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#1
lecsiy

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Hey guys,

Hope everyone's good and all that :)

My question is how easy is it for insulin to get too hot and then useless? I carry with me an Apidra disposable pen (Pretty average insulin pen for all that don't know) in my front pocket. It stays there all day. Whether it be hot or cold outside. I live in the UK so very sporadic temperature but body temps going to be warming the stuff up. Plus we do have the odd days circa 30 degrees Celsius.

Then say if i'm going clubbing with some friends, again the pen will be sitting in my front pocket. For anyone that hasn't been clubbing it can get very very hot and humid and not very nice so i can imagine its very hot for the insulin in my pocket.

Is this kind off usage most likely damaging my insulin? Is there a way off checking? Specifically for Apidra (If anyone has it) And if so does anyone have any tips on carrying the stuff. I hate having to carry around with me a bag but is that really the only solution? Surely some ingenious diabetic out there has come up with something better?

The reason i ask is because my BS's have been wacky recently and i thought off insulin may be the cause?

Thanks

Alex

#2
Subby

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The first consideration in wondering if this is an issue worth bothering with at all, is how long do you use a pen for? What are your daily Apidra requirements?

The reason is, that if we are talking a pocket life of just a week or so, I think it would take really quite extreme temperatures - more extreme heat than you are talking - to be affecting your insulin. This is based on nothing more than my experience (where a couple of times week of 40c+ days has appeared to reduce my rapid performance - but not provable) and on an extrapolated guess from the guidelines, which state that a month of room temperature (or below about 30c, I think) result in zero or negligible degradation of action. You might want to check that with your pharmaceutical notes. I don't know of anything official that suggests Apidra is different from other rapids with this issue.

All that said, one of the best way to test something is to shake up your habits and observe the difference. You could carry your pen in something that insulates it from temperature extremes and movements for a few weeks, and observe if the evenness of the action improves. If it does - it could still be coincidence and something else, but you would have a theory and a practise to adopt.
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#3
lecsiy

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Hey thanks for your reply.

My average dose of Apidra is about 18 units.

I get through, probably on average, 1 pen every 1 and a half weeks.

:)

**** that's annoying! Now what is causing my crazy BS's!

Haha. The search continues..

#4
Subby

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Well... don't completely discount it. Another possibility is a bad batch from the pharmacy. I have had that occur 2 times in 18 years, where the insulin simply didn't work well from the moment I got it over the counter.

How long have your BGs been crazy? Have you tried just starting a new pen, and seeing if you get at least a couple of days of better action?
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#5
lecsiy

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Yeah they've been crazy for a good few weeks or so. But usually more so (Could very possibly just be in my head though) at the end off the pen rather than the start.

I'v started a new pen today so we'l see how that one pans out. It is good to know that I don't have to carry a bag around with me.

Although i'm going to Turkey on a summer vacation in around a month. Would it be bad idea to keep the insulin in my pocket then?

I was thinking off buying a Frio Pack for the holiday?

What do you think?

Thanks.

#6
Subby

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Well, normally I would say don't worry about it if you are not in really hot temperatures. But I'm assuming Turkey could be warm at this time of year and if you want err on the side of caution, a Frio pack is great for peace of mind (and you can get a pen size one). I love my Frios when travelling. Have fun.
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#7
DeusXM

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Put it this way. I kept insulin pens in my pocket when I lived in the UAE. In summer the temperature easily reaches 50C. Never had a bad batch of insulin.

Keep it out of direct sunlight and you should be fine. If you're going on a beach I would recommend putting insulin in a frio pack and then putting it inside an open bag in the shade.

Insulin should be absolutely fine at least all the way up to 38C or so as otherwise it simply wouldn't work inside your body.

#8
Joeprep4820

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I use an insulin pump, with Humalog. Most of the day I keep the pump in my pocket, which probably traps body heat much more than a shirt pocket or what not. I've never had it go bad or lose effectiveness.
Georgetown University Class of 2008
Edmund A. Walsh School of Foreign Service
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Complication free and keeping it that way
Go Hoyas!

#9
don1942

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My doc advised that insulin in the vial should be good for 30 days at room temperature. I would question your doc or the manufacturer if you think the insulin will be subjected for more than 5 days at temperatures exceeding 35C.
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#10
FirstClass

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Well I live in Turkey and if you are coming somewhere near the sea, then you must be prepared with lots of ice-packs. It is REALLY hot right now and a few weeks later it'll be around 35 degrees on almost all the cities in Turkey.So you should also carry those ice packs with you whole day if you are somewhere near the beach. Once the insulin is left at direct light, it'll get really hot in a few minutes and once it is dead, there is no turning back. ;)

Also make sure that you don't get fooled by any of the tradesman. Turkish people are really smart and cunning so they'll probably rob you for a cheap item where you can buy it much more cheaper in the next street. Make sure you bargain in the small shops. (Markets and other shops like those do not allow any type of bargain.) :)
Type 1 since 12.01.09
Used NovoRapid and Humulin N.
Pumping with Mm 715 with Novorapid

#11
art

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posted before but still a good guide

Insulin Storage - Emergency Medicine - Field and Combat Medicine Classes

Diabetics and Insulin Storage
by Chuck Fenwick

I ran across an article on survival and diabetics written by a nurse. It was what we call a basic brush and floss kind of article that quoted from some well-known medical books. I call it a brush and floss article because it contained mostly information which a diabetic already knows, much like the way a dentist tells you what your mom has told you a bazillion times about brushing your teeth.

However at the end of the article the nurse pretty much consigned type 1 diabetics to doom and even referenced Darwin and the "survival of the fittest". I know in the book, One Second After, the diabetic daughter died because of lack of insulin, but the part in the book about it going bad because of temperature variations is not accurate.

Here’s some information which will be of help to those who use insulin, specifically Humulin. We've been helping with diabetic preparedness for several years and there are some important things which are not common knowledge.



Humulin--unopened--has a shelf-life of at least one year at room temperature. And Humulin can be frozen without ill effects to the user. Lilly won't tell you this, but I know of a type 1 diabetic who froze a year's supply for Y2K.

Her name is Madeline and in 1999 she called me to ask if I knew if insulin could be safely frozen. I told her that I didn’t know, but I would find out. Several of us in Medical Corps started making calls and found out it could. I relayed the good news to Madeline.

I suggested that if she were going to freeze it that she keep a log of her blood sugar test values with un-frozen insulin and then with the frozen insulin. She did and her blood sugar did not vary. In fact, Madeline still practices that type of preparedness with her disease.

As for the Darwin and the natural selection mindset, EMP or not, this country is not the Titanic. There are lifeboats for everyone. As medical people, and for non medical as well, our job is not to pick who gets to live or die simply because we may not know the answer to the problem. Our job is to solve the problem and not bow down to Darwin or "selection" or ignorance.

Diabetics, preemies, old people, retarded children and the like are not mass causalities and a matter of triage. They are just a people problem which can be solved. I do not have the moral right to pronounce doom on the sick or injured. I do have a moral obligation to at least try to solve a problem.

To say that a Type 1 diabetic wouldn’t have a tough time of it if the system collapsed would be untrue, but problems can be solved. People who are insulin dependent or dependent on any medications need to put away extra supplies for treatment and support of their condition. I would not solely count on electronic devices either.

Telemetry has a bad habit of failing, so old fashioned ways of checking blood sugar might not be that old fashioned if we lose telemetry because of an EMP. Keep in mind that there are several other diabetic problems and that there are medications to treat them.

Therefore, it is not just insulin which will be in short supply if the system fails.

These supplies will only be a cushion though if a disaster of the magnitude presented in, One Second After, happens. That cushion will give us some time to work on finding answers for a myriad of problems which would surface.

As for diabetics we will have to find a way to duplicate the work of Banting and Best and other researchers of the early 1920s. This isn’t a survival-of-the-fittest type of thing. It is a problem to be solved.

Just recently some Canadian researchers injected capsaicin into the excess pain receptors of the pancreas of diabetic mice. Then a neuropeptide was used to soothe the inflammation. The pancreas immediately started producing insulin and 4 months later the previously diabetic mice were still “cured”.

Is the diabetic survival problem complex? Of course it is. All TEOTWAWKI problems tend to be complex. But they are still just problems to be solved. Keep in mind that if an EMP wiped out all type 1 diabetics, it would not be an end to type 1 diabetes. If it could be ended by some sort of natural selection then where did it come from in the first place?

Summary:

1) Humulin can be frozen without damaging the contents, bottle or seals and then used without ill effect to the patient.

2) Unopened Humulin has at least a one year shelf-life at room temperature (70 degrees F.)

3) Darwin wasn’t a diabetic or a survivalist so who cares what he said.


Art
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#12
bigdave

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generally room temp should surfice however read the label on the box and it will indicate if you need to refridgerate





Hey guys,
Hope everyone's good and all that :)

My question is how easy is it for insulin to get too hot and then useless? I carry with me an Apidra disposable pen (Pretty average insulin pen for all that don't know) in my front pocket. It stays there all day. Whether it be hot or cold outside. I live in the UK so very sporadic temperature but body temps going to be warming the stuff up. Plus we do have the odd days circa 30 degrees Celsius.

Then say if i'm going clubbing with some friends, again the pen will be sitting in my front pocket. For anyone that hasn't been clubbing it can get very very hot and humid and not very nice so i can imagine its very hot for the insulin in my pocket.

Is this kind off usage most likely damaging my insulin? Is there a way off checking? Specifically for Apidra (If anyone has it) And if so does anyone have any tips on carrying the stuff. I hate having to carry around with me a bag but is that really the only solution? Surely some ingenious diabetic out there has come up with something better?

The reason i ask is because my BS's have been wacky recently and i thought off insulin may be the cause?

Thanks

Alex



#13
ramon

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I watched that show DR G MEDICAL EXAMINER and she did a autopsy on a women who traveled on a bus for 5 days. Her bg levels were in the 500's and when her sister gave her the insulin she had on the bus it didn't work and she died. Be safe and keep it cool. When I travel by vehicle I have a small insulated lunch box with a baggy of ice inside. When we stop I go to the ice machine and refill the baggy. Also Walmart has these small blue containers made by Coleman that you freeze that help keep things cool, around $2 apiece and last for 7hrs.

#14
sweetlife

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Link is not working,can you please confirm?

posted before but still a good guide

Insulin Storage - Emergency Medicine - Field and Combat Medicine Classes


My daughter
Found T1 on April 21st 2008
Takes Humalog and Lantus,total 4 shots.
Her C-Pep in May08 was 0.53.
Last Hb1Ac=7.5,I wish she can achieve around 6 or below.

#15
DeusXM

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As a warning, I would avoid ice packs entirely. Ice can freeze the insulin, which is even worse than it getting too hot. Insulin can survive at temps of 40C for few days but the moment it freezes it's screwed.

#16
Subby

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Those Frio packs or similar are definitely the way to go if you do want to keep your insulin cool for whatever reason. They don't freeze, they just keep things nicely cool, and last for up to a week. You just need to dunk them in water to recharge them. Well worth the price, imo.
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#17
LexKing

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I agree with Subby.

The Frio is the way to go!
Regards;

Lex
:cool:

#18
strack350

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I carry my humalog pen with me at all times when I'm out and about. Same for my Levemir pen, though If I know I'll be back home I will not carry it all day. I have gone snow skiing in 0 degree weather, and been on the beach in 95 degree weather. Never a problem in any case, as was said before, don't let it freeze. Other than that your good to go.:D

#19
lecsiy

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Thanks for all your replies guys. I've more or less drawn a line under the heat off my body damaging the insulin so thats one less thing it could be :)

Plus, FYI I have ordered some frio packs for Turkey :)

Thanks

#20
DeusXM

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Good on ya. As a tip, keep ALL your diabetes stuff for your holiday in your hand luggage (don't check ANY of it into the hold). You can take needles and stuff through security no bother. Charge the Frio packs up AFTER you've been through security though - they should be let through anyway despite liquid restrictions but you won't need them till you get to your destination anyway so there's no point giving security another thing to worry about.




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