks and the answer is always assembled from scratch. It is about the dosing arithmetic, and it is deliberately narrow — everything I am not confident about is marked as such.

What is actually established

Do it in two steps and it stops being confusing. First concentration: 10mg into 2ml is 5mg/ml. Then volume: a 0.5mg dose is 0.5 ÷ 5 = 0.1ml. Then units, and this is where people go wrong — a U-100 syringe is graduated in hundredths of a millilitre, so 0.1ml is 10 units. The word "units" has nothing to do with milligrams; it is a volume marking that exists because insulin happens to come at 100 units per ml.

The condition it depends on

The arithmetic is right and one caveat matters: a U-40 syringe changes the markings, not the volumes. If someone hands you U-40 and you read it as U-100 you will be 2.5 times out, and that error has a direction — it is always an overdose.

The practical version

The three numbers to write on the vial: total mg, total ml, and mg per ml. Everything else is division. And the sanity check is that dose volume times number of doses should be less than the volume you put in, because dead space takes the difference.

What I am not sure about

The narrow version of the question is how much material I am losing to dead space, and whether that explains why a 10mg vial gives me nine usable draws rather than ten. If the honest answer is that nobody knows, that is a useful answer and I would rather have it.

— emily_PDX · corrections welcome and will be edited into this post with credit
39 9julia.endo, JessicaM_2024, TomFromTexas and 36 others
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PharmacoVig_BOS
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Oct 6, 2024 at 11:08 PM#2
emily_PDX said:
Do it in two steps and it stops being confusing.

No disagreement with emily_PDX. One condition attached. Concentration choice is a precision decision, not a preference. Reconstitute high and every dose is a tiny volume where one unit of syringe error is a large fraction of the dose. Reconstitute low and you get more graduations per dose, so the same hand tremor costs proportionally less. Against that, more diluent means more benzyl alcohol and a shorter comfortable in-use window.

Correct me if the detail matters more than I have assumed.

Last edited: Oct 7, 2024 at 2:08 AM
38 8Dr.GutHealth, amsterdam_pete, LondonLisa and 35 others
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labquiet_amy
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Oct 6, 2024 at 11:54 PM#3
emily_PDX said:
Do it in two steps and it stops being confusing.

I am going to disagree with reconstituting low as a general rule. More diluent, more punctures, more in-use days at room temperature, and the stability trade-off is real. Precision is not the only variable being optimised.

Last edited: Oct 7, 2024 at 1:54 AM
37 7LibrarianMeg, bri_stats, pete_manc_UK and 34 others
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Dr.PeteFamMed
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Oct 7, 2024 at 12:40 AM#4

Answering the narrow version, because the broad one does not have a single answer. Dead space is the answer to the missing dose. A fixed-needle insulin syringe holds a few microlitres in the hub and needle after the plunger bottoms out, and on small draws that is a measurable percentage of every dose. Across ten draws it adds up to most of an eleventh, which is exactly the "nine draws from a ten-dose vial" complaint. Luer-lock syringes are worse; low-dead-space fixed-needle designs are better.

36 6Dr.BariatricHTX, LindaRN_retired, tommy_boulder and 33 others
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DerekSJ_a1c
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Oct 7, 2024 at 5:00 AM#5
PharmacoVig_BOS said:
Concentration choice is a precision decision, not a preference.

Mine went the same way, slower.

Last edited: Oct 7, 2024 at 10:00 AM
35 5AttorneyGrant, DebRD_ATL, KristenIndy and 32 others
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