Got questions about navigating life with diabetes? Ask D'Mine! Our weekly advice column, that is — hosted by veteran type 1 and diabetes author Wil Dubois. This week, Wil takes on a question about safe temperatures for insulin storage, and what to do when you suddenly find yourself fresh out of this life-sustaining med.

Read on for some tips that may surprise you.

{Got your own questions? Email us at [email protected]}

 

John, type 2 from Pennsylvania, asks: Can you use insulin that got frozen in your car?

[email protected] D’Mine answers: Timely question, given the deep freeze hitting a huge swath of the nation this winter! Did you read that during the last cold snap some parts of the country were colder than Mars? Holy frozen cow! Not that I expect NASA to send insulin-dependent PWDs to Mars any time soon or anything, but I’m betting you’re not the only one dealing with an insulin icicle.

I have written about this before, but it's such a key question that never dies, it's worth answering this question again.

So… can you thaw that icicle back out and still use the insulin? The official answer is “no.” The patient info sheets for all types of insulin say something like: Don’t freeze, and don’t use the damned insulin if you ignored our first instruction. Of course, many D-peeps suspect that insulin can be frozen, thawed, and used, and that big pharma is just trying to trick us into spending more of our hard earned—and limited—dough.

But this exact same advice, not to use thawed insulin icicles, comes to us from respectable neutral sources as well as from big pharma. The Institute for Safe Medications Practices' ConsumerMedSafety site lists six storage tips for “all” insulins. One of them deals with frozen insulin. They say that even after thawing, “Freezing temperature will break down the insulin and then it will not work well to lower your blood sugar. Throw frozen insulin in the garbage.”

Image source: iamatype1diabetic.com

Of course they also say, “If insulin is frozen, do not use. You will not be able to inject the insulin if it is frozen.” Uhhhh… How dumb would you need to be to even try that?!

Well, one dumb statement doesn’t mean the rest of the advice is bad, and I’m often reminded by friends and peers that I frequently underestimate how stupid people can be. This is why McDonald's has to print a warning label on their coffee cups that coffee is hot.

Anyway, when I first looked at the frozen insulin issue back in 2013, I couldn’t find any current science on the subject. But I did find older case studies suggesting that frozen basal was almost always a disaster, while the effects of freezing fast-acting insulin were less clear. At that time, I even suggested there’d be no harm in at least trying frozen and thawed fast-acting, just so long as you did a ton of fingersticks and abandoned the attempt fairly quickly if your blood sugar wasn’t responding in the way it normally did. After all, throwing out insulin that might be good is like lighting a $1 cigar with a $100 bill.

But even though there still isn’t any current science published on the subject, I’m not sure I’d give that same advice today. So why did I change my mind? Partly I’m getting more risk-adverse with age. That, and the fact that there are enough things that can 'eff up your blood sugar without taking unnecessary risks. But mainly it was this brief article in Diabetes in Control, which is the single best independent source of information for medical professionals on diabetes and diabetes meds. The article is the detective story of a doctor trying to figure out why his patient’s Apidra suddenly stopped working. Spoiler alert: It got frozen in the patient’s refrigerator, which was warmer than Mars. But it was the amount of insulin the patient injected with no effect that was astounding to me: About three times her normal dose over several hours while the blood sugar continued to go up, up, and up! All the way to Mars.

That pretty much sealed the deal for me. I’m now convinced that frozen insulin should be left on ice. On any planet.

 

Raymond, type 1 also from Pennsylvania, writes: Good day, I’ve moved into a new city and have left my insulin and test strips behind. Crazy, but I have my glucometer, pen needles, and lancets. I’m on my last pen of each brand, and have only 15 strips. What can I do?

[email protected] D’Mine answers: Well, crap, that sucks. First thing you can do is to call your doc, who presumably is in your old city, and ask him to fax prescriptions for the two insulins and the strips to a pharmacy in your new city. The possible fly in the ointment with this plan is that the insurance folks may balk at filling it, as you most likely won’t be ready for refills. One way around this fly in the ointment is for the doc, if willing, to increase your dose, which should trigger the need for a fresh Rx and reset the refill schedule.

The second thing you can do is to call someone back at your old home and have them FedEx your accidentally abandoned supplies to you at your new digs.

The third thing you could do is visit an ER before you become a legit emergency and see if the ER doc will prescribe you insulin and strips. You might be able to accomplish the same thing at an urgent care clinic. A prescription from a different doc should over-ride the refill timing issue. The reason I suggest the ER or urgent care over going to a “normal” medical practice is the lack of time left with your supplies. I don’t think you’ll be able to get an appointment from a general or specialty clinic before you run out of your stuff.

Those three suggestions are all ways of using the “system” to get you out of your pickle. Another option is to request short-term help from your peers using a diabetes social media app like HelpAround to reach out to see if someone nearby has some overflow supplies they’ll donate to you to get you through this pinch.

Thanks for writing and best of luck!

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.