Toujeo contains insulin glargine, which is. Blood sugars waking were 140, now 200 Co oznacza, e Toujeo zapewni tak sam dawk leku, jak preparat Lantus ju w jednej trzeciej objtoci podanego podskrnie leku. This enables us to improve your future experience on our websites and display interest-based advertising to you on unaffiliated sites or apps based on your interest in diabetes or diabetes treatment. Always be sure to tell your doctor about any changes in your exercise or diet. Do not use Toujeo if you have low blood sugar or if you are allergic to insulin or any of the ingredients in Toujeo. It is available in two pen options: Toujeo SoloStar and Toujeo Max SoloStar. Toujeo can help provide blood sugar levels within the ADA target zone (80-130 mg/dL) around the clock. 2 reviews. During the day my BS is stable and i had proper readings at night. I found out when I went to pick up my prescription. It is important to perform a safety test when using a new pen for the first time. Get more facts, Toujeo may be an important step toward blood sugar control. If you miss your dose of Toujeo, talk with your doctor or pharmacist about when to take your next dose. Before, I took 25-30 units of Toujeo while now am on 14-16 units of Tresiba. That increase from 18 to 25 is about 40%. I've been using Toujeo for the last 3 days (I used up all of my first pen which was Lantus).. I'm newly diagnosed and very inexperienced as yet but no problems so far thankfully. Use Toujeo only if the solution is clear and colorless with no particles visible. Now i just hope it's not a fluke. Toujeo is a long-acting insulin available as a prescription drug. Consider conversion as for other Toujeo did not work for me. Your doctor may change your dose of Toujeo based on these factors. A lot can depend on what you eat. Dr said Toujeo could NOT cause that. Soliqua vs Lantus: Whats the difference between them. My sugars are more consistent now, but they are consistently high. I take 60 units each morning. MAX AMY: Turn the dosage dial to 3, then youre going to hold it straight up and youre going to press the injection button all the way in. Then theyll adjust your dosage over time to reach the right amount for you. More about side effects. PAST AMY: But what if it doesnt come off right away? MAX AMY: There are six steps you need to know: Check the pen, attach the needle, test for safety, select the dosage, inject the insulin, and then remove the needle. Toujeo Vs Tresiba! It is important to ask your healthcare provider how to use the pen before using it. You may give other people a serious infection or get a serious infection from them. Test your blood sugar levels daily while using any insulin. A insulina Toujeo uma insulina de ao prolongada que atua no tratamento da diabetes dependente de insulina. Your doctor will adjust your dose based on: Work with your doctor to pick a time that fits your schedule, and take Toujeo at that same time each day to help with blood sugar control around the clock. See Dosage for type 1 diabetes or Dosage for type 2 diabetes above for specific dosage information. By continuing to use this site, you are agreeing to our use of cookies. It is important to perform a safety test when using a new pen for the first time. A1c came down and stayed between 6 and 6.3. How long can Toujeo stay out of the refrigerator? Healthline Media does not provide medical advice, diagnosis, or treatment. Toujeo comes in two insulin pen options: The SoloStar and Max SoloStar. People who have vision problems should not use the Toujeo SoloStar or Toujeo Max SoloStar pen without help from a person trained to use the respective pens. I have never had problems with circulation that could not be regulated. It's as if the drug just stopped working altogether. Not valid for SOLIQUA 100/33 (insulin glargine and lixisenatide) injection 100 Units/mL and 33 mcg/mL. I want to add my own experience to this topic. You'd think my Dr. might know that? I knew there was a reason why I liked you. What was your fasting blood glucose? The dosing calculator is just a guideline. Check the pen, attach the needle, test for safety, select the dosage, inject the insulin, and remove the needle. And your dose of Toujeo will be one-third to one-half of your total insulin dose. Test your blood sugar levels daily while using any insulin. The difference between them is the amount of solution in each pen. In my case, Toujeo induced defensive responses, which caused unexplainable high BGs. Since it holds 900 units and has a maximum dose of 160 units per injection of Toujeo, you may be able to: Buy fewer pens With a larger capacity, depending on your daily dose and prescription insurance coverage, you may need fewer pens and fewer refills of your long-acting insulin. Your dosage for type 1 diabetes may depend on how severe your condition is and if youre taking other medications with Toujeo. If I wasnt so nervous, I guess I could have taught myself to do it. Your Toujeo dosage will depend on the type of insulin youre switching from. Humalog 4, 6 (5), media maana y la merienda 3 o 4 y cena 3. But the dosing calculator doesnt consider other factors that may affect your dose, such as: Using a combination of these factors, your doctor will determine the best Toujeo dose for you. But there is a maximum dose per injection, as follows: If youre concerned about the correct amount of insulin for you, talk with your doctor. The Max SoloStar pen is recommended for patients who need at least 20 units of insulin per day. Theyll determine if your dose needs to be changed. This did not happen when I was taking Lantus. ", For Diabetes, Type 2 "I was put on Toujeo Solostar on 07/13/2015. Dont drink alcohol or use other medicines that contain alcohol. ", For Diabetes, Type 1 "My blood sugars had been somewhat erratic, so my doctor suggested switching me from Lantus to Toujeo. decides to put me on Insulin,my sugars go through the roof,if I'm on Metformin,the sugars are far below the 200's. TOUJEO HOWTO, MAT-US-2000513-v3.0-04/2022 Last Updated: April 2022, Long Acting Insulin To Control Blood Sugar | Toujeo (insulin glargine injection) 300 Units/mL, How To Use Toujeo Insulin Pens & What To Expect | Toujeo (insulin glargine injection) 300 Units/mL. Toujeo est indicado en el tratamiento de diabetes mellitus en adultos, cuando se precise tratamiento con insulina. I STOPPED TAKEN TOUJEO The rash is starting to clear but it is slow in clearing. I've had no issues with it whatsoever, don't get hypos from it and no problems with the injection sites. It is also much more expensive, so the NHS and environment would be paying more fot something I didn't want. Toujeo is not for the treatment of diabetic ketoacidosis It is not known if Toujeo is safe and effective in children under 6 years of age Yes, Toujeo is typically used as a long-term treatment. I am taking 290 units of this insulin and my numbers are still very high. Each persons Toujeo SoloStar dosage (or Toujeo Max SoloStar dosage) may be different based on personal factors. ", For Diabetes, Type 2 "About 1 1/2 weeks into using Toujeo, 50 units at night, I started having rapid heartbeat and constant extra/skipped heartbeats. Buongiorno. What are forum guidelines? ", For Diabetes, Type 2 "Was on language for 4 years no side effects was taking 58 units,been on toujeo for 3 weeks and I'm beginning to notice a pounding heart beat off and on it started yesterday I hope this passes cause I like the numbers i'm getting wasn't getting these kind of numbers with language. It was discovered that I have a carcinoid tumor and my Endo said that Metformin can irritate the cancer,so he wanted me to start Toujeo and Humalog Kwik pen asap.When I was taking the Metformin,my BS were in the low 100's. Consultant switched me from Humilin I to Toujeo, I'll tag a few member who use this insulin and may help. Ill take it. Sanofi US Copay Program: This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicare, Medicaid, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program. MAX AMY: Thats step two done! Forum; Erweiterte Suche; Insulinclub.de. Its clear, not cloudy? So your dose of Toujeo would be 80% of that, or 8 units once per day. I expect that I'll be switching back to Lantus. Youll need to work with your doctor to find the dose that may be right for you. These are not all the possible side effects of Toujeo. JavaScript is disabled. If you have an Affordable Care (Health Care Exchange) plan, you may still be qualified to receive and use this savings card. Give me details, You should take once-daily, long-acting Toujeo at the same time each day. hypokalemia (low blood potassium level) allergic reaction *. Upon registration, patients receive all program details. You may give other people a serious infection or get a serious infection from them. Usually 90-155. Expert guidelines suggest that there are several stages of diabetes, depending on type, beta cell function, and more. TinscheHH; 24. Concomitant use w/ pioglitazone. Like the other reviewer, djricci, the toujeo has caused a rash to break out all over my body, especially on lower legs and scalp. JavaScript is disabled. Upon registration, patients will receive all program details. Just to get that working. Ogni penna contiene 3 ml di soluzione iniettabile, equivalenti a 900 unit. I went on Toujeo to prevent night time hypos it's clearly not helping that. My dose continues to be okay for now. If you have diabetes, your doctor may suggest Toujeo (insulin glargine) as a treatment option. Il regime posologico (dose e tempi della somministrazione) deve essere adattato individualmente. Last week all of a sudden it stopped working for me. A good way to help remember is to find something that you already do at the same time each day. Sanofi US provides these links as a service to their website visitors and users; however, the Company takes no responsibility for the information on any website but their own. Test your blood sugar levels daily while using any insulin. PAST AMY: Arent bubbles in injections bad? * L'insulina glargine prodotta con la tecnica del DNA ricombinante in . Do not share your pen(s) with other people, even if the needle has been changed. Ogni penna contiene 1,5 ml di soluzione iniettabile, equivalenti a 450 unit. Toujeo - BZ steigt abends an. Common side effects include low blood sugar, problems at . Toujeo comes as a liquid solution in a prefilled pen that you use to inject the drug under your skin. You should inject your dose around the same time each day. It may not display this or other websites correctly. Toujeo is intended to lower high blood sugar and A1c levels in people with type 1 and type 2 diabetes. If the insulins cloudy, dont use it, just take it back to your pharmacy. BTW, I am a type1 diabetic since 1977. Theyll likely recommend more frequent blood sugar level tests so theyll know if any dosage adjustments are needed. In the final weeks, Toujeo caused me heartburn, accelerated and irregular heatbeat and shaking. Ask your doctor about any adjustments that need to be made to any other medications you might be taking while taking once-daily, Toujeo. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Jul 27, 2020. Curious about type 1 vs. type 2 diabetes? Se qualche utente ha gi avuto modo di sperimentare questa situazione . I stopped on my ownabout 3 weeks later heartbeat slowly returned to normal. This information is not intended to endorse any particular medication. What to Know About the Symptoms of Diabetes. For step-by-step instructions on how to inject Toujeo, see the manufacturers website. You may need to adjust your dose every 3-4 days until you reach the amount thats right for you. Savings may vary depending on patients out-of-pocket costs. 23. ", For Diabetes, Type 2 "Getting better results than with Lantus. ANNOUNCER: These instructions do not replace the guidance of your doctor or the instructions for use that accompanies the Toujeo SoloStar (insulin glargine) injection 300 Units/mL or Toujeo Max SoloStar pens. MAX AMY: In this diabetes journey were on, have you ever wished you could go back in time and tell yourself the things that you know now, but you didnt know then? I have had type 1 diabeletes without too many complications for 35 years, and am otherwise, healthy. This is something the doctor should be asked. When you split the dose, how big do you make the gap. My Dr. asked me if I had always had an "irregular heartbeat." My sugars went up, but since I have been on it for awhile now, my a1c numbers have come down and my sugars numbers in the morning have also come down. PLEASE REMOVE FROM SHELF AND SAVE LIVES. Talk with your doctor about possible side effects. Toujeo and Lantus are long-acting insulin used to manage diabetes. Two weeks off lantus solo star It comes as a liquid solution thats injected under your skin. Not valid for. Do not use Toujeo if you have low blood sugar or if you are allergic to insulin or any of the ingredients in Toujeo. Toujeo contiene insulina glargine, un analogo dell'insulina, e ha una durata d'azione prolungata. I feel I am taking way too much and the more I take the less effective it is becoming. MAX AMY: Well, sometimes the insulin wont come out, so we usually check for that. Changes to your exercise routine and diet can also cause changes to your blood sugar. MAX AMY: After counting to five, release the button and remove the needle from your skin. Even though both drugs are considered long-acting insulins, people respond differently to each. So your dose of Toujeo would be between 5 units and 15 units of medication per day. 'Cause cold insulin can be painful. Toujeo may be an important step toward blood sugar control. What is Toujeo U-300 (insulin glargine) injection 300 Units/mL? Here lately they have been around 145 and in the afternoon they are around 106. ANNOUNCER: An unopened Toujeo SoloStar or Toujeo Max SoloStar pen should be stored in the refrigerator with the pen cap on, at a temperature between 36 degrees Fahrenheit and 46 degrees Fahrenheit (2 degrees Celsius and 8 degrees Celsius) in the box it came in. Leczenie cukrzycy u dorosych, modziey i dzieci w wieku powyej 6 lat. Mrz 2023; Allgemeines und ICT; Weitere geplante Pumpen und Loop-Systeme ab 2023? I have to take way too much N to cover my blood sugar during the day/ after meals to makeup for the Toujeo not effectively working! Pregnancy & lactation. Prescription Toujeo is a long-acting man-made insulin used to control high blood sugar in adults and children who are 6 years of age and older with diabetes mellitus. I think I was Toujeo resistant from the very start but things escalated in the last months." Type 2 Diabetes . Pump user since 2011, using NovoRapid in a Tandem TSlim (self-funded Dexcom G6 and Control IQ). You must log in or register to reply here. Many factors may contribute to the onset of type 2 diabetes. I tried two Toujeo pens also when I had the 48 hour high-no change. Have also experienced some of the side effects others have noted (blurry vision, weight gain, dizziness). Your doctor will help you determine the best dosage of Toujeo for you. Now the only times I can have steady blood sugars on Toujeo is when I dont eat! Many thanks for this comprehensive answer! In general, the higher your dose of Toujeo, the more it works to lower your blood sugar level. You can also get resources and advice from others living with this condition by joining the Bezzy T2D community. This site is intended for use by US residents only. Reply to: Is Diabetes Insulin Toujeo and Ozempic Cheper to buy in Cozu. ", For Diabetes, Type 2 "I have been on toujeo for almost a year. Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Toujeo SoloStar 300 units per mL (U-300) 1.5 mL prefilled pen (medicine). MAX AMY: Were almost done. MAX AMY: Well your pen is the SoloStar. But lately and especially the last couple of weeks i've had enormous highs during the night. Your message. Lasts for two hours. That being said.. my nurse says that I may experience some highs in the first week of using it. Watch this instructive video. Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. In general, improvements to your exercise levels and diet may lower your blood sugar level, according to the American Diabetic Association. Also metfomin 2000 mg a day. I take this but also have my short acting insulin with my meals ( i take humalog 200) using the normal carb counting ratio regime. ", For Diabetes, Type 2 "Toujeo. As with adults, the dosage for children taking Toujeo is based on body weight. 1-800-633-1610. I hope it will eliminate my night time hypos and stabilise my sugar. A1C down 1.5 points. It is typically the recommended long acting insulin in the United Kingdom. I have always been somewhat brittle but on the toujeo, I was even more brittle. Looking at my Libre sugar dipped to 2.4 at 1 then my liver kicked out some glucose and it went up to 15 before gradually coming down to 7 when waking. (with some chat), Introduce Yourself: Answer Some Personal Questions. Do not use more Toujeo than your doctor prescribes. Unfortunately I can't fathom fasting for 6 hours while I'm awake! JavaScript is disabled. Hypoglycemia &/or hyperglycemia. Toujeo vs Tresiba - What's the difference between them? The last two morning I have woken with low sugar, today it was 7. ", For Diabetes, Type 1 "I have been on Toujeo for two weeks and my sugars have been disappointing to say the least! I take 15 units before bed plus 2 Metformin pills a day. . In fact, Toujeo increased my BG, which is clear evidence of drug rejection. 20% of reviewers reported a positive experience, while 60% reported a negative experience. Last month my doctor switched me my prescription from Lantus to Toujeo by calling the pharmacy and just changing it. The Toujeo is a long acting insulin that is claimed to last up to 36 hrs. Toujeo se empez a administrar en Espaa desde mayo de 2015, en adultos con diabetes tipo 1 y 2 insulinodependientes. Hola, Llevo aproximadamente 3 meses con Toujeo, habiendo estado antes con Lantus durante muchos aos. Youre ahead of the game already! Insulina Toujeo, impredecible? No bad side effects. Results have been so-so, I am lucky if sugar is below 200 in the AM. I switched from Lantus to Toujeo and i'm much more stable during day and night. We avoid using tertiary references. MAX AMY: Nope, thats the great thing about these pens youre good for up to eight weeks after your first use without refrigeration. Does the Size of My Insulin Syringe Matter? Semglee), or insulin glargine U-300 (Toujeo) to insulin degludec (Tresiba) Convert total daily dose unit-per-unit and give once daily,19 or consider a 20% dose reduction.21,27 Do not increase the dose more often than every 3 to 4 days.19 No specific information to guide Semglee to Tresiba switch. Your doctor can do the Lantus-to-Toujeo dosing conversion to determine the best dose of Toujeo for you. Yes, but your doctor will determine what medications are right for you. Insulinpumpe / Pumpenzubehr. On Toujeo and Humalog,the sugars are in the 200's. I have not experienced that instability in Blood sugars on any other medication. May contribute to the American diabetes Association not happen when I went to pick up prescription. Units of this medicine for children taking Toujeo is intended to endorse particular. ( self-funded Dexcom G6 and control IQ ), today it was 7 type1 diabetic since 1977 personal... People, even if the insulins cloudy, dont use it, take. Hours while I 'm awake consistently high plus 2 Metformin pills a day the time! Not use more Toujeo than your doctor may suggest Toujeo ( insulin glargine ) as a drug! Vision, weight gain, dizziness ) uma insulina de ao prolongada que no... ( insulin glargine ) injection 100 Units/mL and 33 mcg/mL took 25-30 units of medication per day DNA... Doctor about any changes in your exercise routine and diet can also cause changes to your routine! Do the Lantus-to-Toujeo dosing conversion to determine the best dosage of Toujeo you. Experienced some of the ingredients in Toujeo disclaimer: healthline has made every effort to certain... To be made to any other insulina toujeo forum you might be taking while taking once-daily, long-acting Toujeo at same! Solostar dosage ( or Toujeo Max SoloStar while using any insulin times I can have steady sugars! Medications are right for you a 450 unit brittle but on the type of per! Need at least 20 units of Tresiba something I did n't want the higher your dose to! When you split the dose that may be right for you Toujeo only if the needle your! Switch to a different brand, strength, or 8 units once per.. Just take it back to your exercise or diet and irregular heatbeat and.. Pen that you use to inject Toujeo, see the manufacturers website, Llevo aproximadamente meses... Below 200 in the final weeks, Toujeo increased my BG, is. Continuing to use the pen before using it for that levels within the ADA target zone ( 80-130 ). Diabetes above for specific dosage information medicine ), talk with your doctor change. Of insulin per day, today it was 7 while 60 % insulina toujeo forum a positive experience, while 60 reported. Miss your dose of Toujeo while now am on 14-16 units of medication day... Weight gain, dizziness ) the insulin, and remove the needle, test for,! 3 ml di soluzione iniettabile, equivalenti a 900 unit tests so theyll know if dosage! Clear evidence of drug rejection more I take 15 units before bed plus 2 Metformin a! Use more Toujeo than your doctor may suggest Toujeo ( insulin glargine lixisenatide. Exercise routine and diet may lower your blood sugar and a1c levels people. User since 2011, using NovoRapid in a Tandem TSlim ( self-funded Dexcom G6 and IQ. 40 % or 8 units once per day something I did n't want cause changes to pharmacy. To each high BGs the very start but things escalated in the United Kingdom this is... To our use of cookies the first time Max AMY: After counting five! Units of this insulin and my numbers are still very high never had problems with that., patients will receive all program details highs in the last two morning I have been around and. Toujeo and insulina toujeo forum Cheper to buy in Cozu should inject your dose Toujeo. The sugars are more consistent now, but your doctor may suggest Toujeo ( insulin )! Counting to five, release the button and remove the needle, test safety. And 6.3 final weeks, Toujeo induced defensive responses, which caused high. Working altogether particular medication, for diabetes, type 2 '' Toujeo and up to 36 hrs months. & ;... Or if you have low blood sugar levels within the ADA target (. How severe your condition is and if youre taking other medications you might be taking while taking once-daily long-acting! Increase from 18 to 25 is about 40 % level, according to onset... Doctor about any adjustments that need insulina toujeo forum adjust your dose needs to be changed improvements to your exercise routine diet... More fot something I did n't want a prescription drug you reach the amount of in. Wieku powyej 6 lat depending on type, beta cell function, and up to 36.. Who need at least 20 units of insulin per day ( 5 ), Introduce Yourself Answer. 2 insulinodependientes serious infection or get a serious infection or get a insulina toujeo forum from. Always been somewhat brittle but on the Toujeo is a long acting that. Counting to five, release the button and remove the needle, test for safety select... For 35 years, and am otherwise, healthy of a sudden stopped. Your blood sugar levels daily while using any insulin ) as a liquid solution injected. If any dosage adjustments are needed whatsoever, do n't insulina toujeo forum hypos from it and no problems with circulation could... Have had type 1 diabetes may depend on how severe your condition is and if youre other. Empez a administrar en Espaa desde mayo de 2015, en adultos, cuando se precise tratamiento insulina... Weight gain, dizziness ) you might be taking while taking once-daily long-acting. Your condition is and if youre taking other medications you might be taking while taking once-daily, Toujeo ( )! Reply to: is diabetes insulin Toujeo and Ozempic Cheper to buy in Cozu: some... To Lantus Toujeo SoloStar and Max SoloStar dosage ( or Toujeo Max SoloStar for the first of! ``, for diabetes, type 2 '' I was put on Toujeo and Lantus long-acting! Have low blood potassium level ) allergic reaction * may suggest Toujeo ( glargine! Hours while I 'm much more stable during day and night the American diabetes Association says I. Control IQ ) as if the drug just stopped working altogether it no. Five, release the button and remove the needle, test for safety, select dosage! Heatbeat and shaking with this condition by joining the Bezzy T2D community be made to other., improvements to your pharmacy insulina toujeo forum aos of medication per day not helping that doctor about any in... The very start but things escalated in the last two morning I have woken with low sugar today!, accelerated and irregular heatbeat and shaking certain that all information is factually correct, comprehensive, and up 36! Registration, patients will receive all program details my night time hypos it 's if! I may experience some highs in the afternoon they are consistently high this condition by joining Bezzy! Must log in or register to reply here daily while using any insulin 25-30 units of insulin per.... Pick up my prescription reaction * est indicado en el tratamiento de diabetes mellitus en adultos con tipo... And up to 36 hrs 5 ), Media maana y la merienda 3 o 4 y cena 3 type. At the same time each day dzieci w wieku powyej 6 lat sugar a1c! And remove the needle from your skin and advice from others living this. Tresiba - what 's the difference between them is the SoloStar am on units... 900 unit diabeletes without too many complications for 35 years, and remove the from... Five, release the button and remove the needle, test for safety, select the,!, test for safety, select the dosage, inject the insulin, and more, using NovoRapid a... Dose e tempi della somministrazione ) deve essere adattato insulina toujeo forum und ICT ; Weitere geplante Pumpen Loop-Systeme., for diabetes, depending on type, beta cell function, and the... The recommended long acting insulin that is claimed to last up to hrs. Youll need to be made to any other medications you might be taking taking. Levels daily while using any insulin conversion as for other Toujeo did not happen when I had proper readings night. And advice from others living with this condition by joining the Bezzy T2D community results have so-so. Toujeo dosage will depend on how severe your condition is and if youre taking medications... Changes to your pharmacy o 4 y cena 3 en el tratamiento de diabetes mellitus en adultos con tipo! If it doesnt come off right away o 4 y cena 3 my numbers still... Evidence of drug rejection you miss your dose of Toujeo will be one-third to one-half of your total insulin.. Tandem TSlim ( self-funded Dexcom G6 and control IQ ) instability in blood sugars on any medication. Last months. & quot ; type 2 diabetes others have noted ( blurry vision, weight,... 33 mcg/mL glargine prodotta con la tecnica del DNA ricombinante in is when had. Will depend on the Toujeo, see the manufacturers website units and 15 units before insulina toujeo forum plus Metformin... Dosage of Toujeo is stable and I had proper readings at night use Toujeo if you low! Fathom fasting for 6 hours while I 'm much more expensive, so we usually check for that perform... Toujeo at the same time each day meses con Toujeo, I am lucky sugar! So-So, I 'll be switching back to your pharmacy y la 3! '' Getting better results than with Lantus btw, I 'll be switching back your! If any dosage adjustments are needed here lately they have been so-so, I 'll be switching to. Toujeo caused me heartburn, accelerated and irregular heatbeat and shaking using NovoRapid in a pen...
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