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How long does insulin REALLY last?

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#1
PatrickR

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I've seen a similar thread in the past, but now I've got my own experience to go on, and I'd like to hear about yours. Your actual experience, mind - not what you've read.

Now, everybody knows what the drug companies say - 28 days after first use and then get rid of it. Yet it can stay "unopened" in the fridge for 2 years. When I was researching this (will try to give references if I can find them again) the papers I found cited several factors for length of original potency:

Temperature
Exposure to light
Exposure to air
Motion (e.g., being shaken)

When I was using vials, I always left them in the fridge. Injecting cold doesn't bother me, but if it bothers you, let the syringe warm up instead of the whole bottle. I could routinely go 45 days with no loss of potency (Lantus). I've never had vials of Novolog, so I can't speak to that.

The pens change things, because there is no added air. They have caps, so no light. Don't carry them around, so no motion. I can see no reason why they cannot be used until their expiration date. I've got a NovoPen I've been using (from the fridge) for 2 months, and it works just fine.

Also, I've still got a pen (Novolog) that I started using November 4 (it has been room temp for that time). I do carry it with me (as a backup) - mostly I 'm at home for meals. I do check for cloudiness, etc, but so far so good. Used it recently, and I did shoot 5 U, instead of the 3 U I would with fresh, and worked just as expected. Yes, after 3 months it's time to change it out.

So I'm asking about two things really. One is saving money - why throw it out when it is fine if kept cold? I'm sure big Pharma likes it only good 28 days - why that magic number?

The second is emergency/disaster relief. Sure, I have a few months supply. What if the nightmare scenario happens, and I lose power for weeks at a time? Of course I'll help others, but what are the realistic expectations?

I look forward to your informed comments.
Dx'd - August '07
Metformin - 1g 2x/day
Lantus 20u/day
Novolog as needed
Forget those other Rx meds!
Various supplements - still tuning . . .

Mostly lo carb, but loving life
A1c: 5.9
HDL: 119
LDL: 65
Trigs: 87

#2
aggie168

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Yes, the 28 days number have "lots" of safety margin build in. I do not think you will ever get any company or doctor on record that will tell you how to use it over that magical number.

With that said, I personally did not run into that situation before. So I am no help. When I was on Levemir (basal injection) for a short period, I will use up one pen less than 10 days. Now I am on Novolog in my pump, I use one bottle less than 2 weeks.

Others will chime in soon :)

===============================================
DX 02/2002, Minimed 530G(751) w/CGMS on Humalog
Aspirin 81mg + Lipitor 10mg + Losartan 50mg

05/2014 A1C 5.8 Chol=154 Trig=96 HDL=48 LDL=87


#3
Adjitater

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Never had to worry about it as I don't keep them around that long. I use well over 2 vials a month of humalog.

#4
aiah23

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Sorry I use quite a bit of insulin, sounds like more than you so I haven't run into this problem. I imagine it would be one of those 'try it and see if you feel it's safe to do so.'

Fawn
Novolog and Levemir, MDI
Sleep deprived first time mommy working full time! :eek:
A1C: 6.7 as of 04/28/12

#5
Hammer

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The problem with using it longer than 28 days is that you never know if it's still good, half good, or bad. You do know that if it was handled properly, it will be good in that 28 day span. If you went beyond 28 days, then it's a guessing game as to whether or not it's effective, and that is a dangerous game.

You say you had some Novolog from November and you needed more than usual when you tried to use it. My insulin to carb ratio is one unit of insulin for every carb I eat. If I were to cheat and eat four slices of pizza at 35 carbs per slice, I'd need 140 units of Novolog. If the Novolog was good, I'd need 140 units of it......if it was half bad, I'd need 280 units of it. If it was completely bad, it wouldn't do anything and I'd spike way out of control, so I'd have no way of knowing what dose I should take.

With Lantus, I was taking 152 units each night. If it was half bad, I'd need 304 units, which is a whole pen, and if the pen was half empty, I'd need to use a second pen. Chances are the second pen would still be good, so I'd take what was in the first pen, then use the second pen. I'd probably overdose since I'd have no idea how effective the first pen's insulin was.

Right now I'm taking 96 units of Lantus each night, so trying to figure out if it is still okay to use is like playing Russian Roulette. I'd rather not take that chance, so I'd throw out any insulin that had expired or had been left out for more than 28 days.

In the past, I did have new Novolog pens that were bad from the mail-order pharmacy. This happened back when I was trying to determine my insulin to carb ratio. I ate something, took a dose of Novolog that I thought should be correct ( the one unit of insulin for each carb I ate), and nothing happened. That made me think that the dose was too low. The next day I ate the same foods and took a bigger dose, and still nothing happened. I began to worry that I was doing something wrong.

That night, I ate some high carb food (Chinese food with rice) and took 140 units of Novolog, and nothing happened, so I took a correction dose of 40 units and still nothing happened. At that point, I thought that maybe the Novolog pen was bad, so I used a new pen and took another 40 units and still nothing happened. I was afraid to take any more so I didn't.

The next day, I ate the same breakfast food that I had always eaten, took the normal dose and nothing happened, so I opened a new box of Novolog pens from a different batch and tried that and it worked perfectly. Had I not been a member here and read about others who had gotten bad insulin from the pharmacy, I would have kept increasing the dose in an attempt to get my numbers down. That means that I'd have been taking a very high dose of Novolog which would have caused me to use up the bad pens and start into the new batch of pens. Had I opened the new batch of pens and, thinking that I needed to take a huge dose, I would have overdosed and probably killed myself.

Look at it like this......if, when insulin went bad, instead of becoming useless, it became deadly and killed you, would you take a chance and still use it past 28 days? In effect, that's what it does, only, in itself, it doesn't become deadly, it makes you change your dose which can be deadly. Is it worth the risk?

Presently taking: Hyzaar for blood pressure:
Novolog and Lantus for diabetes.
Welchol for cholesterol and diabetes
Mega-Red Omega-3 Krill Oil (300 mg)
Mega-Red D3 (5000 IU)
I was diagnosed in 2003...

(The human body is so resilient that no matter how badly you abuse it, it will still last you a lifetime.)


#6
PatrickR

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Hammer - yes, I take your point. And certainly with what (to me) are massive amounts of insulin, I would feel the same.

There is only the one time I've used that old an (unrefrigerated) insulin; it was just a test case. And had I taken 5 U of fresh-out-of-the-box Novolog, I might have gone low, but wouldn't have been in any danger.

Most of the replies were from folks who use it faster than 28 days anyway, so no worries. There is the disaster scenario, and then I expect people will do the best they can and test like crazy.

I'm not advocating a potentially dangerous method; far from it. The idea is if you keep the pen in the fridge, it has no air in it, why not use it? Not that people should be adjusting doses based on age. Insulin is very expensive, and not everyone has a health care plan, country, or extra cash to afford it.

As I said, with the Lantus I could go 45 days. Now I have the pens, so that is moot, as I use the 3 ml in 20 days (I'm down to 15 U/day). But Novolog - I don't usually use more than 5 U day. If I can keep it cold, and not change dose, and it works - I see no harm.

Just wanted to hear what other people had tried.
Dx'd - August '07
Metformin - 1g 2x/day
Lantus 20u/day
Novolog as needed
Forget those other Rx meds!
Various supplements - still tuning . . .

Mostly lo carb, but loving life
A1c: 5.9
HDL: 119
LDL: 65
Trigs: 87

#7
aggie168

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The idea is if you keep the pen in the fridge, it has no air in it, why not use it?


I think "minimum" amount of air as well as potential of contaminant from the double ended needle still enters the cylinder. Hence the 28 days clock starts after you break the seal the first time.

===============================================
DX 02/2002, Minimed 530G(751) w/CGMS on Humalog
Aspirin 81mg + Lipitor 10mg + Losartan 50mg

05/2014 A1C 5.8 Chol=154 Trig=96 HDL=48 LDL=87


#8
dturney

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Insulin will keep a lot longer than the 28 days if kept in cool storage. Cool containers for insulin being used can be bought almost anywere insulin is sold. Some insulins have a shelf life of two or more years....
:)Diagnosed June 1970
Injecting Insulin since June 6, 1970
42 Years and Counting
Lantus and Humalog
Metformin
I am not young enough to know everything
Modcarb Diet
I eat all the food groups.

:tee:

#9
notme

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I am not certain about pens, but I have used a bottle of humalog for just a short time after the 28 day mark and I have seen a decrease in its potency. Pens, I don't know. What your saying makes sense.
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Nancy


“I don't expect everything to be handed to me. Just set it down anywhere.”.




diagnosed type 1 October 1986
currently using Medtronic MiniMed
Revel 723 with CGMS
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#10
Subby

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I've seen a similar thread in the past, but now I've got my own experience to go on, and I'd like to hear about yours. Your actual experience, mind - not what you've read.


I generally use a given 3ml well before a month is up, so I don't have much personal experience of pushing past that. I have had a penfill go bad after a week of very hot weather and probably being blasted in the sun a couple of times. I've also received insulin that is already bad, twice, from a chemist.

Since you asked only for personal experience, you can ignore the rest of this post. However, you make a number of claims about what "the studies" and general wisdom says, and to my understanding your approach doesn't really hit the nail on the head. I think a better understanding of the forces involved is an important part of understanding this issue. I'm really happy for others to add to knowledge in this way - and if you can't stand discussing the state of medical knowledge out there, we can take it to another thread.

While you quote a number of issues as flat, give or take, equal reasons, so fix this or that issue and you've gained x amount extra life - I don't think it works like that. The primary issue is one of the life span of preservatives once the seal has been broken, once bacteria has entered the insulin - not by way of shoddy habits, but by simply piercing the seal and introducing very small amounts of external bacteria. At that stage, the preservatives have a lifespan before it is slowly negated by an increase in bacteria. I am probably not using the technically correct descriptions, but I believe in general these are the forces in question.

Now, is that precisely 30 days whatever the sitation? I highly doubt it, but studies of insulin purity and efficacy over time have shown that this is about the point that loss may start to occur, given normal room temperature. The one I saw (I am happy to try and find again) found that at 30 days, the degradation was commonly getting to around 5%, enough to consider the action of the insulin compromised enough to start to cause unseen difficulty with insulin therapy.

If you are supplementing and can give or take an unseen or uncertain 5% or 10% of dosage variability before any other consideration, good for you. If you were more dependent on the insulin to cover more needs, by which I do not mean "a high carber" but simply needing to use external insulin for whatever you do including biological needs, you may not consider it such a minor issue. I don't think this is anyone trying to rip anyone off with this particular issue, I think it's a cautious, valid medical standard, designed to cover all scenarios of insulin use including insulin dependent, where both a less significant degredation in action may become a lot more serious in creating difficulties, and where keeping insulin refridgerated is not usually going to be convenient. Personally, if you find it's got enough action for you for 6 months, I don't know of a reason you should not use it. There could be a reason, such as injecting yourself with more bacteria in the mix - but I don't know.

Will keeping cold really prevent the growth of already introduced bacteria? I don't think so, bacteria certainly grows even in refrigerators. I would not at all be surprised if you can prolong the life of insulin somewhat by keeping it refrigerated. Then again, there is something quite interesting that my pharmacist told me. I asked him about this once, he thought about it and said something to the effect... "these preservatives will work best at room temperature." and, "it's changes in temperature that will probably increase degradation the most". So, a bit of intrigue there that I can't really comment on further. He's a senior and experienced chemist, but I don't know enough to check his claims and work out if it is true that these preservatives have more 'muscle' when not refrigerated (if that is what he meant).

Still, if you do keep insulin refrigerated, it would be a good idea not to let it warm up for long when you use it.
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.

#11
art

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I'm an occasional insulin user.
I have had opened bottles in my fridge that I have used for 4 and 5 months. They were fine.
No cloudiness and completely effective.

Now if an opened bottle is accidentally left out of the fridge or gets warm while I'm in transit it gets tossed, cloudy or not.

Art

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#12
Jan B

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By reading this thread and noting how cautious you all are, it sounds like I need to be more careful. However, my bgs remain stable even with my habits. I take a total of 20 units of Lantus daily, and leave my bottle at room temperature (72 degrees tops). I do not ever throw insulin away either, unless it's obvious it isn't working (very rare occurance). 1000/20 = 50 days.
Jan

Type 1 since 1979
Diagnosed at age 18

#13
PatrickR

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Oh ****. Wrote a full page post and then got an error msg. Art and Jan - interesting personal experience - thanks.

Subby - great post. I am not averse to the medical / chemical discussion. But I just lost an hours work, so I will continue another time.
Dx'd - August '07
Metformin - 1g 2x/day
Lantus 20u/day
Novolog as needed
Forget those other Rx meds!
Various supplements - still tuning . . .

Mostly lo carb, but loving life
A1c: 5.9
HDL: 119
LDL: 65
Trigs: 87

#14
fantomas

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I guess this is more of a concern for diabetics who don't use much insulin. In general, I would use up pens in 7-10 days. I would make it a habit to leave a pen with about 20-30 units left in my locker at work for emergencies. Those seemed to stay good past the 28 day mark.

On the other hand, I've had insulin go bad after only a few days, some times for no reason. I carry it in my pocket and I know it goes bad, especially in extreme temperature conditions. For example, took a pen with me to Chichen Itza. Even in a bag with ice packs, it went bad in the 100°+ heat.
-Scott
Animas Ping, Dexcom 7
Diagnosed Aug '92 at age 7
Sept A1C 6.5 :)

#15
lorilei

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i have also gambled and used pens and vials longer..with more rotations from tips and syringes (omg..yes i reuse those too)..my ttd is about 25 or less a day with less than half basal..so approx 9-15 rapid..with a pen ( btw..the pens with higher doses are more preferred by my insurance co, than the lower dose peds versions and cartiridges { just recently checked back into that whole cost}..but less preferred than a full vial)..

bottom line, i monitor often, check and recheck/correct when off..so far most of my pens have performed pretty normally even a bit after the 28 day mark..but my problem has been leaks!!!

lori;)


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#16
rzrbks

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Until 2 years ago I had to pay for all my insulins, Ins wouldn't cover them (Lantus and Novolog). The novolog got used fast enough I never had to worry about it. With the Lantus, I used vials and could get 35 days if I was very careful about having it out of the fridge the shortest time possible. I could even occasionally squeeze 6 weeks out of a vial, but I had to do more B/G checks.

Now, however, I use cartridges, until I run out, since Lantus is no longer making the cartridges. At that point I will have to switch to the disposable pen. Since I inject 18 units a night, each pen/cartridge is used up before the 28 days. And, more importantly, I never have to throw any away.
"I am wounded," he said, "wounded, and it will never heal."

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