Just did my first reconstitution and I think I messed up — anyone have experience?

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.

anders_CPH said:

Dead space is the answer to the missing dose.

That is correct as far as it goes, and here is where it stops going. 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.

Ask again with the specifics and you will get a better answer than this one.

pete_manc_UK said:

I reconstituted a 10mg vial with 2ml of bacteriostatic water and I want someone to check my unit arithmetic before I draw anything, because I keep…

Same position here, arrived at the long way round. 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.

Clinical perspective, offered as context rather than as advice.

Sharing my dosing arithmetic titration experience with compounded semaglutide — I have been tracking injection volumes meticulously:

Using 5mg/2mL concentration with 1cc insulin syringes:

• Month 1: 10 units (0.25mg) — mild appetite reduction
• Month 2: 20 units (0.5mg) — significant appetite suppression
• Month 3: 30 units (0.75mg) — custom intermediate dose
• Month 4: 40 units (1.0mg) — optimal for me, staying here

The beauty of compounded vials is you can do custom intermediate doses. My provider was great about tailoring to my response.