Insulin Oddities...

[Dewey]

In the past, I made a post about Novolog "gelling" up (but couldn't get a good enough pic to show it). Well, it's been happening again (have had several bottles "gel" up after so many days). I called the endo today to see about possibly switching back to Humalog and getting the script filled at a local pharmacy. In the past, I had switched from Humalog to Novolog because the mail order insulin I was getting through insurance seemed to lose potency in transit (possibly due to sitting out in warm conditions, etc.).

Thing is, the old bottle of Humalog that I still have (over two years old, had been opened & half used), is still in liquid form (as insulin should always be!).

The endo did comment that vials could get contaminated, but that would usually only occur from mixing insulins. Both he & his nurse are baffled as to why this is happening and want me to bring a couple of the "gelled" vials in.

Another insulin "oddity" I've been experiencing lately, is that I sometimes get or have the taste of insulin in my mouth/throat. Not sure why this is happening, but I've found that to be a little odd. :s: Maybe it's just all those years of "shooting up insulin." (jk)

[kgm0612]

I've never had a problem with my Novolog gelling up. I keep my unopened vials of insulin refrigerated. I then take one vial out and leave it at room temp until it's empty, which is within 3weeks of opening it.

Hope you figure out what's causing this "gelling" to happen, Dewey.

Karen

[shockme]

that's so weird-insulin gelling up!btw-exactly what does insulin taste like?trish

[notme]

Ewwwww...... If it taste like is smells it is GROSS!

That is so weird Dew. Have you called the manufacturer? I would want to know why too. :confused:

[Dewey]

that's so weird-insulin gelling up!btw-exactly what does insulin taste like?trish
It is weird & I'm actually looking at one of the gelled vials. The insulin taste I sometimes get tastes odd, lol....and yes, it does taste like it smells, lol!

Ewwwww...... If it taste like is smells it is GROSS!

That is so weird Dew. Have you called the manufacturer? I would want to know why too. :confused:
I haven't called the manufacturer yet, since I'm going to take a couple of the vials to the endo. It could be due to the fact that I "recycle" insulin into empty vials, but still....the only thing I do is put unused insulin into the vial, so I'm not mixing anything & don't see how that should cause contamination (to the point of it gelling). I've even thought about air as a factor (too much air in the vial causing an issue, but I always try to release any excess pressure), and have even wondered if perhaps the silicon in the syringe isn't the culprit? If silicon is the case, then what's it doing to the inside of my body (the insulin likely breaks down rapidly enough to where that won't happen inside, but still!)!? :eek: I've thought about numerous possibilities, but none of them really warrant this, & others haven't had similar situations.

After thinking on all of this, going back to Humalog may be the best idea yet...:s:

[LancetChick]

When I was first diagnosed, I was told not to shake insulin or expose it to heat because as a protein, insulin can change character much like eggwhites. I'm not sure if you could actually make a meringue out of insulin, but I was told it can solidify.

[Cyborg]

Is your fridge too cold?

[BriOnH]

Is your fridge too cold?

I have been trying to reproduce the gel incident and never thought of that. Doh. That question makes a lot of sense.

Does your lettuce / veggies freeze up at all Dew?

If I remember the pick right it showed pretty clearly it was Gel imho. Also if I remember right you let it sit out so I would imagine it should thaw.

[Dewey]

When I was first diagnosed, I was told not to shake insulin or expose it to heat because as a protein, insulin can change character much like eggwhites. I'm not sure if you could actually make a meringue out of insulin, but I was told it can solidify.
I haven't shaken any of the bottles. A couple of the bottles (2, the third one was in my purse) had been sitting out and hadn't been moved in a while. The ones that were sitting out were in normal room temperatures (i.e. anywhere from 70 - 75 degrees or so).

Is your fridge too cold?

I have been trying to reproduce the gel incident and never thought of that. Doh. That question makes a lot of sense.

Does your lettuce / veggies freeze up at all Dew?

If I remember the pick right it showed pretty clearly it was Gel imho. Also if I remember right you let it sit out so I would imagine it should thaw.
Though Cyborg raised a good point, I don't think the fridge is causing the problem. My veggies seem to do fine (no frost on them) and hubby (a looong while back) had even turned the fridge down.
The problem with that theory is that both insulin that I have in the fridge & out of it has become "gelled." In other words, it happens, regardless of whether the insulin is refrigerated or not, but does not happen to all vials (just some of them). I just gave my endo's office 2 bottles (gave him a total of 4) that had been in this condition for weeks/months without being moved or put in the fridge at all (the 3rd one was in my purse & the 4th one was refrigerated). One of the worst ones was one that was not refrigerated. Talk about strange! :s:

[ant hill]

The mail order insulin I was getting through insurance seemed to lose potency in transit (possibly due to sitting out in warm conditions, etc.).
I'd like to ask questions on the delivery of your insulin Dewey.
As i know that these people don't care what's in these pakages whether they are delicate or not and you lucky people are entering the summer soon and that the insulin should be kept cold and out of the light!!. You may be doing the right thing buy keeping it in the fridge but are they?? :confused:

[BriOnH]

Does your endo have any theories? I think it's a pretty safe assumption this is happening to others as well. Probably not a bad idea to save a gelled vial as well.

We will get to the bottom of the gelled insulin!

I wonder if it can be used as a gel somehow.

[Dewey]

I'd like to ask questions on the delivery of your insulin Dewey.
As i know that these people don't care what's in these pakages whether they are delicate or not and you lucky people are entering the summer soon and that the insulin should be kept cold and out of the light!!. You may be doing the right thing buy keeping it in the fridge but are they?? :confused:
You raise a good point, Peter. I'm not sure if the mail order folks are doing the right things (i.e. prior to delivery), but when the insulin arrives, it is cool & when opened, it's still in liquid form. That said, there's still a possibility that they're not storing it properly at the originating facility, and this could lead to the "gelling" once the bottles are opened? Not sure, but it's definitely a good thought!

Does your endo have any theories? I think it's a pretty safe assumption this is happening to others as well. Probably not a bad idea to save a gelled vial as well.

We will get to the bottom of the gelled insulin!

I wonder if it can be used as a gel somehow.
I haven't yet heard from the endo, but will be calling him shortly to find out if he knows why this is happening.

[Dewey]

Ok, I Hate to double post, but my endo's office called back (shortly after I called) & said that the bottles were indeed from the same lot number. I think someone may have mentioned that in the earlier thread (http://www.diabetesforums.com/forum/type-1/14337-insulin-looks-like-gel.html) (or someone from my endo's office may have asked that), but I think I misread the bottle numbers (or looked at the wrong ones, lol :stupido2: ).

My endocrinologist & his nurse didn't understand why the insulin had "gelled up" either, but contacted the manufacturer and filled out an incident report.

The Novolog rep. is supposed to come by Monday to look at the vials (I also imagine he will send them back to the manufacturer). As Brian said, I held on to one of the vials that had gelled. Hopefully, we'll learn more about this "gellish" incident sometime next week.

If nothing else, it's good that the company is aware that something funky happened.

[shockme]

so hopefully soon we will learn why this happened!trish

[ant hill]

Ok, I Hate to double post, but my endo's office called back (shortly after I called) & said that the bottles were indeed from the same lot number. I think someone may have mentioned that in the earlier thread (http://www.diabetesforums.com/forum/type-1/14337-insulin-looks-like-gel.html) (or someone from my endo's office may have asked that), but I think I misread the bottle numbers (or looked at the wrong ones, lol :stupido2: ).

Hey Dewey, You have the manufacturer's on the run. :T

[Dewey]

Hey Dewey, You have the manufacturer's on the run. :T

LOL, it sure sounds like it, huh? ;)

To echo Bryan42 in another thread (http://www.diabetesforums.com/forum/dieting/19107-my-pet-fat.html) & as said to Cin earlier.....Guess (like those dopey commercials) I can say I (or in this case the insulin) was "Gellin' like a felon!" (Sorry, couldn't help it). :rofl:

[BriOnH]

Gellin like a [diabetic] fellon. Rub some gelllon on and eat some mellon, fellon.

[ant hill]

was "Gellin' like a felon!" (Sorry, couldn't help it). :rofl:

LOL Dewey, You make me laugh.:hahaha: :T

[Lynne59]

I am on Lantus, Humalog and Humlin N and always keep them in the fridge. When I go out I carry a cooler with me that keeps my insulin cold. I don't think refrigeration is the problem. Do you use different needles to draw a shot? I know some can't be mixed with Lantus.

[JasonJayhawk]

Here's my theory... You can create a gel-like vial of Novolog by introducing ("seeding") an insulin crystal into the vial. One would hope that the low pH of the vial to prevent the gelling to occur, but once a crystal of an insulin protein has formed, it creates a seed for more crystalization.

Could previously-used syringes have been used to introduce an insulin seed, Dewey? Maybe you could get a job working for an x-ray crystallographer's lab. hee hee.

That's just my guess!

Like what LancetChick said, the protein is becoming damaged somehow.

[Dewey]

I am on Lantus, Humalog and Humlin N and always keep them in the fridge. When I go out I carry a cooler with me that keeps my insulin cold. I don't think refrigeration is the problem. Do you use different needles to draw a shot? I know some can't be mixed with Lantus.
I'm on the pump, so I only use one type of insulin. I do use the same needle on my reservoir to refill the reservoir sometimes, but not every time.

Here's my theory... You can create a gel-like vial of Novolog by introducing ("seeding") an insulin crystal into the vial. One would hope that the low pH of the vial to prevent the gelling to occur, but once a crystal of an insulin protein has formed, it creates a seed for more crystalization.

Could previously-used syringes have been used to introduce an insulin seed, Dewey? Maybe you could get a job working for an x-ray crystallographer's lab. hee hee.

That's just my guess!

Like what LancetChick said, the protein is becoming damaged somehow.
Jason, you may be right. I've used previously used syringes at times to draw more insulin from the vials, and I usually push air into the bottle to help replace the volume removed. It is very possible that a crystal was introduced. That said, why was it that only one batch of the insulin has had this issue, and not all of the batches?

Another thought (that others have mentioned) is that it could be due to heat. The mail order people I get insulin from have been known to have issues regarding Humalog & its potency (due to storage and/or transit issues). I may be digging for theories, but I also even thought about the possibility that the silicon/e in the reservoirs was somehow reacting with the insulin (but that theory gets blown away by the fact that it only happened to one batch of insulin).

Novo-Nordisk sent me a self-addressed package to send the gelled vials of insulin in. They had me send it to their safety dept., so they could review it under a microscope & try to figure out just what happened (& why).

I will be calling them some time either tomorrow or Monday to see if they've found the reason behind this. I find this all very intriguing and, if nothing else, maybe it can help others prevent issues from occurring. I'm still strongly considering going back to Humalog. While the old vial I have is not a potent one (it's over two years old), it's still in liquid form. I'd prefer to use insulin that won't gel up, whether in the vial or in me. :ahhhhh:

[jimbob]

Ah just spread it on some toast and enjoy! Maybe a new way to treat Type 2's?

[Dewey]

Well, I think I may have gotten to the bottom of this mystery myself.

I called Novo-Nordisk the other day, and they said they'd have their safety dept. contact me in a couple of days. In the meantime, I took a vial out of my little black "fanny pack" purse (I had forgotten it was in there).

When Carwy & I arrived in Vegas, we couldn't check into our room right away. We decided to go for a ride & I had my purse on my side....due to the sun & heat in Vegas, my purse got quite hot to the touch. :s: I moved it over to my other side (in the shade), but not before it affected a couple of things (i.e. a couple of alcohol swabs, etc.): one of which was my insulin vial. I now have the gelled vial of insulin sitting on my desk. I can't say for sure exactly what temp. Novolog "gels" at, but can say that it was over 105 degrees Fahrenheit in Vegas (when this apparently happened).

That said, it still doesn't necessarily explain why the other vials gelled as they did (as they weren't in high heats in my apartment)...One thing though - I think they're shipped from Vegas, so is it possible there's an issue in transit? Not sure, but when they arrive, the cold packs with them are usually still cold. :s:

Hopefully, the safety dept. will call back in a few days & give me more info. on why & what exactly happened to the vials I sent in.

Just thought everyone would like an update. :) I'll provide a couple of pics of this vial that's gelled:

http://i22.photobucket.com/albums/b325/Dewey_B/GelledClearpic.jpg?t=1183693399http://i22.photobucket.com/albums/b325/Dewey_B/GelledClearpic3.jpg?t=1183693433
http://i22.photobucket.com/albums/b325/Dewey_B/GelledClearpic2.jpg?t=1183693468