Is anyone else experiencing this? I have been a low dose user and a vial of insulin can usually last me for several months. At least that was my experience with both Humalog and Novolog for years. But it seems that the last 3 vials of Admelog have become ineffective at performing glucose transport after just one month. Is this designed obsolescence? Thanks in advance for any information you can provide.
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Patient info for both vials and pens says don’t use for more than 28 days. Vials never last me that long, but I’m sure I’ve had a few pens on the go for longer than that. I didn’t notice any deterioration in action, though.
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It is supposed to be the same as Humalog but since it’s made by a different company, you never really know if it is truly the same.
I found this comment on Reddit:
I will tell you this though and this is only my personal experience with the drug but admelog does not do well out of the fridge, even for a couple of days so keep it cold as much as you can. I know everyone stores insulin in the fridge when it hasn’t been opened yet and some store it in there when it’s not in use (they do say once opened it can last 28-30 days out if the fridge) but admelog looses its potency really fast and I find that when I do this my blood sugars run significantly higher so keep that in mind when traveling etc . Hope this helps and good luck
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I experience this with Novolog, losing its potency in the vial after 21 days. And I keep it in the fridge in between withdrawals (for my pump).
Like you, I am very sensitive, use less insulin than most (10-13U/day total). Therefore, a change in potency is quite noticeable to us.
What a waste…
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Do your endos write prescriptions for more than 1 vial/month, even when you use less than one? I have never run into an issue like this, but my new endo seems to be very focused on how much insulin I use and writing the prescription to that number (which has boiled down to 2 vials every three months; I would prefer one vial per month in case I break a vial or the potency goes awry, which happens to me every so often). It’s just exhausting having this argument with someone who should be my #1 advocate.
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@JessicaD,
Can I suggest something to you?
There. Fixed it for ya!
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@JessicaD Mine does the opposite!
We calculate how much I use, plus all the losses in the my pump system, making sure that’s not exceeding my 21 days issue, my biggest constraint. So I get 5 vials for every 90 days. More than enough to feel safe.
Then she separately prescribes backup pens for emergencies/pump failure (Rx specifically states that), basal and bolus. My insurance plan has never once questioned it in 6 years.
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To prevent breakage, I use similar to these:
Insulin Vial Silicone Protector Sleeve https://a.co/d/bRM1EP8
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Hi @JessicaD,
One other thought. More practical than my previous post. 
Here is something for you to use with your prescription “negotiations”.
According to the FDA (and also the American Diabetes Association):
Insulin products contained in vials or cartridges supplied by the manufacturers (opened or unopened) may be left unrefrigerated at a temperature between 59°F and 86°F for up to 28 days and continue to work.
And if you are using NovoLog, you have an even better advocate. The maker of the insulin itself!
There is no way 2 vials in 3 months would work with the 28 day period of use! According to this, you should be allowed to get a new vial every 28 days, or 3 vials per month.
Of course, I don’t throw out insulin vials. I use it for as long as there is insulin in it.
But if your endo is going to go by the book and insist on prescribing only what you use, then your endo needs to follow all the rules in the book, including the 28 day rule.
If they don’t, you ask them - Dr. Endo, are you going against the recommendations of the FDA, the American Diabetes Association, and the insulin manufacturer?!?!
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Thanks @Eric and @MsCris . I definitely have the manufacturers’ / FDA guidelines in my back pocket – it just seems like EVERYTHING is a negotiation with this new doctor, which I’m not used to. I much preferred my r’ship with my primary care dr who previously wrote my diabetes prescriptions and basically followed all of my preferences, which I don’t believe are wildly outside the diabetic norm. I am going to try pumping, though, which PC dr was not comfortable overseeing. I would like to find an endo in Boston who is open to some slightly out of the box approaches (e.g., I would like to try a GLP-1 agonist). This seems to be next to impossible. Anyway, I am picking and choosing my battles for now.
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One factor that can contribute to degradation of insulin in the vial is flushing the syringe/cartridge into the vial to get rid of bubbles. Bubbles in the vial can lead to shearing of the insulin protein (true for all proteins). More importantly though, the coating of the syringe/vial to prevent proteins from sticking to the sides leads to degradation of the buffer, resulting in the insulin forming hexamers that are less active, and more sticky. This occurs at the tip of pump cannulas, and causes inflammation.
Medtronic came out with their 7 day sets that have a different plastic polymerizer, and prevents/slows this down. They also mention not back flushing bubbles out of the cartridges. Tandem bought a biotech that was working on this issue and will probably come out with a 7 day product line. I will see if I can find a video that covers this issue. To digress a little, the Snap Pump used pen cartridges to get around this issue, and was studying this problem: after folding, former employees started up the company to continue this line of research, and that is the company bought byTandem.
It is for this reason that Insulin is sold in glass vials, or pen cartridges, and recommend not prefilling pump cartridges ahead of time.
I would recommend trying not trying to flush bubbles out back into the vial, but rather expel into air; the little bit of insulin you waste is less than having the insulin no longer be active.
So, this is probably much more than anyone wanted to know, but that could be the issue you are experiencing with insulin not lasting longer than 28 days. The insulin is still active, but not as effective. I try not to use insulin after the third refill of a cartridge because I saw greater BS variability.
Mike
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This is all new to me, and it’s interesting and surprising and almost shocking. Can you point me to any references in the open literature where I can learn more about therapeutically significant insulin degradation caused by (a) injected bubbles shearing the insulin protein, and (b) transfer of syringe/vial coating causing the formation of less active insulin hexamers, and (c) causing the formation of sticky insulin hexamers that cause inflammation at cannula tips? How could I have not known about any of this?
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The shearing of proteins in solutions having bubbles was something I learned in grad school biochemistry class way back in the 70’s.
Here is the link to the YT video that covers degradation of insulin in plastics:
Mike
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I spent a couple hours on google scholar, and found lots of articles on bubbles and plastic and proteins, but nothing that I found makes me think that there’s an actual problem with pushing my bubbles from the syringe back into the insulin vial. Is an air shot theoretically better than pushing the bubbles back into the vial? Maybe, but does it really matter? Not as far as I can see.
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