Insulin Temperature - The Review

This is of course purely from the users mindset. Having come to cooler temperatures this fall, the issue of body temperature and external temperature factors effecting my insulin and its effectiveness have come to mind again.

All three of the more familiar insulins, (Apidra / Novolog / Humalog) for type I Diabetics, appear to all be on the same page as per temperature levels for storage and insulin pump use.

New Bottle to Insulin Pump Use

• Apidra-------------------- 36 - 98.6 degrees F
• Novolog------------------- 36 - 98.6 degrees F
• Humalog------------------ 36 - 98.6 degrees F

So, a poll of user issues with this is not really necessary I feel. What I do feel is necessary is to do some testing myself. So I shall proceed and write later about this when I've obtained some results later under varying conditions. The main question here seems to be in my head..."What is the percent of deterioration, in effectiveness of the insulin, over time in an insulin pump cartridge while being exposed to an average variance of daily temperatures"?

I may not be able to obtain data about remaining effectiveness for the insulin, but I can obtain data about temperature levels from environmental and body variances on the insulin in my cartridge. After all, most of us are very active individuals and throughout our daily routines I'm sure we all come into contact with environmentals that exceed the temperature limits for our insulin. Let's see what I find.

Transitions

    Well, I'm on the last bottle of Novolog I'll use for the warmer part of the year. It's cooled down significantly here and so training doesn't get so hot anymore. Time to transition back into Apidra use in the pump. I brought this issue up back in April and made some notes and changes because of it.

   I'll post a survey on here about insulin usage that I would be very interested in reading results from folks. Let me draw it out and make sure it's appropriate and it will be posted sometime today. Thanks.

Tuesday - Anniversary and Update

   Anniversary, yes, the one nobody should forget. Today makes 7 years for my wife and I. Great ones and we look forward to many more. Tonight, it'll be dinner at our favorite restaurant we don't visit very often...J. Alexander's.

   As for updates, I can say I have yet to have a "No Delivery" issue since having swapped over from Apidra to Novolog. I hate that, because Apidra was kind of a nice change. I liked how it reduced the bell curve from going so high for me post prandial. I can get close with Novolog though. I've just been pushing hard to dose at the very first bite of food, unless my sugar was already low, then I'll wait a few extra minutes before doing. I think it'll be a touch and go next fall when I start up the Apidra again. For now though, I have to associate the "No Delivery" alamrs on the pump to the Apidra insulin and not to bad cartridges.

Thursdays Thought

   OK, here's a thought. I'm thinking that maybe there could be an association between using Apidra and my having so many "No Delivery" alarms of late. I've used Novolog in the pump for many years and NEVER had a "No Delivery" alarm from it. It could be coincidence to have been having the alarms of late and to be using Apidra at the same time. That's easily possible. This is my last cartidge of Apidra I'll use for the summer as I just emptied the latest bottle.

   I'm just trying to brainstorm the possibilities here and see what others are experiencing. So, any others having "No Delivery" alarms...fairly often?

APIDRA - What's the BIG DEAL

Some Details: This spot concerns those who use Apidra in an insulin pump and exercise fairly often. Realise that most of this data is from personal experience, that linked and quoted data is tested and factual according to each of the respective companies.

   I saw my endo this last week and my wife got to meet her for the first time also. It was a good sit down. We were looking at my bg's and trending along with correlative food intake. What the endo wanted to know was if I was having high, almost uncontrollable glucose levels at certain times of usage from the pump. When I say "certain times" I'm referring to how many days worth of insulin I put in the cartridge and when those problems highs were starting in...I fill it for a 3 day usage. So, it turns out it was almost always like day 2 or 3 of a cartridge when I started having uncontrolled high Glucose. I could take two times the normal amount of insulin and the glucose would barely budge. So, here's the issue. Apridra, made by Sanofi Aventis, has a 77 degree threshold, after which the effectiveness of the insulin degrades. They also state, "Infusion sets (reservoirs, tubing, and catheters) and the Apidra in the reservoir should be discarded after 48 hours of use or after exposures to temperatures that exceed 98.6 degrees F (37 degrees C)".

   So, "control we have a problem". We're talking about users of a product ranging from the not so energetic to the very energetic. Those very energetic are going to get their outside body tempts above 98.6. Let's face it normal body temp is 98.1 degrees and add a good run to that on a sunny June afternoon......forget using that cartridge of Apidra attached to you hip, according to Aventis. I sleep very comfortably during the winter under a wonderful down comforter also. The temps under that thing are great for the body, but horrible according to Aventis for your Apidra. NO WONDER I 'VE HAD PROBLEMS GETTING THOSE SUGARS DOWN SOMETIMES.

Let's do a little comparison here with Apidra, Novolog, and Lantus.

Production: Apidra and Lantus are manufactured by Sanofi Aventis. Novolog is manufactured by Novo Nordisk.

Insulin Recommended Storage (Pump/Tubing/Etc)

Apidra Infusion sets (reservoirs, tubing, and catheters) and the Apidra in the reservoir should be discarded after 48 hours of use or after exposures to temperatures that exceed 77 degrees F (37 degrees C)".

Lantus The opened (in-use) cartridge system in OptiClik® should NOT be refrigerated but should be kept at room temperature (below 86°F [30°C]) away from direct heat and light.

Novolog NovoLog® in the pump reservoir should be discarded after at least every 48 hours of use or after exposure to temperatures that exceed 37°C (98.6°F).


   So, here we have a confused intersection of details. Pump companies, let's just use Minimed, say to change your infusion sets and cartridges every 2-3 days. Insulin pharmecos say to change insulin every 48 hours regardless and sooner if the insulin is exposed to temps greater than a range of 77 to 98.6 degrees.

   I will state the following from self-observance. I've never had uncontrollable upswings from Novolog during high intensity exercise, summer months, sleeping under a very warm comforter, or even going 4 days (I know, I know) on the same cartridge of insulin. I can only state that I have done most of these things with Apidra and am having issues with uncontrollable high glucose about every 2-3 cartridge changeovers. I think if I were more closely analysed this, it would be revealed that the insulin is going bad from temps exceeding 77 degrees.

Test Solution:
I've started to fill the cartridge for 1.5 days worth of insulin. Let's see how this goes, until July when temps will force me to use Novolog for safety again.


Food For Thought: It's summed up in three alphanumerics "TT1". They use Apidra and they use the Omnipod, which is attached to your body, not clipped to your hip. How long do they use their insulin pods for? Even more importantly, what does the sustained external body temperature get to for one of their cyclist users?


What Say you?