I’ve been on the stuff 54 years, going back to Lilly beef and pork harvested NPH u-40 and cannot remember a bottle of insulin that was in effective.
Until a week ago. The night after some Chinese takeout (carbs counted) my numbers went through the roof off the scale, took big blouses on pump, one by syringe and it took 3 hours to “drop” to 13. Next day ran all in 10s-11s. Checked the line, and stuff was coming out end. Was like that a few days, with 2 infusion changes- no bends, kinks in cannula. Finally dawned on my to try a different bottle of insulin, and it all came down to normal levels.
I keep my bottles in the fridge, maybe it was warm the day I got them and drove home.
Insulin is pretty hardy stuff overall. It gets shipped to me and the cold packs are always melted and sometimes at room temperature. But it’s also always packed in Styrofoam. I’ve left my insulin pens in my car during the summer for 3-4 hours and have them be okay. They did a study on stability of it for a month plus not being refrigerated because in poorer countries they can’t and it did well. As long as it doesn’t go above a certain temperature. I believe shaking or constant movement can do it in more!
I do have sites go bad constantly with my pods so I do MDI shots for bolusing for the most part. And I could swear a few times I’ve had a new pen not work well, switched and been fine. Once a year or two years maybe? I always wondered if maybe one is at the edge directly in the sun on a cargo plane or???
I know when I lived back on the mainland when I was picking up my insulin in vials at the pharmacy it was not in the refrigerator. It was just in the pick up bins and I said it’s supposed to be refrigerated and she just shrugged. In talking to her I got the impression they didn’t have space to store all their insulin in their refrigerator. Granted most can be out for days as long as it’s not in direct sun. (that month at least probably) But knowing how employees aren’t always careful about changing/stocking out products, you can never tell how long it’s out for? They did at some point start keeping it refrigerated, they must have gotten a bigger refrigerator!
But yea, maybe over time a handful? Never back on the mainland I think, but here, where shipping can be a little trickier, yes.
I don’t think I have ever had bad insulin. Like @Marie said, sometimes sites go bad.
And sometimes you can have something and not even know it. A few weeks ago, my BG kept rising and it took a lot more insulin to bring it down than normal. I thought I had a bad pod. I felt fine, but took my temp and had a fever. So I sook a Covid test and … surprise!
Whatever the issue is, of all the possible reasons, I would suspect bad insulin last.
Like @Marie, I’ve read a few articles about studies (not blind or double checked, but seemingly scientific otherwise) about insulin use in hot climates where refrigeration is not available or common (mostly Africa, Asia, India, Middle East, but there’s areas of the US and Europe too), and insulin was shown to be pretty hardy and effective over a period of weeks and even a couple of months. So I’m not overly concerned about storage, though I still believe “reliable” cooling systems should be used when available. Would be interesting if there was an inexpensive test or safe color changing additive to indicate insulin’s strength or exposure level to known effect reducing agents without having to do a chemical analysis! Seems to me there are so many variables (illness, change of body chemistry, level of exercise/work to name a few ala @Eric and @CarlosLuis) its difficult to “know” and easy to suspect the insulin or pumps. Hence, “If in doubt, change it out!” applies to both the insulin and devices. On the other end is too cold or frozen insulin. In my recent hotel fridge mishap (potential freezing), the insulin didn’t have crystals, wasn’t cloudy or discolored. I tried the suspect insulin in a pod (should have used MDI, but live and learn [it was late, I was tired…that’s my story and sticking to it!]). The Frio pack was solid, but I think may have insulated the insulin, and I believe @Eric said Insulin has lower freeze point previously (just looked it up and found a freezing point of 14 F/-10 C, probably safe from hotel frigs that usually have difficulty keeping a soda can cool [until they don’t!]).
I recall that room temperature should be safe for storage and it’s more important to keep from getting hot. Still I backpacked many times in Arizona, Utah, w/o issue (of course getting good exercise).
When I lived in the US and had to dance through ACA health care I recall ordering a 3 months supply (forget from where) that it came in those styrofoam squares with cold packs. No problem. And for the first year here in Canada before I got coverage, I had a scheme where I had it mailed to a friend who would reship it here. All was “cool” with how it worked!
Yeah I am not convinced I will know. I did 2 site changes (all abdomen) in the bad stretch, no hard spots. And moved to adjacent spot with the new bottle, so still using same area. When I was stuck in the high range I gave syringe boluses in my leg and they hardly had any affect.
I have no fever or any symptoms, not feeling any illness (been working outside on the property 7 hours a day).
I still don’t know but it sure feels so much better being in a good range. I was close to a flat 7 all night yesterday.
Well this has been my day. I do have to admit I ate a slice of meatloaf at 3:30 pm which must of had the equivalent carbs of 10 Snicker bars. I should of skipped the protein and fat and went straight for carbs.
I got off work and thought I would finish scraping my garage to help get me in range…nope.
Thought I would take it easy with dinner and have a spinach and ranch dressing salad (yes two ingredients). Obviously that was a good move.
Walked 4 laps(about a mile) after the wreckless spinach salad.
So now I sit here with 9.5 units onboard and my BS steady at 225.
I have had issues with chinese, or even Thai, food due to addition of carbs/sugar/honey. I have to closely monitor BG and give mini-boluses. The higher BG will last hours!
It is difficult to tell if the insulin is bad. Has the insert gone bad, has the insulin in the cartridge starting to lose activity (aggregating), Was the tubing crimped, but not enough to trigger an alarm, or has a subcutaneous pocket formed not allowing the insulin to diffuse. I have put in new inserts and thought that the insert was in a bad spot - but is it possible that the tip is blocked and a larger dose of insulin is needed to opens it up. Or is it temporary insulin resistance?
I have noticed that sometimes an open bottle is not quite as active after the first couple pump refills. But I sometimes feel that higher BSs after starting a new vial is due to it having less activity.
A quote from Sir Arthur is appropriate :-), the one about eliminating the impossible and whatever remains, however improbably, is most likely the explanation.
The various studies were conducted in real world conditions by people in the real world; had they applied to an academic institution to test the effectiveness of boiled, or indeed frozen, insulin the ethics committee would have sent them for reeducation. So they did their best with the conditions.
The temperature conditions weren’t extremes; sure, they were 35C and the “room temperature” was at least 40C but the insulin was stored carefully. No refrigeration, but stored out of the sun in Styrofoam or similar to prevent large diurnal temperature variations. They demonstrated some decrease of effectiveness but did not explain it; their aim was to test the hypothesis that insulin stored carefully in such conditions remained effective. They proved that.
On the other paw… Extreme temperatures will kill insulin and a sufficient temperature will do so almost instantly. Never microwave insulin. Popsicles, no problem, insulin tea, think again. But we all know that
I’ve experienced enough of the US supply chain recently to not be confident that my insulin is not pre-boiled, YMMV but my feeling is that if it doesn’t work don’t use it.
It’s more difficult for those of us with 'pods; we can’t simply change the insulin, we have to change the site too.
But for everyone else insulin can be destroyed, easily, by heat so don’t assume it hasn’t been when things go wrong.
It’s a carb boatload for sure, maybe calls for an extended mode bolus like pizza sometimes needs.
Mine was after an intense several hours of physical labor (including moving an old piano). I made a big mistake by not even thinking about a portion topped with sweet and sour sauce (which I do not even like).
Thanks for that background. I am resigned that I may never know for sure but am so relieved I broke the cycle. Highs just zap me and also make me a bit cranky. I can be a bit reluctant to abort an infusion, I’d make a good post Depression thriftster.