I understand all the warnings and supposed symptoms of not refrigerating insulin, with that in mind, can I ask:
Are there any studies or documents anywhere which show the theory as facts?
I have refrigerated insulin as a kid, but in the last 10 years I’ve rarely done it, and I’ve also had it in some very hot places (currently live in the tropics). I have NEVER seen a difference to control due to insulin conditions. Site change, yes. Sickness, yes. Even stress, but never unrefrigerated insulin.
I have just moved to a pump and have boxes and boxes of unused (unrefrigerated) Novorapid (Novolog). I am using it in the pump and my doses are in the realm of many other T1D’s.
Not trying to say everyone’s wrong and I’m not, but my guess is, there’s a lot of over exaggerated hype.
If anyone has documents, I’d be very interested to see them, and any discussion of course
This has been discussed before. I posted a pointer to editorial in Diabetes Care on this issue. The manufacturers tested to a certain time under a restricted set of conditions. It doesn't say that your insulin won't still be good in other conditions, it only says that if you store the insulin refrigerated, it will still be good for two years with high confidence.
I have had 2 instances recently that demonstrated to me insulin that gets heated beyond body temperature loses it's effectiveness almost immediately. The first time it was Apidra in the pod which I blamed and changed out for Novolog which is supposed to be the most temperature tolerant of the rapid acting analogs, but when it happened for the second time I knew it was not necessarily the type of insulin, but the conditions. Like everything else, this may be another case of YDMV. Some people use apidra in their pumps in Arizona and don't notice any drop in effectiveness, I used it in Massachusetts and found skyrocketing blood sugars after 4 hours in the blazing sun. I keep my insulin refrigerated because that's what I have always done. It doesn't mean it wouldn't be just fine in my D closet but why add another variable in an already complex equation ?
FWIW - I just returned from 11 days in Ecuador, mostly at higher altitudes (not steaming hot by any stretch). My back-up insulin spent some time during some of the days in a hot van and it became about 50% effective (aka - degraded).
I lived for 5 years on a sailboat in hot climates, always kept my insulin refrigerated, and rarely had a problem.
With the exception of the fact that if insulin goes bad there can be seriously negative consequences, I think the storage standards and expiration dates printed on the vials have a lot of leeway to them. You can call it over-exaggerated hype, I call it being aggressively conservative. One of my colleagues used to say, it is way better to under-promise and over-deliver than the reverse.
