I have not used them. Given recent review of studies on temperature effects on common various insulin types, I question the value of these devices given their cost. While manufacturers caution of the temperatures and ≈28 day life of insulin, major well founded studies in both developed and remote regions of the world have shown insulin degradation to be minimal over several weeks with minimal cooling efforts (water in clay pots for example) being effective. While I wouldn’t ignore the manufacturer warnings completely, they are only putting out what they’ve studied and founded FDA approvals on. Perhaps using ice/cooling packs/gels and insulated containers is just as effective, obviating the costs of such devices, simplifying travel, recusing the cost and mental stress over the safety required. Obviously the environment traveled will be a deciding factor as well; I certainly wouldn’t leave supplies in the glove compartment of a car parked in Death Valley.
I used ice packs and insulated containers (a Yeti), and still on a similar trip my backup insulin went bad. Delays, etc., happen, I didn’t have enough frio packs for everything all at once, since my backup was to stay cold on purpose. Ice packs require a freezer, which not everyone has. Fridge, yes. That’s why I’m trying this method this time.
Potency: once I open a vial I notice my insulin losing potency after 21 days. I am extremely sensitive.
For reference, 1g of dextrose raises my BG 35 mg/dL and my ISF is 1:95.
After 21 days, each and everything month, for years, I have to increase my basal rate 10-15% the last week (and adjust my carb ratio, ISF, etc), and longer it acts more like R insuli. And no, it’s not my menstrual cycle, that needs 25-30% more.
As an experiment, for three months I opened a new vial every 21 days. Never needed to increase my basal rate, other than my menstrual cycle.
So while the experiments may have noticed “minimal” change, how the body reacts to that change varies from person to person. Trust me, I notice!
I know this is off topic, but I would take a full month to finish off a single vial on my pump (I fill each reservoir with 1mL/100u and it lasts me three days), so my endo prescribes me cartridges. Would using 3mL cartridges instead of 10mL vials solve your potency sensitivity issue?
This is an interesting point to bring up, and it may bring some things to light about insulin degradation, and some of the possible causes.
We don’t really “open” an insulin vial ever. We take the cap off and start using it, but that does not open it. The insulin is still enclosed with the rubber stopper, and the stoppers are self-sealing.
After we take some insulin out, it is still closed inside the vial by the stopper.
The only difference when we start using a vial is that we are introducing outside air, and also exposing the insulin to more surface area of air.
A bit hard to describe with words, so here is a quick illustration I made to show what I mean.
This image is assuming someone is storing their vials upright, but the same applies no matter how you store your vials.
As @Finn mentioned cartridges, the difference there is that the insulin is NOT ever exposed to air. Since the plunger moves, there is minimal air contact.
Another image, although this is pretty obvious to everyone already. But I just like adding the images.
What I do is minimize air exposure in the vial by keeping it under negative vacuum.
When I first start the vial, I take out 200 units of air right away. That starts it at negative vacuum.
Then, I always remove less air than insulin I am taking out. That keeps it at negative vacuum.
For example, if I am removing 100 units of insulin to put in a pod, I only put in about 65 units of air.
Thoughts on this?
BTW, if you do a google search on the phrase negative vacuum in insulin vial, guess what the first link is?
Yay! It’s FUD!
This post describes it pretty well:
@jbowler, this seems like something you would have thoughts on too, so adding you.
I use 3mL reservoirs and fill to only 70U. I use 10-13 u per day total, and change every 4th day. Starts losing effectiveness after that. It’s a lot of waste, but it is what it is.
Thanks for the insight, however, I’d like to focus on who has used this particular equipment for similar trips.
I am a former bench chemist and field geologist with a Masters degree and PG. I use the term “opened vial” because that’s what most people understand.
I know how a septum works, I know dynamic vs static equilibrium, etc, I ran headspace gas chromatographs and published a paper on a unique application of the technique. I designed and managed many, complicated environmental sample collect and analysis programs, too.
@MsCris You’ve done your own history and seen impacts with opened and un-cooled/refrigerated products, so obviously go with your experiences. Your sensitivities are significant; the first person I’ve heard from that level, so all the more reason to use what works for you! Please come back and let us know what you think of whatever product you try; always good to know and pass on for others of similar situation.
Just to be sure we’re not mixing up 3mL reservoirs and 3mL cartridges, I was suggesting getting 3mL cartridges of insulin (penfills that would be used in reusable pens) to fill your pump with, rather than insulin from a 10mL vial.
You said you fill your reservoir with 70u every 4 days, so a 3mL cartridge/penfill of insulin would be finished after about 17 days on average, under your 21 day potency cutoff.
Obviously you know what works for you and have probably already considered changes like this, but I thought I’d mention it in case it helps you or someone else who’s sensitive to insulin.
And sorry again, I know this isn’t the question of your post, but it could be another way of partially solving your problem of insulin not working as effectively after 21 days. I also appreciate that prescriptions for cartridges and vials might not be as interchangeable in some places and on some insurance. I’m in Germany and my endo is happy to prescribe whatever insulin I request in whatever format I ask for and it’s all covered the same by insurance.
Finn, I’m in the U.S. A different healthcare landscape for T1s!
My private insurance no longer covers the Penfill cartridges. I still have the pen though, just in case they ever do again. I used to carry them as my pump backup.
Yes, I change the reservoir every 4 days. While I fill with 70u (so I can have the min 60u required), there’s the tube to fill, air bubbles to flush on occasion, etc. And site changes every 1-2 days with 0.75 u each time (different body parts, different absorption, mine just don’t last).
The insulin in my pump never lasts more than 4 days. It starts losing effectiveness and I notice it. At first I thought there was something wrong with the pump overheating - they replaced it, no difference. I’ve tried novolog and humalog, same thing happened (with humalog being slightly worse).
I’m just that sensitive to it all. When I’m out eating and ask many questions about ingredients…I know within 20 minutes if they didn’t tell me the whole truth!
That’s annoying. I hope for you that your insurance covers penfills again one day. Cartridges certainly make pump life easier for those of us who are really sensitive to insulin or use low doses. And as you said, they’re ready-made pump backups.
@MsCris , please do share about your experience when you return and what you learn. Your post has appropriately reminded us that our diabetes experiences differ from each other, yet we can still learn from each other.
I spent 5 weeks in a semi-remote village with no electricity and high temps. It can be done. But frio bags were sufficient for my needs. The biggest issue I faced was handling unknowns in a new culture and where I could not control the situation. And feeling alone, because no one could understand. (That’s what makes this forum so appreciated. People here do get it! ) My prayers are with you.
I use this cooler for my travels. I have been very happy with it! My previous cooler was a liquid that once it melted and sounded like liquid caused all kinds of trouble with TSA. I believe this is a gel. My only concern is that the small bottles of insulin do not fit tightly. My husband constructed padding to go around it that keeps it secure and is easy to see what it is when it is flagged by TSA. We keep it in a refrigerator when we are on the road. I’ve had no issues with my insulin and its usage. That being said, I have not had a super long trip where I’ve had no refrigeration available! Good luck!
That’s no problem for durations of a few months. There isn’t much literature about this but a lot of research has been done on people in Sudan as a result of the war there (which makes them free experimental subjects):
For those who aren’t going to follow the link, or, indeed, aren’t going to read it:
[W]hile storage at ambient temperature (25–30°C) is usually permitted for the 4-week usage period during treatment
So that’s 86F for the Americans out there, then:
[T]emperature fluctuations were measured in Dagahaley refugee camp (Northern Kenya) using log tag recorders. Oscillating temperatures between 25 and 37°C were observed.
(The camp is where Sudan refugees were ending up.) 37 is 100F.
Taken together, these results indicate that insulin can be stored at such oscillating ambient temperatures for the usual four–week period of use.
There is at least one other paper using the same disgraceful data source that documents the degradation of insulin efficacy while stored in non-refrigerated conditions in, I think, the same refugee camps.
We really do need to do this research on ourselves. It’s been done (by us) for freezing, but for heat it’s more difficult because heat really does damage insulin and measuring reduction in IU with heat is a lot more difficult.
I use a 4AllFamily canister, medium size, the economy system that doesn’t connect to a power supply. It was $40. I balked for quite a while before buying it and tried to get by using my YETI tumbler as well. The 4AllFamily is much better at keeping insulin at refrigerator temperature, longer. I don’t put it through any extreme events but this coming Saturday is a good example of when it will be used. I’ll be outdoors, in both shade and sun, for about 12 hours. It’s 90 degrees out there with horribly high humidity. The humidity is so high that Frios won’t work. I’ll be able to have it hold the pen that’s almost out and the next to be used, all day, and never think about it. Even with the canister being opened when I want to dose, it stays cool with my bag in and out of the sun, on a beach, or in the car while I hike. Worth it.
) My prayers are with you. 