Researchers replicated the camp’s daily temperature, which ranged from 77 to 99 degrees Fahrenheit, in the lab, and tested the insulin’s effectiveness. They also studied leftover insulin from vials that patients had used after storing them in their homes.
They discovered that even without refrigeration, insulin kept at the camp’s tropical temperatures was safe to use for four weeks — a revelation that could be life-changing for diabetes patients around the world.
FUD is always in the front.
From June of 2017…
And even more than the 4 weeks they are referencing. I have some that has been unrefrigerated for almost 3 years (since August of 2018) that I will demo.
It would be really cool to reach out to some of the people referenced in the article - Mohamed Hussein Bule, Philippa Boulle, Gojka Roglic, Ali Bishar, Et al… and invite them to FUD.
I’ll never forget reading the long line of posts you referenced to me on this subject. While I appreciate pharmcos need to limit their studies…they can’t test “everything”…and submitted to the FDA, etc., the amount of “seeming” advice and guidance that grows up around and becomes “law” when it hasn’t been tested is flabbergasting! I can’t help wonder how much insulin…and many other meds…has been disposed for having been “outside” of tested temperatures “best by” dates that in fact “may” be meaningless and are at least questionable.
Agree completely @TomH and @Eric . While I appreciate that they can’t test every instance, the fact that they have chosen not to release how robust the current products are can’t help but anger me more than slightly. When I was reading the article, I could not believe how people’s whole lives were revolving around traveling to the hospital to get their insulin since it was going “bad” in their homes, when in fact it wasn’t. At some level the manufacturers should release the information because it is what is right for humanity, rather than just the bottom line.
@Chris, bottom line is all they are interested in. It shouldn’t be like that, but it it. Were it not, they wouldn’t be charging what they do for their products. Getting people to discard their insulin early is just another tactic.
I have an adult (very adult) daughter who used to go through my kitchen and pantry and discard everything that was past the “use by” date, like she does at home. Her siblings and I raised such a great fuss that she finally stopped doing it. As with insulin, those “use by” dates are mostly fiction.
For what it’s worth, can confirm that Afrezza is also much less sensitive to temperature than marketed as. I haven’t exposed it to heat, but the pharmacy failed to refrigerate a box and then was willing to give it to me anyway and replace it, so I said sure. They told me not to re-refrigerate but that it should only be used within 10 days or something. It’s been fine for well over 6 weeks now (still working on my last package of 4s from that box).
That is great, this is the first time I remember hearing the Afrezza is also robust. Add it to the list!
But if you add “BEST if used by”, the manufacturer is very happy. They make more money!!
Am I the only one who seems to actually notice that insulin does degrade over time? I mean, I use old insulin and wouldn’t toss insulin just because the best before date passes. But if I use insulin that’s been left out of the fridge for months to years, it is definitely less potent than the new refrigerated insulin.
Just the other day I found a cartridge that had been out at least a year and used it, but I was then stuck at 12 mmol/L for the entire day, despite corrections, until I remembered that I needed to set an increased basal rate. Once I did the increased basal rate for the rest of the day and night and another correction, things were fine. Switched to a refrigerated vial after that and no longer needed the increaed basal rate.
I don’t know if you are the only one, but we have not found this.
My insulin stays in the refrigerator, except when filling pump cartridge.
Been a long time on pump, but last time I did injections (NPH + Reg), I used syringes so still always kept in refrigerator. Injected am, dinner and bedtime. Morning NPH covered lunch.
Started pumping with Reg, so insulin only out of fridge every 4-5 days during filling. Same now, with novolog.
@Jen I don’t think any of us would “willy-nilly” ignore the Pharma/FDA warnings; it’s not like I would endorse using my car (sitting in the hot sun) glove compartment as a storage device for my meds. I count myself lucky to be retired with a decent pension, have good insurance that covers my (for the most part) my needs; but I also don’t like the thought of discarding supplies that may be useful (to me or others!). Heck, I look forward to Dexcom producing a reasonable/reusable application device without the waste stream. Certainly anyone thinking or finding a product degraded needs to open a new pen, vial, or whatever. But for those not experiencing an impact or not having the budget for supplies, it’s good to know what’s possible.
I don’t think I’ve ever tried using insulin that’s been out for close to a year. I do find that at least some long acting insulins tend to degrade fairly quickly (Lantus starts to be somewhat less effective in not that much longer than a month, certainly within 2-3, outside of the fridge), but short acting is pretty robust. But I would say in general with medications, you know there has to be wiggle room re these recommendations since they need to put the best by date when they are confident they will still be at 100% efficacy, and few meds degrade at a super steep slope. But it does vary a lot by compounds and formulations–apparently some antibiotics degrade a lot faster than NSAIDs (which last forever), for example. A non-pharm example—I can usually taste when a Diet Coke or any soda sweetened with aspartame is even a few weeks past expiration date, because aspartame has an unusually steep slope for degradation.
What would be really lovely, is if the manufacturer’s cleared this up by publishing their testing data, so we would have some more reliable information than just injecting ourselves with old or mistreated insulin to understand the limits.
I didn’t have to use the cartridge I found, as I don’t have to worry about diabetes costs (Canadian), thankfully. But I just figured I’d give it a try rather than just going straight to the garbage, as there are several members here who do say insulin is fine unrefrigerated for months/years. (I don’t know for sure that the one I used was a year old, may only be a few months old, as I have gone in that kit a few times in the past year. I just haven’t used it on a daily basis rotating out the supplies like I used it, now that I’m home all the time.) I also agree with @cardamom that long-acting insulin seems to go bad fairly quickly. I take pump vacations every now and then and always have to open a new cartridge/vial because the one I used months ago is near useless.
I notice similar, and in quite a short time. I use a Humalog pen once a day, and I inject approx 5 U, so it’s out at room temp for roughly 60 days. Towards the end of the cartridge, I do notice it’s less potent.
Here’s a recent research paper about insulin storage/longevity that seems to back up our experiences with a long shelf life. The only manufacturer data I could find in this stated:
" …Novo Nordisk showed quality assessment results of 233 insulin vials that had been sent back to the company because PwD or HPCs in the United States had voiced concerns about their quality…The insulin content in over 95% of the vials, that had been collected over three years, was within USP requirements recognized by FDA (±5%) as assessed by HPLC…Only in five of the vials returned to the manufacturer by the consumer, potency and/or appearance was found to be out-of-specification. This is of interest to note, as the returned insulin was subjected to unknown storage and shipping conditions in the hands of the PwD, at least some of the insulin will have been past the recommended discard time period and the vials and pens were already opened and used."
The referenced 2018 paper by Novo is:
Concentrations of Intact Insulin Concurs With FDA and EMA Standards When Measured by HPLC in Different Parts of the Distribution Cold Chain (nih.gov)
So I recently found a vial of (unopened) Lantus in my fridge that expired in 2013. Figured I would give it a try and it seemed to work, but was underpowered and not in a consistent way. So I threw it out. Note: it had been refrigerated consistently since it had arrived, I’m guessing well before 2013 (!!).
I do believe that vials, both short and longer acting, stored at constant refrigerated temperatures are fine well beyond their expiration dates. 2013 was my most extreme experiment, but I have tried both Humalog and Lantus expired at least 3 years out and results have been perfectly in line with fresh from Lilly insulins. Jessica
Thank you for adding your experience to this thread. Good stuff. That is indeed an extreme experiment. Based on all the feedback I am guessing that the 'Log’s Novalog and Humalog have the most robust formulations but that your mileage may vary for the basal insulin’s. But 3 years past expiration is great to know about Lantus.
I thought everybody had seen Matt’s greenhouse video!! Afrezza: Extreme Thermal Stability on Vimeo
Matt’s partner is a biochemist so they really know their stuff. Unfortunately they can’t afford Afrezza anymore so they stopped being active.