Insulin in Transit
I have a pump and use Humalog. I change the cartridge every three days and have noticed a dropoff in effectiveness on day three. When I traveled to Ireland for 12 days, I decided to change the cartridge every fourth day while I was there. I increased my boluses on day four, but could never catch up with my increased glucose readings. The insulin seemed to be at a 20 to 40 percent effectiveness.
Lilly or some other manufacturer must have on hand the degradation rate at different temperatures. I would assume the temperature of insulin in a pump in my pocket is somewhere between room temperature and body temperature. I realize that insulin is a complex animal, but any information would be helpful to making adjustments on day three or day four.
Don McNamara
Via the Internet
In the article “Symlin Up Close” (Mar. ’08, p. 51), the generic name of the drug Byetta was in one instance misidentified. It is exenatide. Clarification In the article “Get in the Game” in the Apr. ’08 issue, the term “nurse educator” was used. We think it useful to clarify that this term was used in a descriptive sense only, as a “nurse educator” is not a recognized specialty. The article also referred to certified diabetes educators (CDEs). In addition to registered nurses and registered dietitians, a number of health care professionals are eligible to obtain the CDE credential including pharmacists, clinical psychologists, occupational therapists, optometrists, physical therapists, physicians, podiatrists, physician assistants, and exercise physiologists. To find a diabetes education program in your area, visit www.diabetes.org/education/edustate2.asp.
Christy Parkin, MSN, RD, CDE, responds: Yes, insulin is a complex animal. It is a small protein that is particularly sensitive to environmental factors, especially temperature extremes. Although I do not know whether temperature was, in fact, the cause of your loss of insulin effectiveness, all of the insulin manufacturers warn against using insulin that has been exposed to temperatures higher than 86°F, either in the vial or in your insulin pump cartridge. The temperature of the insulin may exceed ambient temperature when the pump housing, cover, tubing, or sport case is exposed to sunlight or radiant heat. Another point to consider during your travels is that any unopened insulin you are carrying will need to be refrigerated at 36°F to 46°F, and not exposed to any extreme heat, cold, or light. After the vial of insulin is open, it can be used for up to 28 days. However, there may be more going on than simply changes in insulin temperature.
Travel can make blood glucose control somewhat difficult due to the body’s response to changes in time zones, sleeping patterns, eating schedule, activity level, and other factors. That’s why extra blood glucose monitoring is recommended during travel. Also, it is not uncommon to notice a drop in effectiveness of insulin on day 3 of pump wear, which could be a site issue or an insulin issue. Changing sites every two days can be very helpful, although I realize that changing sites more often increases the cost of your supplies.
In your case, using your cartridge for an extra day (from 3 to 4 days), combined with international travel, may have contributed to your higher blood glucose levels. The main thing to remember is that it’s important to check your blood glucose frequently while you are traveling so that you can make appropriate insulin adjustments. And, again, you need to protect your insulin from extreme temperatures. If you continue to have questions about the effectiveness of your insulin, I recommend that you contact the manufacturer. In the case of Humalog, contact the Lilly Answers Center at 1-800-LillyRx (1-800-545-5979).
Comments
Comments are subject to review and will not be posted immediately. If you have an urgent medical question, please consult a health care professional. If you have a question for the staff of Diabetes Forecast, please send it to Mailcall@diabetes.org.Traveling with insulin
How can I keep insulin refrigerated at 36F to 46F when I am on a 14 hour flight? I tested cold packs in an insulated bag, but it didn't work.
RE: Traveling with insulin
You asked how to keep insulin refridgerated during long flights? My answer is it's really not necessary. Bring the cold packs anyways, since they'll last for a few hours. However the temperature on the plane does not exceed (usually) 75 degrees Fahrenheit, so it will not expire in 14 hours. I've traveled to Brazil and Germany, and I've have no problems.
5 days and more with pump
Hi I wear an insulin pum and know what tyou are talking about, but since you don´t mention if changin the cartrdige and not the reservoir makes any change I suppose you are having the same situation I did, so before the insulin I would first check my skin at the cartdrige place it might be getting a litle bit of inflamation an that is the cause you might not get the same absortion and effect a few days latter and so on, you might not see any signs but they could be rednes, rash or even a little itch surrounding the area or at the same spot of the needle at the time you remove it (these should have been explained bu your pump trainer or provider) try cheking the type of cartridge, you may also ask the pump provider what type of options you may have.
I some times with a corrret cartridge found that I could left it on for up to 5 or even 6 days with no problem at all, at a beach (because I didn´t want the cartrdige to be seen outside my bathing suit), but as I said I had changed several times the type of cartridge (short long, 90º 45º etc.)until I found the most confortable to me, check which one works the most for you.
Travel Overseas with Months of Insulin Supply
My father will take a trip out of the country and need to bring several months worth of insulin supply with him. Can he put insulin supplies in a piece of luggage and check them in? Is the temperature in the luggage cabin too low for insulin? If yes, what is a good way to travel with his insulin supply? Please advise.
Post new comment