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c/reconstitution·posted 2 years ago by u/gradient_goblin

insulin syringe is the most under-discussed thing on this board

Discussion Well Actually ×5 Slow Clap ×3 Cold Box ×1

insulin syringe is the most under-discussed thing on this board. Making the case below, and I expect to lose some of it in the comments.

Bacteriostatic water contains benzyl alcohol as a preservative, which is what makes repeated entry into the same vial reasonable. Plain sterile water has no preservative.

Adding more water does not change how much peptide is in the vial. It changes the concentration, which changes the volume you draw for the same amount. That is the entire relationship.

The arithmetic in full: concentration is mass over volume, so 30mg into 2mL gives 15mg/mL. A U-100 syringe is graduated at 100 units per millilitre, so 0.75mg is 0.75 divided by 15 millilitres, which is 5 units.

That is everything I have. The rest is opinion and I have tried to keep it out.

5,428 up / 989 down85% upvoted52 commentsid kv9qbv10 Jul 2024

52 comments

30 in this archive, depth 6

best — the order this archive was captured in

u/hub_opssite staff546 points·2 years ago

Aim the stream down the wall of the vial rather than into the cake. Reconstitution is a solubility problem, not a mixing problem, and mechanical shear does nothing helpful.

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u/RetaAndRegret20 points·2 years ago

Agreed on the swirl. There is no reason to shake it and a good reason not to.

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u/ahmed_rasmussen1 point·2 years ago

Started reconstituting everything to a round concentration and the six-in-the-morning error rate went to zero.

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[deleted]1 point·2 years ago

[deleted]

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u/quarter_dose_queenlow and slow1 point·2 years ago

bacteriostatic water has the preservative, sterile water does not

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u/alcohol_aversion1 point·2 years ago

more water is not more drug, it is the same drug in a bigger volume

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u/declared_value_dv1 point·2 years ago

What is written on the vial right now?

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u/sofia_danquah260 points·2 years ago

Are you accounting for the powder volume, or is that where the confusion is?

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u/swirl_dont_shakereconstitution205 points·2 years ago

The lyophilised cake displaces a small volume, so the true concentration is very slightly lower than the arithmetic suggests. It is a fraction of a percent and it is dwarfed by fill tolerance.

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u/marta_weiss0 points·2 years ago

Pushback on the syringe advice: a U-100 barrel reads units of volume. Calling them "doses" is how the confusion starts.

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u/ruben_cabrera124 points·2 years ago

How many mg in the vial and how many mL are you adding?

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u/rosa_mensah59 points·2 years ago

That only works if the fill weight is exactly the label weight, and it usually is not exactly anything.

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u/gradient_goblinOP0 points·2 years ago

Bacteriostatic or plain sterile water?

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u/alcohol_aversion102 points·2 years ago

I keep a laminated card in the drawer with the arithmetic on it. Looks ridiculous. Has never once let me draw the wrong volume.

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u/aurel_boateng61 points·2 years ago

The dead space question sent me down a rabbit hole for a week. It is a fraction of a unit and it is the same every draw.

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u/arne_restrepo78 points·2 years ago

If your calculation produces a fraction of a unit, the concentration is wrong for your dose. Change the water volume until the numbers land on whole units.

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u/elodie_grimaldi92 points·2 years ago

Spent 20 weeks confused about this until somebody drew the table for me. 20mg, 1mL, 20mg/mL, 2mg is 10 units. That is the whole thing.

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u/quiet_reader_9928 points·2 years ago

if the maths gives you a fraction of a unit, change the concentration

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u/britta_nakamura35 points·2 years ago

label the vial with the date as well as the concentration

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u/sleep_apnea_sam23 points·2 years ago

Correction: that gives 20 units, not what you have written. 5mg into 1mL is 5mg/mL and the division follows from there.

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u/yusuf_nakamura27 points·2 years ago

I would not round that figure. At 1.67mg/mL a rounding error of two units is a real fraction of the intended amount.

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u/zaid_balogun19 points·2 years ago

Disagree with the "more water is safer" framing. It is not safer, it is just a different number to divide by.

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u/a1c_arcT2D27 points·2 years ago

This. Showing the working is the fastest way for somebody else to spot the mistake.

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u/india_generic_g54 points·2 years ago

Not quite. Bacteriostatic and sterile water are not interchangeable for a multi-draw vial, and the difference is the preservative.

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u/janek_ferrari15 points·2 years ago

Research-use-only material is not approved for human use, so treat everything in this thread as arithmetic about solutions rather than instructions for a person.

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u/gradient_goblinOP61 points·2 years ago

Is that a U-100 syringe? The barrel markings change the answer completely.

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u/freya_onwuka13 points·2 years ago

dead space in the needle hub is real and it is small

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About c/reconstitution

The arithmetic and the technique. Bacteriostatic versus sterile water, reconstitution volume as a concentration choice, converting mg/mL into insulin-syringe units, dead space, swirl-not-shake, stopper coring, and how long a reconstituted vial is actually good for. Math errors get corrected fast and politely.

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