I have Type-1 Diabetes – and have had it since 1986. I consider myself fortunate as I have been able to maintain good glycemic control over the years. Now, 30 years after my diagnosis, I am still without complications. But it has not been easy. The lows, the highs, the counting carbs, timing of meals, variability caused by exercise – are all challenges that I face every day. There is, however, no greater daily challenge than making sure that my insulin is kept cool and safe.
Throughout the years, I have attempted to heed my endocrinologist’s warnings about the importance of keeping my insulin below 86° F. I always carried my insulin in an insulated icepack and strived to replace it within 8 hours—before the ice melted. In warm weather, I could never go longer than 8 hours away from a freezer from which I could replace the ice. It was a metaphoric 8-hour chain to refrigeration. Despite my best efforts, I apparently did not always replace the ice in time. Despite my usual intake of carb units and dosage of insulin, my blood glucose levels sometimes skyrocketed.
At first, I thought it was a fluke. My insulin looked the same, was not warm when I inspected it, and was obviously still working—at least to some degree. So, I continued to use the same insulin for several days. During this time, my blood sugars were out of control. It was only after I went to the pharmacy and spent a great deal of money replacing the insulin (insulin, beyond the prescribed dose, is not covered by insurance), that I was able to bring things back into control. This pattern happened often until I learned how to better deal with the issue of the temperature sensitivity of my medication.
I am not the only person dealing with the problem of keeping temperature-sensitive medications safe. I am one of millions of people dependent on insulin. Besides insulin, many medications used by people with Type 1 and Type 2 Diabetes also must be kept within a specific temperature range. Byetta, Victoza, and Bydureon all need to be kept within temperature ranges similar to those required for insulin.
Many medications have recommended storage at room temperature, defined as between 68° and 77°F. These same medications also allow for temporary “excursion” periods ranging as high as 86°F. Temperatures above and beyond this range can have a significant effect on each medication.
The risks are great if any medication is compromised by exposure to temperatures beyond its safe range. The loss of efficacy with insulin makes the efficacy of a given dose of insulin a variable. When you have Diabetes, there are so many variables that affect your blood glucose level. You do not want the efficacy of your insulin to be one of them.
The lack of awareness and adherence to the temperature sensitivity of medication is where there is the greatest opportunity for medications to lose their efficacy due to exposure to heat. It is vital, therefore, that you become as knowledgeable as possible on this important subject.
WHAT YOU SHOULD KNOW
The patient or caregiver should know the recommended safe storage temperatures for every medication that he/she uses. You should ask your doctor or pharmacists specifically about the temperature requirements for your medication. Temperature ranges for insulin, and all prescription medications, are also readily available from various sources, including section 16 of the Full Prescribing Information document, which usually accompanies each prescription. This document is also available on the manufacturer’s website for that medication.
The specifications for insulin are a bit complicated. Insulin can never exceed 86°F. However, for storage beyond 28 days (some insulin brands are for up to 42 days), the insulin must be refrigerated. This is extremely important information, as the full spectrum of mistakes is made by patients. Some patients assume that their insulin always must be refrigerated. Some assume that regardless of how long it is stored, it just needs to be kept below 86°F. Some aren’t aware of the temperature constraints at all.
For long term storage, I keep my insulin in the refrigerator. For every day, however, I discovered that the most practical way for me to keep my insulin cool was with an evaporative medication cooler. As such a cooler only needs water to be activated – and only needs to be re-activated every two days, it cut that metaphorical eight-hour “chain” that I used to have to refrigeration. Because it never needs icepacks or refrigeration, it is ideal for travel and a necessity for emergency preparedness. We are now the United States distributor of the FRIO® evaporative medication cooling case.
- Know the safe temperature storage range for each of your medications.
- Keep the medication within the prescribed temperature range at all times. If insulin is kept within the proper temperature range for weeks, but within that time was exposed to an hour of 100° F, that insulin will have lost some efficacy.
- Store medications in the coolest area of the house. Do not place medications in an area of sunlight.
- Medications that should be refrigerated should be kept between 36° and 46°F.
- For mail order medications, be sure the medication is not left in the mailbox for more than a day. It can get above 140°F in a mailbox on a hot summer day. Although the mail order pharmacy puts in enough ice and insulation to account for that day of heat, it does not account for cooling when the medication is in the mailbox for several days.
- When driving, keep your medication in the climate-controlled interior of the car, not the trunk.
- When parked, do not keep your medication inside a hot car; it can also get above 140°F inside a parked car.
- When flying, never pack medications in check-in luggage. Always keep your medication in your carry-on bag.
- If you need to carry your medication with you (traveling or just during the length of the day), use a medication cooler. There are ice pack coolers which will keep your medication cool for up to 8 hours (between activations) and evaporative coolers, which will keep your medication cool for 2 to 3 days (between activations).
- Inspect your medications before you take them to see if they have any change in form. If insulin is cloudy, it is compromised. It is important to note that there can still be a decrease in efficacy even if there is not a visible difference.
Issues relating to temperature-sensitive for medications are serious for people with Diabetes. Awareness and knowledge can avoid this problem and improve the quality of life for you and your loved ones.
About the Author
Dan Katzki is the chief operating officer of ReadyCare, the national distributor of the FRIO® Medication Cooling Case.