Has anyone done any disaster planning for a prolonged (at least a week) power outage and ways to keep insulin cool, in an otherwise warm environment (85-100 degrees F)?
Insulin can survive that without any problem.
I never refrigerated any of my insulin when I was in college.
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Yes, that scenario fits within my insulin supply disaster planning. Start by extending the time insulin stays cool in the fridge by not opening the door. Depending on temperature after 2-4 days I start the clock on the 30 day expiration countdown. Then it depends on the disaster and what I need to do to get to a reliable supply of insulin before that 30 days is up. My plan relies on a cheap insurance copay for insulin so loss of my on hand supply is affordable. The insurance plan also allows me to declare a disaster and get a refill ignoring days supply limits once a year.
For the rest of the time I just need to keep the insulin under 86Ā°F, that is easily done with an insulated box in the shade on a 100Ā°F day.
Ok but assume the pharmacy doesnāt have power either. The whole grid is down. No one else can be relied upon. Most of the time I canāt rely upon my pharmacy even when the power is working, just saying.
Frio coolers just need to be activated by water and will keep your insulin safe for a long time. I oversoak mine, and theyāll last for about a week. You can always reactivate them by soaking in water again.
They have different sizes, too. The one I use the most is one that holds 2 bottles. I have another one that could hold 4 bottles, but Iāve never had to use that one. They may make even larger ones, but Iām not sure.
The first time I used a Frio was on a 10 day trip to CA. It was mostly in the 90s every day, and I left the Frio in the car much of the timeā¦no problem with the insulin.
Personally, pharmacy plan A for me is have UPS deliver a thirty day supply of insulin on day 25ish of a power outage. I should have mentioned, I never have less than a 30 day supply of insulin at home as part of my T1D disaster preparedness. Iām sharing what I do, if you want to give some specifics about how you live with diabetes and manage risk we can work on a plan for you. Iāve done a lot of disaster planning and actual recovery as part of a previous IT job. So much recovery.
Do you use retail pharmacies instead of mail order? Iām with you on not being able to trust them. Since I need insulin more than I need food and shelter Iāll relocate to somewhere I can get insulin if UPS canāt deliver and local pharmacies have failed to implement disaster recovery plans.
To clarify Frio packs can keep insulin at room temperature. They arenāt a ice pack that can keep insulin at a long term storage temp (Novolog long term storage temp for example is 36Ā°F to 46Ā°F).
If I was concerned, I would probably do something with an electric generator or portable solar type cooler.
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I also do not refrigerate my insulin. I live in Losangeles. I only never leave it in my car otherwise itās just fine
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There have been quite a few heat stability studies done on insulin. Enough that I struggled to choose just one to link. Quick Google if you want, though.
We have to remember that there are insulin-dependent diabetics world over, even in lesser developed countries without refrigerated storage or dependable electricity. Their insulin still works. Time and time again, the studies show that insulin is much more durable than the FDA mandated guidelines would have you believe. Insulin stored unrefrigerated in African, Tropical, Equatorial, etcā¦ locations is shown to have nearly the same efficacy as that stored according to manufacturer guidelines. Hot temps, fluctuating tempsā¦ Itās good.
Insulin doesnāt just spoil. Thereās no defining moment of badness. It is a constant state of degradation from the moment itās made. As time goes on, the weak bonds that tie the insulin molecules into a very specific knot break apart (denature) or they smash into one another like little demolition derby cars, tearing one another apart. Both cases lead to a change in the critical shape of the molecule, so our bodies can no longer recognize and use those particular insulin molecules. Heat helps those weak proteins bonds break and movement (shaking the bottle) leads to more demolition derby action, so they speed up the degradation process a little bitā¦ but literally every other insulin molecule in the vial is still good.
This is a constant process. At first itās just a few busted molecules, but more are always accumulating. We know from the FDA guidelines that by the expiration date on the box, assuming the insulin was stored in the same conditions the manufacturer tested, AT LEAST 90% of the insulin molecules will be as good as the day they were made, and no more than 10% are broke down busted. We donāt have any way of knowing whatās going on inside any vial thatās been stored contrary to the testing parameters, but a few hours/days/weeks outside the manufacturer guidelines are going to have very little impact. The vast majority of insulin in the vial is still good. Maybe after a rough few months itās only 86% effective, instead of 90% effective, but itās still going to work. You might need a little more, but given how variable insulin needs are, you might not even notice a difference.
Go all the way back to original insulin research done by Banting and his crew more than 100 years ago, and they recognized that insulin didnāt start denaturing (cooking) until 122Ā° F. Even at 149Ā° F, half the insulin molecules were still good and functional. This 50% good/bad split is what he called the melting point of insulin. Then they discovered that adding preservatives to insulin, which are still used today, increased that melting point all the way to 183Ā° F! So you can basically cook your insulin to a simmer and still use it, youād just need twice as much.
Those preservatives also cushion the insulin molecules, turning those little demolition derby cars into much more gentle bumper cars.
Now cold temps are another thing altogether. Ice crystals win tear the insulin molecules apart. Your insulin is much safer in the 100Ā° ambient temp than in a fridge with a sketchy thermostat or in a cooler with dry ice. Since I live where the winters are brutal, thatās my bigger concern. Not really, though, because we have a wood stove. No issue keeping the house warm even without electricity.
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@Robyn_H , thatās a wonderful posting youāve written, but I just wanted to point out a small detail: The āinsulinsā most of us (probably) are using are actually āinsulin analogsā, and the exact parameters are probably slightly different . It wouldnāt surprise me if the parameters for insulins from different animals are slightly different .
It takes me a while to get through insulin, both lispro and glargine. I keep mine in the fridge and theyāve lasted til I finish the bottles (I do MDI), which is anywhere from 4-6 months. I imagine theyād last longer if I didnāt use it by then. Throwing away insulin after one month, and not keeping it in the fridge, has, given my own experience, always seemed strange and unnecessary (this is just me and my experience).
Lets try to stay on topic.
@Cat99 I apologize for my comments distracting people from your question. Iāve edited my post.
No worries, I appreciate all ideas and points made
Thank you all fascinating discussion and helpful points (please keep going, if inclined!)
The 2 times we have extended power outages (>24 hrs), I bought bags of ice the first time (messy as it melts) but kept the fridge sufficiently cool, but not the freezer (bye, bye frozen food). The second time - 5 lbs of dry ice for the freezer and 5 lbs of dry ice for the fridge. Everything happy for the 4 day outage and no mess.
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Could you dig a deep hole or put it into the basement? They used to have cellars to store food in the olden days. 100 is pretty warm.
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Thats a good ideaā¦
ā----āā
At a depth of 3 feet underground, the average temperature is usually around 50Ā°F (10Ā°C), remaining relatively constant throughout the year due to the earthās ability to store heat, with variations depending on your location and climate; in colder regions, it might be slightly lower, and in warmer areas, slightly higher.
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Iāve lived in SW Oregon for 24 years now and, until very recently, never had any cooling in the house. The temperature range where I live, over those 24 years, is a little under 15F to a little over 115F. In summer Iāve always kept insulin out of the fridge while using up - so up to 30 days - and the temperature really has varied between 80F and 120F.
Your upper limit, 100F, is body temperature (37C) and degradation does occur at that temperature but it takes about a month to see any measurable degradation when insulin is kept in containers which average out the variation. @Robyn_Hās references are to a study done in a refugee camp iin Darfur; insulin was observed to degrade a bit, but not too much to change the dosage requirements. The insulin was, of course, stored carefully.
Itās the averages that matter.
I just skipped back through the data from my weather station for 2024 and the highest weekly average is 81.9F, the low that week, on July 13 was 58.3F, the high, on July 9, was 104.9F.
Those are outside temperatures. Because of the design of my house it takes several days for the internal temperatures to change significantly; the air blowing through the house will be 105F if I forget to close the windows in the morning, but pretty much everything will still be 80.
So if you are concerned just put the insulin in a ācoolerā; not something that cools, one of those little things that you stick the beer cans in when going out.
Iāve taken more care when Iāve gone backpacking in summer in the US but the math is still the same; use an insulated container to average out the numbers. Thatās all that is needed.
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