Insulin "frying" in my pump.

[Mich]

Criminy! Is it just me? I've posted about this before and folks reply with tales of wearing their pumps full of perfectly good insulin for five days on the beach, in the desert and through all kinds of weather.

In the last two weeks my insulin has lost it's effectiveness THREE times before the 3 day mark. I'm always incredulous that it's true and go slowly on my conclusion. It usually takes me a while to discover it. When I keep going up up up, even without eating, I go through the list:
----Did I snack and forget that I did it?
----Am I getting sick or have an infection?
----Is my set working?
---- Is my tubing OK?
-----Am I in pain, is something stressing me?

I correct using a syringe, and watch my sugar climb again. The infusion is not working. My insulin has denatured. It's WATER!

An early set change with new insulin fixes it.

This happens in all-day heat of over 80 degrees.

I'm wearing my frio on my belt loop with my pump and tuving coiled up inside, upside down (to save the Cozmonitor) like I do when desert camping. It's cumbersome, but it works.

Those of you where it's hot, does anyone else EVER experience this? Am I doing something wrong? (I keep my pump in the shade and in my pocket.)

Mich

[notme]

I never experience this Mich. Something is not right. I wear my pump for at least four days with no change in the insulin from the day I put it in. I don't wear a frio and don't have a pump cover. I also live in California, Mich and it is hot all the time. Are you outside most of the day?

Something is not right with this........ I don't even know what to advise.

[Subby]

Mich, twice I have gotten insulin from the chemist that, through carefully testing and thinking much like you have, I have concluded strongly was a bad batch.

Once, I got it as I went on a camping trip way out on the bush. As soon as I used a vial for more than half a day out of the cold chest, (and yes the weather was quite hot), my BG just climbed and climbed (and I felt insulin deprived, I imagine you know the feeling, even if BG levels are not drastic).

What a horrible camping trip that was. At some stage I got into town, bought a new batch and things were back to normal.

This happened to me again earlier this year. The batch of insulin I brought simply did not perform consistently. I bought another batch from another chemist, all was fine. I tried another vial from the first batch: all was not fine.

My only theory about why that happened for me each time was that it had been left in the warm somewhere in the supply chain and was near the end of its' stable life. Now, one pharmacy was somewhere I would not be surprised if a pharmacy assistant left it sitting out the back for a few weeks in the warm under a counter or something, and put it back in the fridge not mentioning it. The other place, the thought is more of a surprise.

Guess I'm suggesting you get another supply of insulin, if you haven't tried that yet. Although, it sounds like this is a long standing issue for you? Maybe something subtle does occur with the levels in the insulin with getting warmer, that doesn't affect most people, but your body is different...

[Subby]

I correct using a syringe, and watch my sugar climb again. The infusion is not working. My insulin has denatured. It's WATER!

An early set change with new insulin fixes it.


Just thinking about this more... where did the syringe correction insulin come from - the fridge or are you carrying other insulin?

You may be able to resolve whether it is the pump insulin or something else (set/site etc) by next time correcting by shot, but drawing from the seemingly ineffective reservoir, and seeing if it works.

[Doug]

Living in Texas Ive never had that expereince while wearing the pump

Once or twice I took the pump off and it got too hot in storage in car or on boat - but never while it was on me

As was suggested try injecting from the cartridge to test the insulin - or alternatively do what I do - change the site

Ive found that after 4 years of pumping my sites dont last more than 2 days now - I was told to use new territory for the sites and have been and it didnt help ... Something else is going on - so first thing I do is change the site ( using same cartridge and tubing ) and correct then see what happpens - 90% of the time it fixes the issue

[butterflykisses]

I have also had a bad batch of insulin where it would initially work, but then gradually over the next day or so, my BG would start rising. I have also had sets that were the problem. It seems sometimes the site just gets more irritated, probably in a place that gets moved a lot? And I wonder if just the irritation itself causes some inflammation that causes problems with absorption? Changing the site, not the insulin cartridge, solves the problem. I have also suspected bad batches of infusion sets...but?

[poodlebone]

I'm not in an extremely hot climate but even when we do have 90+ degree days I have no issues with insulin. I fill my 300 unit reservoir completely and use it until it's empty, at least a week, often up to 10 days. The open vial is in my bag, no Frio pack or anything. I do keep the pump & tubing under clothing as much as possible when outside.

[butterflykisses]

My only theory about why that happened for me each time was that it had been left in the warm somewhere in the supply chain and was near the end of its' stable life. Now, one pharmacy was somewhere I would not be surprised if a pharmacy assistant left it sitting out the back for a few weeks in the warm under a counter or something, and put it back in the fridge not mentioning it. The other place, the thought is more of a surprise.



That reminds me of an experience at Walmart picking up insulin. There have been many times when I went to pick it up that it was hanging outside with the rest of the pills and unrefrigerated prescriptions. Since I was picking it up within hours of ordering it I wasn't really concerned. But then one time I ordered it meaning to pick it up and circumstances prevented me from getting there to pick it up...for almost a week. sure enough, they pull it from the rack instead of out of the fridge. I was irritated and asked the tech "isn't that supposed to stay refrigerated until opened?" She didn't say anything, went and got the pharmacist who says "it's fine, it's just a month supply, right? You'll use it within a month, so it should be fine." and then goes on to say "it doesn't really need to be refrigerated, they don't even ship it refrigerated"!!! I transferred to another pharmacy after that.

[Mich]

Thanks to all of you.

Subby and Butterfly's experiences made me think It could be that this is an improperly stored batch of insulin, all of my problems were from the same two bottles that were one month's supply.

The suggestion that it could be my site and not my insulin never entered my mind. If this is the case, it just began happening after 3.5 years, but I'll look into it since that's about where Doug is in his pumping history. I thought all I had to look out for was bent cannulas and such. Sheesh.

I want my pump to work like Liz's and Nancy's!

Thanks again, all.

Mich

[SCC]

My .02 is that if I'm playing a busy golf time (two days on a weekend), and out on the hot summertime course for 5+ hours (northern virginia is totally pathetic that way....) that on the third day, the insulin seems weaker - only sometimes. And I am saying HOT - for example two 95 degree days in a row.

Hope you solve it and let us know :) Good to be prepared!

[Cluck]

I'm reading this thread with interest because I am considering starting the pump.

I can't work out whether or not those who are saying that their insulin becomes ineffective are outside in the heat all the time and those whose insulin remains ok, go outside occasionally but are otherwise indoors.

This is quite important for me because I am outside in the heat all summer long and outside in the freezing cold all winter. In both cases for up to 6 hours at a time, with brief trips inside. I'm wondering if I am going to have similar problems.

[poodlebone]

I'm indoors most of the time. I do go out for a walk after lunch every day for about an hour and spend a lot of time in the sun. I make sure to keep my pump & tubing out of the sun, covered by clothing. I think the temperature would be less of an issue in the winter when you can keep it covered up even more, especially if you also clip it inside a pocket.

[JJM335]

Since you are changing your set as well as your reservoir, have you considered the possibility that the problem may be with the set?

I now change my sets every 2 days, because I cannot reliably get a third day without my Bg's climbing rapidly on day 3. I also find that sets left in for 2 days leave a small red dot that fades in about a week, whereas those left in for a third day leave a big red bump that is still visible after a month. I change my reservoirs when they run out, usually after about three and a half days, so I know that the problem on the third day is the set.

Joel

[Mich]

Thanks, Joel. I'm beginning to suspect my sites.

On the first three failures, I was in 85+ degrees for most of the days, only cooling down to high 70's in the evening. The actual insulin bottle was refrigerated. When I got home, I had another bottle of the same batch, I decided to go get my next month's insulin as soon as the insurance company would let me.

The first set with the new batch began to weaken the 3rd day. I keep my pump in my pocket and my tubing under my clothing on the shady side of my body. Yes, it was hot, but remember, this has not consistantly happened in 3.5 years of pumping--until now. And I have had itchy sites I had to move and one really badly infected site when Coastal Eddie was a kitten and chewed my tubing.

I suspect I need to use more skin. It seems like I need to wait a month or so before even getting near an old site. I've tried to keep them away from places where I might snag them so I will have to start getting pretty inventive.

If I figure it out, I will share.

Mich

[JJM335]

I suspect I need to use more skin. It seems like I need to wait a month or so before even getting near an old site. I've tried to keep them away from places where I might snag them so I will have to start getting pretty inventive.

Mich

Maybe, but with me, I have always rotated my sites religiously, and anyway it doesn't seem to make a difference where the site is.

The reason that 3 days is the recommended maximum for any site is that preservatives in the insulin can cause an inflammatory reaction at the site - this is what interferes with the efficiency of insulin absorption. CGMS probes don't have any preservatives, which is why you can leave these in for up to 10 days without problems. If you are starting to react more to the preservatives, the location of the site won't make any difference.

Joel

[manatee.h]

Hi Mich,

Similar things do happen on me some times. As I remember, it happens twice or 3 times during my 7-year pump life, and it is back to normal after I changed a bottle of insulin.

Would you check the following to possibilities:

1. Are you always outside in high temperature environment?
2. Do you keep your insulin below 2C degree in the fridge?

[Mich]

Hi & thanks.

This particular time, when the second, third and fourth set changes went bad, I was camping and traveling in very hot weather. Even keeping my pump in the shade didn't help. Normally, our weatner is not that hot.

I keep my insulin (like many with diabetes) in the butter compartment of the fridge, where it stays at a steady temp in the high 30s. (about 2.8)

Mich