I could swear I need a checklist of everything that can possibly happen so I can start checking these things off. The trip to the Bostonish area went mostly okay. I didn't have any significant change in insulin requirements, but the first day we were on the island, I had to lower my basal by .05 and bolus by one g/carbs. After that, everything was normal. I anticipated how much extra insulin I needed on the plane and was right. That was great.
Now, for the weird part. The first day we were there, the place we were staying was around 90° and up. By the end of the day, the insulin in my pump had gone bad. I then had to refill it with cold insulin. I do have a pump frio, but I didn't think it would be warm enough outside to bring it. It wouldn't occur to me that I'd need to use it inside, since I can't be in that kind of heat due to another medical condition. In retrospect, we really should have rented a car and gone to a hotel. I did bring a frio for insulin, but it didn't really keep it cool enough. I did make sure to water it enough and let it breathe, so maybe it's because I used the waterproof inner bag? I'm still not sure why. When we got back, I just ended up throwing out all the insulin I took with me since our flight had been delayed and it had been hot, etc.
Despite all these precautions...the vial of insulin I opened upon our return (from my fridge) was bad. The first day, I thought it could be a million things and used 11% more insulin. The second day, I used 25% more insulin. Today, I woke up out of range for the first time in six months and was using 50% more insulin (!) when I finally went, "hey, wait a minute..." After I'd decided to return the insulin, I remembered that J. once had to return some bad insulin to the pharmacy (and we use the same one). I asked him when and he said a month and a half ago. Sure enough, that's when I picked mine up. So, I took them back to the pharmacy and got replacements. The pharmacist was quite surprised and looked grim when he said he'd have to pull everything from that lot. He didn't remember J. returning his. That got me thinking...if a whole shipment of insulin goes bad, why do so few people notice? Are most people getting it Type 2 and it doesn't make much difference? It's very noticeable to me because my TDD is so low. Do people not test very often? I wonder why that is.
7 comments:
Good question? Maybe it is b/c we assume the insulin is fine and that WE are doing something wrong. It is so difficult to pinpoint causes, and then you can always throw in the element of stress as a possible explanation. I think it is really creepy that you cannot rely on the insulin being good. In the summer when it is hot I really try and use my FRIO pouch that fits around my insulin pump.I think that people who are very sensitive spot such problms more easily. Sililarly, I have to wear my insulin pump upside-down to prevent air bubbles from getting in the line. Small bubbles mess be up since I often take only 0.2U/hr. At night, bubbles can really cause problems. Do you have to wear your pump inverted? In the summer I have more troubles with bubbles. This summer I have no such troubles since it is cold and will not stop raining..... I am glad you enjoyed your trip to Boston.
Chrissie - interesting. I think you're right, because I know I didn't think it was the insulin until the third day. I'd probably be more inclined to think it was if everything else hadn't changed, too. I haven't had many problems with air bubbles, so I don't wear my pump upside down. When I had to put the cold insulin in, I waited until it had warmed up and then primed the air bubbles out.
I'm curious. How do you know it's gone bad? Because your numbers were off so much?
I keep mine in the fridge because of those lovely summer days when the temperature gets into the 90s. I'm north of Boston so I know some of what you experienced! Thankfully we don't have too many of those.
Bernard - I can tell when the insulin because my bg goes up a lot when I haven't eaten and I use way more insulin but my bg still won't come down. I should have clarified that I was using all that extra insulin, but still running higher. Normally when a correction does nothing, I will do an injection from the same vial. If that doesn't work, I'm pretty sure the insulin is bad.
I am just thinking here about my erratic, unexpained need for more insulin since February. I have used different bottles of insulin - how can I check if "they are from the same batch"? I have not blamed the insulin b/c the rapidly changing amounts have been occurring since February, so in that time I have of course used different bottles. BUT perhaps this INSTABILITY in the insulin is a sign that it is bad (it DOES inconsistently reduce my bg values)and perhaps these insulin bottles are all from the same batch! It is like I just NEED to believe the insulin functions correctly. Last week I had hypos and went back to normal insulin levels. This week I need to increase the amounts again. Could it be the insulin???? SIGH! Have I changed the bottle? I guess I better investigate. In your comment to Bernard you say that if neither a correction bolus or an syringe injection fail to lower your bg you say it is the insulin. Two points - it could be that your body is producing counter-regulatory hormones which fight the insulin or that ketones are preventing the normal effects of insulin. Haven't you found that repetitive correction boluses eventually get the bg down. You have to admit that when you have a high test and you take insulin and the bg doesn't go down, you get very stressed! And this of course makes it harder to get the insulin to work properly. Secondly, if the insulin does cause a decrease in bg, BUT NOT AS MUCH AS IT SHOULD GO DOWN, that could be b/c the insulin is defective, unstable. I usually have such a hard time pinpointing the true causes, so I assume the insulin is OK!
Chrissie - I guess I didn't explain fully. I generally don't have highs because I can feel them, but I do have a range I like to be in. I will correct aggressively down to that range, and still don't have many lows, probably because I still make a tiny bit of insulin. The way I do corrections (don't try this at home) is to do a correction and wait an hour. (Normally, I will drop significantly in an hour). If nothing happens, I do another correction and bolus for something with a lot of carbs. Then I check at 30 and 60 minutes to see if I've dropped significantly (and if so I eat the snack). I am very sensitive to insulin, so if I don't drop from that, something is wrong. I used to continue doing corrections every hour, but it would be like 10-12 hours before my bg finally came down, so now I cut to running through a list of things like taking an injection and changing the set. I could also tell it was the insulin because as soon as I changed it with new insulin, everything worked perfectly and my normal basal worked fine. Things are very consistent for me generally, so it's probably easier for me to tell what the problem is.
I'm on a beta blocker (for something else), so I don't get adrenaline spikes in cases of stress that would act against the insulin. The tradeoff is I also don't get adrenaline spikes with lows, which is what causes shakiness, pounding heartbeat, etc.
The pharmacist said he'd pull everything from the same lot number, but I don't know if each shipment is broken up by lot number. My guess is that the problem happened on the truck delivering the insulin or in the pharmacy, because I use Novolog and J. uses Humalog. He used his right away after picking it up, while mine sat in the fridge (no power outages) for 1.5 months. I think we may have even picked them up on the same day. I don't know how it would get exposed to heat (the most likely thing) in the pharmacy, though. I know the lot numbers are on the box, maybe on the bottle, too?
Now I understand more clearly - if the bg does not go down in a 10-12 hour period then something HAS to be wrong with the insulin. I know your body is different from mine, but I am very sensitive - my normal total daily dose is about 15U. Since February everything has been up and down. My CDE said just Friday we cannot understand all the elements that affect our bg levels and we just must deal with what happens as it happens. He is a good guy now that he finally accepts that my management is excellant and very aggressive. He cannot recommend my aggressive methods to others b/c one has to be VERY careful. I too do repetitive correction boluses. The quickest way to get a bg down is to do the correction bolus with the next meal bolus, but wait to eat until the bg is at 80mg/dl.You have to be very careful doing this b/c once the bg gets below 100 it starts to drop like a stone. At this level, with the bg falling quickly, you must eat immediately.
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