I am traveling to Europe, and have to take insulin vials with me for my pump. I have tried to use the Frio pouches but with limited success. I need to keep the insulin cool for 36+ hours while on the plane and making connections in airports. Any suggestions or advice is welcome.
2 Likes
@Jess41 What I’ve found with using Frio packs is they require air circulation as they depend on evaporation for the cooling effect. If you put them in an enclosed container (suitcase or inside a backpack), their effect will be reduced. I use them, but ensure they’re in an outside mesh pocket of my backpack (check regularly they don’t fall out). Another thing to know, while insulin should be cooled for long term storage, if a trip isn’t over a month long, your insulin will likely survive the trip and remain effective (look up studies of insulin storage in hot/extreme environments and elsewhere here on FUD). I’ve found the ice packs sold with most containers don’t last nearly as long as my plane trip takes (travel to the airport, ride, etc.). I’m sure they help, but not for long. Also, beware the small refrigerators in hotels; many have poor temperature control (cool or freezing). I once discovered my Frio packs frozen like rocks and think I got them out before insulin (lower freezing point) followed suit! Remember the most important rule: Carry your diabetes supplies with you, not in checked bagage! And, be willing to tell gate agents, flight attendants you have critical medical supplies if they try to separate you from them. Medical supplies/equipment, in reasonable quantities, are exempt from standard carry-on rules as long as the bag contains only medical supplies (ok, you might sneak in some headphones…no…a Snickers Bar!). I’m sure others will present their tips and tricks as well! BTW, don’t forget to enjoy the sites and enjoy your trip, even if for business!
5 Likes
The simplest solution works best. Using insulin that is unrefrigerated (or Frio cooled) for up to 28 days is the safest way to go. The biggest danger when traveling is over-heating or freezing your insulin supply. Leaving your insulin in a car parked in the sun is the classic scenario for over-heating insulin. Attempting to refrigerate your insulin in a hotel fridge is fraught with risk. My rule when traveling is to never use a hotel or any other fridge to cool your insulin supply.
1 Like
Hi @Jess41,
Welcome to FUD!
You don’t need to do anything to keep it cool. It works fine without refrigeration.
I never refrigerated my insulin in college, and I survived.
And I have done some experiments with it. Here is an extreme example.
car-baked-insulin-an-experiment-for-irish
Not suggesting anyone do this, but it was just a demonstration for people because there always seems to be a lot of concern with refrigerating insulin.
8 Likes
Welcome to the group, @Jess41! I’ve flown across the Atlantic plenty of times over my 50+ years with diabetes and have always just stuck my insulin in my carry-on, no special cooling packs required. It must work, since I’m still here!
Have a great – and worry-free – trip!
8 Likes
Seconding (thirding?) what others have already said; air travel and airports from the US to anywhere in western Europe (and most of the world) do not create any issues for insulin. Indeed in my case when I am travelling to somewhere hot my complaint is that I’m always freezing in the airport.
You are heading into 40C+ (100F+) weather. The problems start when you get out of the airport at the end. As Eric pointed out it’s not that hard. When I lived in Europe and when I still went there intermittently they didn’t experience high temperatures like now but I live in Oregon and I certainly experience those temperatures regularly.
So keep the stuff (insulin and CGMs) in something that you do not ever let go of (lost a backpack in Heathrow once; left it on the bus, boy did my wife insult me.) Put it in deep; that’s sufficient. Stick it in the hotel 'fridge if it has one, you may find that most European hotels don’t have them and you would be correct but you probably won’t go to enough to work that out.
If someone steals it (something that I admit has only ever happened to me in the US) as in the US a pharmacist will be able to supply replacements.
Don’t sweat it. Everything you can get in the US is available in Europe. You will end up in a big airport the first time you enter. There may be some delays because of the handling of the new entry requirements; make sure your own entry permits are in order! I don’t know what your travel arrangements will be but if you have forgotten something don’t worry; unless you are somewhere you don’t need it it will be available.
5 Likes
I have traveled to Europe several times over the last few years. I didn’t use anything to keep my insulin cool, I just stuck it in my carry on so that I had it with me all the time. Years ago, when I was first diagnosed I went to a diabetes education class and there was a rep from Eli Lilly who said you don’t really have to worry about temperature. After all when it’s in you body it’s at 98.6 degrees. He said the worst thing is light so always keep it in the dark as much as possible. That was 30+ years ago so don’t know it that is still true, but that’s what I’ve been doing ever since and never had a problem.
5 Likes
I agree w everyone else! We do use thick thermos bottles with plastic-encased ice in them when we leave from anywhere by plane, or driving around, since it is often possible. But we have no qualms going unrefrigerated for a month.
When we are walking around during the day, say visiting, we do use a Frio bag where evaporation will work, often in an open outer pocket of a backpack.
I would feel a bit more nervous in these super high heat days right now at 40C. In these cases (we were in Extremadura in Spain in August at one time), we simply make sure that the Fruit bag remains in the shade. Sometimes I have made a shade screen on the backpack with a couple of wood sticks to help.
Insulin is such a resilient substance that we don’t worry too much. The one area in the world where we have not dared go in vey high heat is a long trek in the Central American jungle because there is little evaporation there and a Frio bag won’t work well. I do think we would still be OK, but I am nervous about talking the risk.
6 Likes
I travel about 200 days per year. I don’t even think to consider it…. It’ll be fine. Even by the fda needed to prove for approval standards there is no degradation at 88 degrees farenheight over 28 days. We have plenty of stressors and worries. This not need be one of them. Use common sense, put it in the fridge when you can (although I’d caution you about hotel fridges as they are super cheap and can freeze things solid)…. Don’t leave your entire nest egg of insulin baking in direct sunlight or in a hot car etc… I promise you it’s really not a concern with a modicum of common sense exercised
Frios do work well in certain environments— in high humidity air they don’t evaporate as much and therefore don’t accomplish much— but again, it’ll be ok if you’re not putting your insulin in your cars exhaust pipe and driving cross country. People around the world in places that don’t even have refrigeration use insulin successfully.
7 Likes
I’ve read a couple of studies about using clay pots, usually initially soaked in water, in the desert areas of Africa with no availability of refrigeration/cooling and similar environments for storing vials/pens of insulin. It worked for the short term (read months), i.e. efficacy wains but slowly out a few months. Most of us don’t have the means of testinng that efficacy though, so sensibillity (whatever that is) has to intervene. But I’m with @Michel & @Sam, we mostly need to apply some “reasonable” standard of sensibility. I’m also with @Michel, the high humidity and high heat without cooling, where evaporation wont work, is probably the most challenging environment for insulin products. All of this said, I recall the experience of using a hot tub (I think for too long!) and the following 12 hours, whether biology or “cooked” insulin, its the only factor I could blame for the high experienced and perceived need to replace the pump/insulin, the replacement worked as close to immediately as I could expect. Though I did enjoy the hot tub!
5 Likes
I don’t even try to do this.
NPH is a fairly volatile, unstable insulin that is prone to deterioration and it has been fine with me carrying it around unrefrigerated in the summer. I get a little nervous as I approach the end of the bottle, and so brought a second, unopened bottle on recent travel…just in case.
4 Likes
That’s my next experiment!
5 Likes
So far as I know and speaking as a chemist, not a diabetic, NPH is exactly as stable wrt heat as all other insulins. With my chemist hat on all insulins are equal.
3 Likes
I hope this is seen by all who responded to my inquiry about keeping insulin cool while flying to Europe. Thank you! I overthink things at times and let the worries get the best of me. Your comments and advice are reassuring. It’s great to have access to this forum and all the experience that users bring to it.
10 Likes
I don’t think it’s as shelf stable as newer insulins.
Was @Terry saying he mixed NPH and R? I’ve been keeping the syringes seperated for the long and short insulin.My memory isn’t great. Can you mix NPH w/ short term insulin in the same syringe?
1 Like
Not safely. When I was first diagnosed I was put on PZI (Protamine Zinc Insulin, which is an NPH) and regular, mixed in the same syringe. A couple of years later an expensive endo declared that mixing the two was a problem.
NPH is based partly on the fact that zinc encourages the formation of insulin hexamers, which both stablize the insulin and delay the progress of the insulin through the skin to the veins. The hexamers form anyway but zinc stabilizes them.
Mixing regular with NPH results in something intermediate, at least that is what the diagnosis was when I was around 14-16.
Many years later I was told, when I was on MDI Lantus and regular, or maybe a 'log, that I should not even inject the two close to each other; I should separate the injection sites. I suspect that was because the endo I was talking to was thinking of NPH and Regular.
So the zinc stablizes; I would expect something with a greater proportion of the hexamer to be more temperature stable (chemist hat on here).
All insulins form the hexamer. However from what I’ve read recently at least one of the new ones requires zinc, so that might be a problem for temperature stability.
Zinc is an essential nutrient and it is always present in our bodies. Even if an insulin with absolutely no zinc is injected after the injection zinc might encourage formation of the hexamer and therefore provide extra stability. Even though the insulin will be gradually heated to almost 40C (around 37C, the core temperature of our bodies +/-) some additional stability may result. It doesn’t matter much except for long-acting; insulin sticks around for about 8 hours as it transits through our skin and when it gets to a vein it only lasts about 4 minutes (technically that’s the time it takes for half of it to disappear.)
2 Likes
I last used NPH in 1987, so I had to look up before commenting. It was common practice, as taught by clinicians, to mix NPH and R in the same syringe. To refresh my memory, here’s the AI summary. Clear before cloudy …
When mixing NPH (cloudy) and Regular (clear) insulin in the same syringe, always draw the Regular insulin first. The golden rule to remember is “Clear before Cloudy”, which helps prevent the slower-acting NPH from contaminating the Regular insulin vial. [1, 2, 3, 4]
Step-by-Step Protocol
1. Preparation
- Inspect & Mix: Check expiration dates. Gently roll the NPH (cloudy) bottle between your palms to mix it evenly. Never shake it, as this causes bubbles that can affect your dose.
- Clean: Wipe the rubber stoppers of both vials with fresh alcohol swabs and let them air dry. [1, 2]
2. Injecting Air [1]
- NPH Air: Draw air into your syringe equal to the prescribed dose of NPH insulin. Insert the needle into the NPH vial and inject this air. (Do not draw out any NPH yet). Remove the needle from the vial. [1, 2]
- Regular Air: Draw air into the syringe equal to the prescribed dose of Regular insulin. Insert the needle into the Regular insulin vial and inject the air. [1]
3. Drawing the Insulins [1]
- Draw Regular: While the needle is still in the Regular insulin vial, invert (turn upside down) the vial and slowly draw up the prescribed dose of Regular insulin. [1]
- Check for Bubbles: If you see any air bubbles, gently flick the side of the syringe with your finger to float them to the top, then push the bubbles back into the vial. Double-check that you have the exact Regular dose. [1]
- Draw NPH: Insert the needle into the NPH vial, invert the vial, and carefully withdraw your prescribed dose of NPH. The total volume in the syringe will now be the sum of both doses. [1]
4. Administration
You can substitute rapid acting insulin analogs (Humalog, Novolog, Apidra) for the Regular insulin as above. Clear before cloudy still applies!
2 Likes
Fascinating. 
Yes, I remember this. This was how we did it. And we would roll the NPH so it was in solution. Maybe we stopped mixing them after a certain number of years, like John says. I just can’t remember. Isn’t that terrible?
2 Likes
and they are endowed by their Creator with certain unalienable Rights.
1 Like