# Do you keep your current insulin in the fridge?open it



## Radders (Oct 7, 2017)

i've always kept my current vial out of the fridge but now that my total insulin requirements have dropped, a vial lasts longer than a month, and if I refill the pump five times I definitely notice that the insulin in the last refill is less effective. That means I would have to throw away the vial after 24 days, still containing 400 units which seems wasteful.
I'm wondering whether the insulin would last longer if it was in the fridge, or whether it is the time when you first open it that counts? I just know I will forget to get it out in time to warm up before refilling though.


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## Redkite (Oct 7, 2017)

No, we were told that when you start a vial, that starts the clock ticking, and after 28 days you should discard any remaining.  You say you've already noticed that it becomes less effective towards the end of a vial, so don't risk it!


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## SB2015 (Oct 7, 2017)

I was also told to keep the current one out of the fridge and discard after 28 days.  Since I am quite often more than an hour from home I just carry a small bag with cannula, infusion set, cartridge, pusher in, and vial in my handbag so no time for it to be in the fridge.  I have got caught out so glad to have these with with me.

I too often have some left over as I don't use a lot of insulin, but I want my diabetes to fit round my life so I just accept that.  I have tended now to fill my pump with a little extra so it allows me to remove any big bubbles that appear without any concerns about running out. 

With FIASP I am changing cartridge every three days so with the set priming there is only a little left.


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## HOBIE (Oct 7, 2017)

Why is this in Pumping section ? Same as Pens ? Have never stored Insulin anywhere else but fridge. Apart from holiday


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## trophywench (Oct 7, 2017)

Always stuck mine back in the fridge after using it whether it was for jabs a million years ago or for my Combo pump.  Never noticed any difference re effectiveness but whatever - if you are supposed to chuck it - chuck it!


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## Radders (Oct 7, 2017)

HOBIE said:


> Why is this in Pumping section ? Same as Pens ? Have never stored Insulin anywhere else but fridge. Apart from holiday


It's not quite the same though Hobie if you only fill the pump every six days.


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## Pumper_Sue (Oct 7, 2017)

Mine has always been kept in the fridge and have always used past the 30 days. From reading the instructions with Fiasp it does imply to keep open vials in the fridge, with my bovine insulin it always stayed stable no matter where it was kept.


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## Pumper_Sue (Oct 7, 2017)

HOBIE said:


> Why is this in Pumping section ? Same as Pens ? Have never stored Insulin anywhere else but fridge. Apart from holiday


Hobie what is it with you and your criticism of where posts are put? You have been guilty on many occasions of placing posts in the wrong forum yourself 
This post is exactly where it's meant to be and for a reason.


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## Radders (Oct 7, 2017)

trophywench said:


> Always stuck mine back in the fridge after using it whether it was for jabs a million years ago or for my Combo pump.  Never noticed any difference re effectiveness but whatever - if you are supposed to chuck it - chuck it!


The reason I don't keep my current vial in the fridge is because I was told that filling the cartridge from a cold vial would lead to bubbles - is this a myth, do you reckon? Interested to hear from the fridge- keepers on this one!


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## Radders (Oct 7, 2017)

Redkite said:


> No, we were told that when you start a vial, that starts the clock ticking, and after 28 days you should discard any remaining.  You say you've already noticed that it becomes less effective towards the end of a vial, so don't risk it!


Yes you're right Redkite but I was thinking that if it's in the fridge in between uses it might last longer than 28 days. I'm sure I have read other comments on the forum from people who have used it for longer by doing this. 
I suppose the air we inject into the vial might be what starts the deterioration. I'm always looking for ways to avoid waste if at all possible though!


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## Radders (Oct 7, 2017)

SB2015 said:


> I was also told to keep the current one out of the fridge and discard after 28 days.  Since I am quite often more than an hour from home I just carry a small bag with cannula, infusion set, cartridge, pusher in, and vial in my handbag so no time for it to be in the fridge.  I have got caught out so glad to have these with with me.


I only carry a spare pen - I worry I would break the vial if I carried it everywhere!


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## HOBIE (Oct 7, 2017)

Radders said:


> The reason I don't keep my current vial in the fridge is because I was told that filling the cartridge from a cold vial would lead to bubbles - is this a myth, do you reckon? Interested to hear from the fridge- keepers on this one!


Hi Radders. I always keep my insulin in the fridge like you are suppose to. I have never had probs with bubbles like some. That's half bottles full ones. No difference since being on pens inc Glass syringes. Prob before fridges where common


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## stephknits (Oct 7, 2017)

I always take mine out and about so that I can change if needed.  The DSN has always said to keep current one out of fridge and with you.


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## Radders (Oct 7, 2017)

HOBIE said:


> Hi Radders. I always keep my insulin in the fridge like you are suppose to. I have never had probs with bubbles like some. That's half bottles full ones. No difference since being on pens inc Glass syringes. Prob before fridges where common


When you say "like you are supposed to", would you mind explaining why you say that please Hobie? I have always been told not to!


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## HOBIE (Oct 7, 2017)

I was told to store Insulin in the fridge. It gets delivered from the chemist in a different bag from tablets because they store it in a cold bit of the van. Ask your chemist


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## Radders (Oct 7, 2017)

HOBIE said:


> I was told to store Insulin in the fridge. It gets delivered from the chemist in a different bag from tablets because they store it in a cold bit of the van. Ask your chemist


Ah, I see! Yes of course I keep it in the fridge before it's opened but that instruction doesn't apply to the cartridge or vial currently in use, so I was told.

I was just looking at the instructions for my insulin and apparently I should be changing the whole set every 48 hours! Well I don't think that's ever going to happen.


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## Matt Cycle (Oct 7, 2017)

HOBIE said:


> Why is this in Pumping section ? Same as Pens ? Have never stored Insulin anywhere else but fridge. Apart from holiday



I was on Ultratard basal for around 20 years until 2006.  10ml vials and injected via a syringe.  I always kept it in the fridge when in use and at 1000 units per bottle and using around 20-25 units per day this lasted 40-50 days.  Never had any problems with it.


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## Radders (Oct 7, 2017)

Matt Cycle said:


> I was on Ultratard basal for around 20 years until 1986.  10ml vials and injected via a syringe.  I always kept it in the fridge when in use and at 1000 units per bottle and using around 20-25 units per day this lasted 40-50 days.  Never had any problems with it.


Thanks Matt. Isn't it odd how we have all been told different things!


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## trophywench (Oct 7, 2017)

I've never had less bubbles initially when filling either type of syringe or plastic pump reservoirs whether it was kept in the fridge or the latest one left out.  It is true that doctors invariably used to tell us to keep animal insulin in the fridge between jabs, and when I changed to synthetic stuff and pens I only kept the 'in use' pens of bolus insulin in my handbag - the basal pen when it was one jab at night again in the fridge, only later using 2 x Levemir a day did I start leaving that basal pen in my bag too.  I've never ever noticed any difference when jabbing cold insulin or room temp insulin.

I have had two whole occlusions in pumps - first with the Combo - I'd changed the whole caboodle one day somewhere where there was no light, me thinking at the time I could see ok.  Ooops - I'd entirely omitted to prime the tubing!  The second time with the Insight when I'd somehow managed to fold the tubing in two and trapped it somewhere it couldn't escape from.  That's in 8 years of pumping and both times it was 'User Error'.

Like I said Radders - if you think it deteriorates after 28 days out of the fridge - then sling it.  Or keep it in the fridge!

However what's 'normal room temperature' ? and how can we ensure easily that every room either us or our insulin is in during every period of 28 days is 'normal' ? - we can't, can we?


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## trophywench (Oct 7, 2017)

Ultratard was an insulin zinc suspension, much as a number of older ones were - and they DID have to be fridged else they went crystalline - Humalin I does that too if it's out too long.  The one or two a day older animal insulins did that too.


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## Pumper_Sue (Oct 7, 2017)

Radders said:


> The reason I don't keep my current vial in the fridge is because I was told that filling the cartridge from a cold vial would lead to bubbles - is this a myth, do you reckon? Interested to hear from the fridge- keepers on this one!


Just take it out 20 mins before needed solves the problem if there was one in the first place


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## Sally71 (Oct 7, 2017)

We keep the in use bottle out of the fridge as that's what we were told to do, daughter's insulin requirements have shot up so much in the last couple of years though that we don't have a time issue, one 10ml vial barely lasts 3 weeks at the moment!  I was told that the pump must always be filled with room temperature insulin because you are more likely to get bubbles if it is fridge temperature; whether this is actually true or not I have no idea, I have never tried it.  If I find I need a new vial and have forgotten to get one out of the fridge I just warm it up in my hands or down my bra for a few minutes before filling the pump.  I don't actually see how it could cause a problem if you wanted to put it back in the fridge between uses, and would have thought that would extend the life time.  I also think the 28 day rule is only a guideline and you might well get away with more if you are lucky.


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## everydayupsanddowns (Oct 7, 2017)

Radders said:


> Yes you're right Redkite but I was thinking that if it's in the fridge in between uses it might last longer than 28 days. I'm sure I have read other comments on the forum from people who have used it for longer by doing this.
> I suppose the air we inject into the vial might be what starts the deterioration. I'm always looking for ways to avoid waste if at all possible though!



I have to say that has always been my assumption too - that the insulin is good for 28 days at room temp, but that if I put it back in the fridge the '28 day clock' would halt. I hadn't thought about air or anything else having an effect - so that's interesting!

One thing that strikes me @Radders is whether you could use penfill carts instead. I used up my stock of NR carts when I first started on a pump, and while they weren't 100% as easy as a vial, they were easy enough. Penfills are so much smaller you'd have less trouble using them up within the 28 days I would have thought?


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## Radders (Oct 7, 2017)

everydayupsanddowns said:


> I have to say that has always been my assumption too - that the insulin is good for 28 days at room temp, but that if I put it back in the fridge the '28 day clock' would halt. I hadn't thought about air or anything else having an effect - so that's interesting!
> 
> One thing that strikes me @Radders is whether you could use penfill carts instead. I used up my stock of NR carts when I first started on a pump, and while they weren't 100% as easy as a vial, they were easy enough. Penfills are so much smaller you'd have less trouble using them up within the 28 days I would have thought?


I'm not sure that I would be able to fill the pump cartridge with a pen fill cartridge: I haven't tried it but the pump cartridges I use come with an attachment that fits over the neck of the vial. Not sure it would work on a cartridge but you're right that it would solve the problem of wasted insulin, I suspect that might be negated by the additional glass though of the cartridges. I would use two cartridges where I currently use one vial.


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## Radders (Oct 7, 2017)

Pumper_Sue said:


> Just take it out 20 mins before needed solves the problem if there was one in the first place


I must admit I had thought it would take longer than that to warm up, Sue!


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## trophywench (Oct 8, 2017)

Nah Radders - 20 mins is a max.  If it's the summer (or this time of year like me the CH is whacked on) it takes far less - and if you take it out the box and cuddle it in your hand for a minute or two - it's fine.  I expect like camera batteries used to be on the school skiing trips my teacher mate used to organise, a well endowed lady - she was much in demand by all her charges as she had a knack with them that she didn't divulge to them - they went under one of her boobs inside her bra!  Magic Miss!  LOL


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## Radders (Oct 8, 2017)

Thank you to everyone for your contributions. I've been thinking about the reasons why using it straight out of the fridge might cause bubbles. I seem to remember it being about the sudden change in temperature. That got me to thinking that surely there will be another sudden change by just as much when the pump goes back on my person. 
In the fridge: 4 degrees
Room temp: 21 degrees-ish depending on the season, could be more or less
On me: 37 degrees
So going straight from fridge to pump would be quite a large jump I suppose. 

Next vial I am going to try keeping it in the fridge and just letting it warm up for 20 minutes as Jen and Sue have suggested. I will then see if it lasts for five refills (30 days) and if it does I will try six (36 days). The deterioration I have noted isn't sudden or catastrophic so I don't think it's a high risk. I just notice that I need rather more to correct than normal and have to do more corrections. 

The fact that Apidra is only meant to last 2 days in a pump has shocked me the most! For all the years I have been pumping I have had 6 days out of it, although I did notice some deterioration on the sixth day for a couple of months when I was doing some quite vigorous circuit training. Those days are over now!


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## Radders (Dec 4, 2017)

Update. I think my experiment proved that the 28 days still applies when Apidra is kept in the fridge. I had forgotten the experiment was going on and couldn’t understand why my levels were so bad, then I remembered! I forgot to write the date on the vial when I started it but it must have been getting on for 5 weeks. 
It didn’t stop working but was less effective, giving me gradual overnight rises and correction doses that just didn’t seem to do anything. A couple of times I changed the cannula and it seemed to solve the problem, but only for a day or so. This fooled me into persisting a bit longer than I should have! Hindsight’s a wonderful thing. 
I still think it takes longer to warm up from the fridge than 20 minutes. I have been filling the cartridge and letting it stand so that the vial is out of the fridge as short a time as possible but the bubbles have time to rise to the top to be primed out. Today I did this and left it for an hour before changing the set, and it still felt cold.


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## m1dnc (Dec 6, 2017)

Radders said:


> .... I've been thinking about the reasons why using it straight out of the fridge might cause bubbles. I seem to remember it being about the sudden change in temperature.....


No, that's not the reason. It's because the solubility of a gas in a liquid _decreases_ as the temperature increases i.e. the opposite of the solubility of a solid in a liquid which _increases _with increasing temperature. So when you take the vial out of the fridge and let it warm up slowly any dissolved air or other gas that has been used to flush the vial during manufacture, comes out of solution in the insulin into the gas space at the top of the vial or as bubbles formed when the vial is shaken as the reservoir is filled. If you don't let it warm up properly, that dissolved gas gets transferred to the reservoir and then comes out of solution as bubbles later.

As to the 28-day 'rule',  the very rough rule of thumb that chemists use is that the rate of a chemical reaction doubles with every 10 degree rise in temperature. So if you keep the insulin in the fridge at 4 deg and then take it out to a warm room at, say, 24 deg, the rate of degradation of the insulin (which is a chemical reaction) will increase four times. There are most likely other effects that also affect the degradation of the insulin when you start using the vial, such as the effect of introducing air into the vial as the insulin is taken out. The loss of insulin activity is gradual so that at the 29th day it won't suddenly stop working, but as time goes by its effectiveness will be more unpredictable. Best keep to the rule.

Personally, I don't keep it in the fridge after it's been started  when I'm in the UK where we don't usually have temperature extremes. But when I'm in a hot climate, I keep it in the fridge and let it warm up for a bit before use.


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## Radders (Dec 6, 2017)

m1dnc said:


> No, that's not the reason. It's because the solubility of a gas in a liquid _decreases_ as the temperature increases i.e. the opposite of the solubility of a solid in a liquid which _increases _with increasing temperature. So when you take the vial out of the fridge and let it warm up slowly any dissolved air or other gas that has been used to flush the vial during manufacture, comes out of solution in the insulin into the gas space at the top of the vial or as bubbles formed when the vial is shaken as the reservoir is filled. If you don't let it warm up properly, that dissolved gas gets transferred to the reservoir and then comes out of solution as bubbles later.
> 
> As to the 28-day 'rule',  the very rough rule of thumb that chemists use is that the rate of a chemical reaction doubles with every 10 degree rise in temperature. So if you keep the insulin in the fridge at 4 deg and then take it out to a warm room at, say, 24 deg, the rate of degradation of the insulin (which is a chemical reaction) will increase four times. There are most likely other effects that also affect the degradation of the insulin when you start using the vial, such as the effect of introducing air into the vial as the insulin is taken out. The loss of insulin activity is gradual so that at the 29th day it won't suddenly stop working, but as time goes by its effectiveness will be more unpredictable. Best keep to the rule.
> 
> Personally, I don't keep it in the fridge after it's been started  when I'm in the UK where we don't usually have temperature extremes. But when I'm in a hot climate, I keep it in the fridge and let it warm up for a bit before use.


Thanks David, very informative. I am still a bit puzzled as to why the effect of the temperature difference between room temp and in the pump on my person doesn’t have the same effect as the change from fridge to room temp.


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## HOBIE (Dec 6, 2017)

Can you imagine going to Asia on a Motorbike ?  No fridge.  4000mile with no probs, was hot when we got there. Road surface was very slippery when wet. We herd a storey of a bloke who was doing a world tour crashed his bike because of a rain storm over there. Wet road & diesel.


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## trophywench (Dec 6, 2017)

I though you were using cartridges and pens then Hobie?  Were you there longer than 30 days then?  Or did you have bubbles?


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## HOBIE (Dec 6, 2017)

Have never had bubbles. Had my insulin in a cool bag but got hot in my Top Box on Bike. Was there & back in 10 days 600 mile in one day. Was not on a pump then but same Insulin in vials (novorapid)


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## trophywench (Dec 6, 2017)

So - what is that to do with the subject of the thread?


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## HOBIE (Dec 6, 2017)

Insulin out of the fridge ! in the heat aswell


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## m1dnc (Dec 7, 2017)

Radders said:


> Thanks David, very informative. I am still a bit puzzled as to why the effect of the temperature difference between room temp and in the pump on my person doesn’t have the same effect as the change from fridge to room temp.


I think it's down to the temperature difference.  When you take it out of the fridge to room temperature the difference is getting on for 20 deg, but the difference between room temperature and the pump on your belt or in a pocket is pretty negligible in comparison.


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## Radders (Dec 7, 2017)

m1dnc said:


> I think it's down to the temperature difference.  When you take it out of the fridge to room temperature the difference is getting on for 20 deg, but the difference between room temperature and the pump on your belt or in a pocket is pretty negligible in comparison.


my body temperature is 37 C and my pump is normally under clothing so wouldn’t be far short of that, so a very similar rise in temperature I would have thought?


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## trophywench (Dec 7, 2017)

My mate in Cornwall pumps with Apidra too - and ALWAYS has bubbles - and occlusions - with it.  I've had ONE occlusion all the time I've had a pump - complete user error - cos I hadn't primed the tubing properly.

Novorapid rules ok!  Seriously, Apidra does seem to have many more bubble trouble than anything else.  Haven't a clue why though.

Do you invert the vial as you remove it from the fridge or wherever it's been and leave it for 3 or 4 minutes before you stick the reservoir business end up into the insulin?  Then fill the res REALLY slowly? then let that stand a bit after?


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## Radders (Dec 8, 2017)

trophywench said:


> My mate in Cornwall pumps with Apidra too - and ALWAYS has bubbles - and occlusions - with it.  I've had ONE occlusion all the time I've had a pump - complete user error - cos I hadn't primed the tubing properly.
> 
> Novorapid rules ok!  Seriously, Apidra does seem to have many more bubble trouble than anything else.  Haven't a clue why though.
> 
> Do you invert the vial as you remove it from the fridge or wherever it's been and leave it for 3 or 4 minutes before you stick the reservoir business end up into the insulin?  Then fill the res REALLY slowly? then let that stand a bit after?


I found that Novorapid was not rapid and had a long and unpredictable tail for me, leading to some very erratic results. I have only ever had one occlusion and that was when I had a steel cannula in my back so was almost certainly insertion error! 

That’s a good idea re turning the vial upside down, thanks. I must have given the impression that I suffer a lot from bubbles: I don’t!


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