Anyone have their Insulin degrade in this heat recently?

[rockape37]

I encountered this last Sunday whilst on Night shift though I didn't at the time realise it could have been a heat Problem.
I am very new to pump therapy so when I see my BG rise to 15.7 I merely thought I had miss calculated a microwave meal I had taken to work. But when my BG didn't respond to a correction I thought of other things and re primed the infusion set.
Keytones where perfect but I still got high readings after breakfast so I changed my infusion set and canular.
Later that afternoon after a 2 hr drive to visit our daughters I checked my to be horrified with a massive 20! Now I did consider that it could be damaged Insulin but as I am new to pump therapy I spoke to my Diabetes nurse with whom I explained what I had done, and yes she said it sounds like the Insulin being the problem.

I did a complete change and used insulin from a new vial and discarded the drop I had left in the other one. Perfect, back on track.

I have never in the 26 years being on insulin had insulin degrade on me and I have to say that I have spent hours on end working in and from my van with Insulin pens. I have insulated them as best as I can and have tried to create a breeze running through my van not only to keep my insulin in good order but also both myself and my dog cool as possible.

My working situation has changed and I am undercover for the most part but I suspect that it was the heat that killed off my Insulin.
As this is a first for me I'm just wondering if Insulin in pumps are more susceptible to the heat bearing in mind that we are wearing them continuously?
Incidentally I get 3 fills from a vial with a drop left over and the degraded insulin was the 3rd fill, and 1 reservoir lasts me 2.5 days.

Your thoughts, ideas and experiences are most welcome.

Regards

Martin

 

[noblehead]

As this is a first for me I'm just wondering if Insulin in pumps are more susceptible to the heat bearing in mind that we are wearing them continuously?

I think so, when on injections I'd keep my pen in a Frio Wallet in warm temperatures, I've suspected on a couple of occasions that the insulin might have deteriorated on the 3rd day before a pod change, like you this has been evident by higher than expected bg levels.

 

[RuthW]

Yes. Exactly the same. Hot weather and loaded with insulin from the end of the vial.


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[Diamummy_]

My daughters doesn't seem to be doing too well in the pens and have changed it yesterday which seemed to help, do you think it would be worth me getting a frio pouch for my daughters pump which she is getting on Monday ? Thanks all (sorry for jumping on your post )


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[endocrinegremlin]

I've never had my insulin degrade and it has faced 40 degrees in Barcelona and Seville before. However, I have had bad vials or bottles of insulin where the temp wasn't the issue. I just got unlucky. So, that is another thing to keep in mind.

Oh and those Barca and Seville visits were before anyone told me about keep cool packs. It was just a stuffed at the bottom of the handbag and hope job!

 

[Snapsy]

Haven't had this experience so far but thank you for drawing my attention to the possibility. I change my cartridge every 6-7 days - it's prefilled, I don't do it from a vial or anything - and whenever I do this I put a new cartridge in that has been at room temp since the previous change, and replace that one in my kitbag with one from the fridge.

So each new cartridge has had 6-7 days out of the fridge, and then I wear it next to my body for the next 6-7 days. And that's quite a lot of heat to deal with, particularly in this weather.

I'll be keeping a close eye on any unexpected rise in my blood sugar levels - thanks for the pointer, @rockape37 !

 

[Chas C]

As already mentioned, I'd be very suprised if you'd get insulin heat issues in the UK with a pump. I've used a pump in 30-40 degrees replaced the empty cartridge every 4-6 days with no issues and the pump kept in my shirt pocket without any other cooling.

I have had issues pen insulin in hot weather when its 30-40 degrees but this was after 8-10 days or so use where it could not be stored on me with frio protection I'd then replace the pen with one out of frio storage and all would be fine.

 

[rockape37]

Well I had a similar problem again yesterday morning, I did a complete set change before breakfast and My BG after this and before lunchtime were within range. My wife and I were at a zoo so walking around at a leisurely pace in the lovely warm weather, anyway my 2hr alarm for a BG check sounded and the results were a big 19.7 despite a corrective dose as per my pump recommended it had climbed to 24.8 by 1700hrs.
I did another set change and used the remaining Insulin from the same vial confident that this would solve the problem. It didn't as 1.5 hrs later although it had dropped my BG was 19.9 my pump recommended another correction which I reluctantly took. Well 1hr 40 mins later my BG was 14.4 still high and not happy and getting hungry, also getting late as I really wanted to solve this before I ate and possibly I should have waited a bit longer but my belly was rumbling and it was 2100 hrs now.

So I another complete set change with a fresh vial of insulin which I had prepared at room temp. My BG since then has been Hunky Dory should I say.
Now I decided to connect the infusion set together that I had removed earlier and inserted the plunger into the reservoir and when depressed Insulin moved freely through the tubing and out of the Cannula, so that wasn't the problem me thinks.

Thinking of what has been said earlier on Pumps and Insulin are used in much hotter countries so why would a mere 26 degrees degrade my insulin or is there something I am missing?

Incidentally I wear my pump around my neck under my T-Shirt , am I exposing it to the elements or body heat too much, I think not.

Anyway if you folks have any ideas or suggestions I will gladly read them.
I will solve this problem eventually hopefully so I can avoid it from happening again or at worst reduce it.

Regards

Martin

 

[jrussell88]

As Chas and others say, temperature is unlikely to be the cause of your problems. I've kept pens for weeks at 35-39 °C without any change in effectiveness.

It might be a different matter if they were in direct sun and the temperature could get much higher.

Maybe obvious, but are you sure about your correction factors, and the time for the insulin to work?

But it looks like you were running higher than usual. If it wasn't the insulin, what else could have caused it?

 

[grr]

Frio pouches have helped preserve my insulin. I also noticed while holidaying in Croatia that my insulin requirement decreased with the hotter weather over there. I carb count so I only inject insulin I need for the food I consume.

 

[tim2000s]

Okay @rockape37, here's my view. In the heat of the Ibizan summer, I spent 6 days over there using my pump. For the entire time I was there, my pump was worn on my hip and the temperature never fell below about 28 degrees celsius.

During that time, the only time I felt my insulin had degraded due to heat was on the 5th day of the holiday after yet another day outdoors in the 35 degree heat. I normally change my reservoir every 6-7 days, like @Snapsy.

When I change the insulin, I fill the reservoir with a full 3ml penfill and use a fresh one each time. I therefore don't need to keep a vial going into and out of the fridge. I assume when you refill from the vial it goes back in the fridge?

The temperatures we've seen in the UK over the last couple of days and the duration of them, wouldn't, in my opinion cause significant degradation of the insulin in your pump reservoir using the model of filling from a penfill that has come from the fridge and spent an hour at room temperature, with maybe the caveat of, "unless it is in direct sunlight for that period of time". Especially when the insulin only lives in your pump for 2.5 days.

However, if you remove the insulin, allow it to warm to room temperature, fill a reservoir, return to the fridge and repeat this twice more, I could see how, with slightly elevated ambient temperatures, your vial of insulin could be denaturing more quickly as it could be causing adverse stress. Given that the guidance on most rapid acting insulins is that when they are kept at an ambient temperature below 30 degrees, it does seem a little unlikely.

The other thing I'd check is the temperature of your fridge. It's possible that the area where you keep the insulin is too cold and as it gets used up, the smaller amounts cool too much.

Finally, I'd be looking at your cannulas and locations of them.

The best way to check this is to keep an eye on whether it happens again, and if it happens and isn't the end of a vial, then check your cannula types and sites.

 

[rockape37]

I take the new vial of insulin out of the fridge (door) at the very least 2 hours before i fill the reservoir and it never gets put back in. Each 3ml reservoir lasts me 4 days and i get 3 full fills from each vial.

I'm certain now that heat hasn't played any part in the very high BG's that i experienced as mentioned earlier in this post. I have since been avoiding the areas that i used to inject and I'm following a more structured site rotation where i insert my canulars now as i should do. So far so good.

Thank you for your input it's most appreciated.

Regards

Martin

 

[Chas C]

Martin, that's good news. If I get unexpected highs then I change the cannula and give the old location a rest. I always rotate around my waist and arms but still sometimes get a dodgy location.