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Hot, Hot Heat.

Magical StuffInsulin is not a cure, but it is quite the magical substance.  Every single day, my body fails to produce its own insulin.  And every day, I am able to supplement my physiological failures with some nice, cool synthetic hormones.  Mmmm, delicious.

I’m very careful with my insulin supply.  I have the little white boxes neatly lined up in the fridge like my army of miracles.  I take careful note of the expiration dates and I always reorder on time.   One time, while I was in college, I dropped my last bottle of Humalog on the floor and it shattered into a million pieces.  I drove 2 hours to the closest 24 hour CVS to purchase a bottle out of pocket. 

I’m dedicated to the stuff.

Which is why this past weekend surprised even me.

Chris and I went home to Rhode Island for the weekend to visit grandparents and hang out with our friends.  A few of my College Roommates (there were seven of us) were heading to Narragansett Beach for some sandy shore festivities and I was running late (per usual) in joining up.

“I’m about twenty minutes away.”  The first sip of my iced coffee and a quick half-unit bolus on the pump as I waited at the stop light on Route 1 South.

“We are already at the beach.  Just park at the hotel and meet us down here.”

“Will do.” 

Drove like a maniac to the hotel.  Tossed the car into a spot, hung the parking pass in the mirror, and chucked my overnight bag (complete with change of clothes for later and all my medical supplies) into the trunk of the Jetta. 

My navy blue Jetta with black interior.  The one parked in the hot, hot July sun, no shade in sight.

Stupid girl.  Not thinking...

I spent all day on the beach without thinking much about my car.  There were other things to concentrate on, like trying not to kick sand up on other people’s blankets, playing in the Atlantic Ocean, and making sure my bathing suit didn’t suffer the consequences of the rough surf. 
A day on the beach laughing and talking and making plans for that Saturday night.  Around four o’clock, we walked back to the hotel and started calling dibs on who would shower first.

“I just have to grab my bag.”  I popped the trunk and retrieved my overnight bag.  The zipper was hot to the touch.   I still didn’t make the connection.

In the hotel room, I noticed that my pump site was completely sticky from sunscreen, sand and salt water.  I could barely get the infusion set to reconnect to the site.  Luckily, being ever-paranoid, I had the Quick-serter, a back-up infusion set and a bottle of insulin tucked neatly into my overnight bag.

A nice, steaming hot bottle of insulin.

Oh for crying out loud.

Almost a brand new bottle and I had cooked it.  Even worse, I didn’t have enough insulin left in the pump cartridge to freestyle for the rest of the night – the reservoir had to be changed.

“Moron,” I muttered to myself, sticking the bottle of insulin into the hotel fridge, hoping that the insulin would be magically useable if I just made it cold once more.  After a cold shower, I took the bottle from the fridge and began priming the pump.

“That wasn’t in your car all day, was it?” one of my Roommates asked.

“Yeah.”  I rubbed the IV prep on my thigh and waved my hand at it to dry it off.

“Is it still going to work?”  Roommate looked concerned.

“Here’s hoping...” Inserted the site, fixed-primed, and took a preemptive correction bolus.  “I’m 155 mg/dl now.  If my bloodsugar comes down, we’re back in business.”

“Otherwise you’re driving two hours to that CVS again, right?”

“Right.”  Flashed a hopeful grin.

About twenty minutes later, my bloodsugar eased down to a tight 100 mg/gl and my night of Fancy Dinner and drinks at the Coast Guard House was saved. 


Was this a fluke?  Shouldn’t this bottle be considered “ineffective” and tossed?  Why is it still working, to this day??  Has anyone else had their insulin supply survive an unfortunate turn of events?

Faithful Readers, insulin is a magical substance.  Not only does it sustain my life and keep my body running properly, it can also apparently sustain prolonged exposure to high temperatures.  It’s definitely not a cure, but it is tough stuff.    

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Comments

You were just plain lucky! When life throws you an unexpected nice surprise, just "bask and savor".
One time I froze a bottle in the car and when it unthawed there were some weird gross chunks floating around.
Glad you enjoyed your trip.

I think if you take a look around you will find that generally Insulin is a pretty hardy substance. I was always told by Endo that I could keep my insulin in my bag instead of risking leaving it a fridge during my vacations. This is all off the top of my head, so someone correct or confirm if you know this but I think storing insulin at room temperature it will last for months instead of a couple years in the fridge.

Diabetes Mall seems to suggest that potency of insulin is the biggest risk. I've left humlaog pens in my car (in the summer as well) by mistake before and in a pinch used them when I forgot the good stuff at home. It has always worked for me, but I think it certainly does lose some of its punch.

it's good to be lucky ;)

What I can't believe is that they came out with the insulin bottle size that I dreamed up years ago! Humalog in a small vial for pump backup?! Is this actually available?

huh. now I'm the moron. Is that a pen cartridge?

I wonder if you can stick a syringe into that skinny catridge size. I've often thought it would be great to hve a small 'backup' to toss in a bag so that if it does get forgotten in the trunk of a car, purse, pocket, you don't lose a whole vial of insulin.

Maybe I should just get a pen :)

Working with proteins - and insulin is a protein - I can only support the fact that proteins are tough yet still fragile in certain conditions. Heat does have a destabilizing effect on proteins, incl. insulin, but the effect need not be irreversible. For more (scientific) information on this, try this link (http://class.fst.ohio-state.edu/FST822/lectures/Denat.htm - how do you make hyperlinks in blog comments?) and scroll down to "Thermal denaturation".

Another thing: think about how insulin, after all, carries out its actions in the body at 37.5 degrees Celcius (that’s 100 degrees Fahrenheit, I believe) and even warmer during a fewer. The fact that diabetics need more insulin when feverish has nothing to do with the insulin loosing its effect at these temperatures, rather that during illness and fewer a lot of other hormones and factors that counteract insulin action are present in higher amounts than usual.

Bottom line is that insulin exposure to heat may not be detrimental, but of course it is better to be safe than sorry, which is why we try not to keep our "artificial" insulin at too high temperatures, whenever possible.

Glad you had a fantastic day at the beach and your insulin survived the stay in the hot trunk, Kerri!

A head scratcher, indeed.

I'm actually heading out for a day at the beach this weekend and was considering going off the pump for the entire weekend. I know you considered this for your cruise, but I think you didn't choose that option, right?

Do you have some "freestyle" approach to a day at the beach you could fill me in on? (Oh, am I remembering correctly that you wrote an article about this for dLife? I'll go search that out now).

Thanks!

Kass - It's a pen cartridge. But I have most definitely stuck a syringe in it and drawn out a shot. I've also used a pen cartridge to refill a pump reservoir. I've also drawn an injection from a pump reservoir.

The only thing I can't seem to do is make my own insulin. :)

Heidi - I think about the fact that insulin is coursing around in my 98.6 degree body whenever I start to get unnerved at the fact that my pump has been tucked into my pocket in the sun too long. And to make a hyperlink in the comments, just utilize the a href command like you would in your blogger template. If that doesn't make sense, email me.

Minnesota Nice - I loved that I was lucky that time. And that I continue to be lucky, because I'm still using that boiled bottle to this day.

Alexis - My endo told me that insulin in the fridge will last until the expiration date, a bottle in room temperature in the summer will last 30 days, and for the cooler times of year, 2 months. Personally, I don't test that theory because I covet insulin and hate the thought of wasting any. However, I have left my humalog back-up pen in precariously hot/cold places and have used it just fine. I think the potency is slightly affected, but I don't use it enough to really test that theory.

Phew!

Kevin - You must have been commenting just as I was answering comments. :)

I didn't choose to go off the pump for my cruise because of the pain in the ass transition from pump to Lantus. I have been wearing my pump to the beach for the last three summers. Seriously not a big deal. When I'm laying out, I have it my side and wrapped up in a light colored t shirt or towel. When I go in the water, I tuck it into a plastic ziploc bag and chuck it in the cooler. It's just more convenient for me than disconnected, dealing with shots all day long, and then messing with the reconnect. I'd rather just roll on as usual.

And no one notices the damn thing. It helps that I have the infusion set on my thigh. Makes it a little less obvious.

The dLife article is at Diabetes Can be a Day at the Beach!

I lugged around all my diabetes supplies (pre-pump) in a large bag throughout Europe. Europe in late August, early September is hot. And there is no air conditioning anywhere. Somehow, I managed to survive on my hot insulin for a month. Glad to hear that you didn't have to drive for new insulin!

I carry insulin with me in my meter, which often sits in my unairconditioned purse, and I haven't had a problem, but it sounds like you got a nice break with the insulin in the car.

And I *LOVE* the photo. Insulin with sunglasses. Nice.

i've cooked many a bottle of insulin (i'm stupid) and luckily it's always worked. maybe it's better than we think.

:o) glad you had fun at the beach.

Lyrecha - Chris has been fiddling with Photoshop. He'll be very pleased that you liked his sunbathing Humalog.

This summer, I've also mistakenly left insulin in my car for several hours only to come back and find it at a less-than-optimal temperature. Since I had so many vials in there, I was horrified when I realized what I'd done. I didn't want to waste all of it, so I tried it out and haven't noticed a difference. I've used insulin from two of the vials, so I'm expecting the rest to work just as well.

I don't know if we were just lucky, but I suspect that insulin, as it's been suggested in the comments here, isn't quite as fragile as we've been led to believe. (That doesn't mean I'm going to take any more chances, though!)

At any rate, I'm glad you didn't have to give up any part of your trip to go driving for more insulin!

I've been to Naragansett beach! When I was 15. There were some seriously amazing waves caused by Hurricane Felix (I think) which had just spun away from the New England Coast. I went to see the Keanu Reeves film 'A Walk In The Clouds' in a little cinema there, and Naragansett was the first place I ever ate Lobster.

As for the insulin, I think a lot of recommendations are very precautionary. I've used insulin that has been out of the fridge for months or exposed to fairly high temperatures without problems several times. I did have bad insulin earlier this year. It didn't toally not work, I just needed an awful lot more of it.

Glad your day wasn't ruined though. That would really have sucked.

I guess it isn't as fragile as originally thought. But I'd buy a Frio pack for next time. Just to be safe.

For Kevin: I had my daughter on an untethered regimen for a week. She took Levemir and just bolused with her pump as needed. It worked really well for us. The protocol has a write-up on the Children With Diabetes web page - search on Dr. Edelman. I know a lot of parents who have done this with great success.

The graphic of the insulin bottles wearing sunglasses are a funny touch! :-)

Wow - that's some extreme surviving your insulin did!

That picture is great - made me chuckle out loud. Chris - you did a good job man!

Does it seem to have lost any potency? Not sure if it would based on Heidi's comment - but I would venture to guess that your trunk was much hotter than just 100 degrees...

I remember that I once, in a pinch, used (for a few hours) some insulin that had been in my sports bag for YEARS - like at least 2 or 3. It got me through, but was most certainly less effective than fresh stuff.

Thank goodness that we can get creative when it comes to survival!

Hi Kerri,

I've had similar results with my insulin and always wondered why.

I know that a hot car can get way hotter than body temperature, but I figure that most of my insulin is room/body temperature anyway since it has to go through the tubing which is generally right next to my skin.

Years and years ago, I also used to use a bottle of Regular til I ran out... and I was taking less than 10 units a day. I never noticed a difference in the effectivenes either.

You can never be too safe I guess. But I wonder if it's some kind of marketing ploy by the insulin manufacturers so you have to buy more?

-Stella

In 14 years of living with diabetes, I have never had insulin go bad on me...even during various questionable occasions. But then I think about the tubing that my insulin is sitting in before it makes its way under my skin and how it's pressed against my body, otherwise known as a 98.6 degree personal heater. It has to survive those conditions every day no matter what outside influences are present.

Take a look at my Medco games post. it might be a clue as to what happened with your bottle.

Basically it isn't that sensitive to heat.

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