Refilling cartridges - please chime in

My son is going on a 2 week backpacking trip this summer, and I have a question about refilling his cartridges while he’s away. Usually, we put just enough insulin in a cartridge to last until the next site change. When we change the site, we get a new cartridge and fill it with fresh insulin.

Is there any reason we can’t fill a cartridge completely - 200 units - and just change the site every few days while he’s on this trip but only change the cartridge when he has used 200 units? He usually uses about 20-25 units/day, but I suspect he’ll use quite a bit less while on this trip. Conceivably, he might be able to get away with only having to fill his cartridge once while away if he starts out with a full cartridge.

Can a single cartridge be used for 2 weeks? Any issues with the insulin itself in being in the cartridge for 2 weeks - crystallizing, degrading, etc.? Daytime temps will be in the 80s or 90s; night temps in the 40s.

Thanks for sharing your experiences.

Hi Austin's Mom.

I routinely fill my cartridges completely. I use a similar amount of insulin (20-25u/day) and a 200 unit reservoir lasts me about a week. I even refill it once, so get 2 weeks out of a cartridge. (I use a sterile 3ml syringe from the feed store to refill so as to avoid contaminating my insulin vial). I haven't had a problem with the insulin (Humalog) lasting a week close to my body (98.6 degrees, right?), winter or summer.I just replace the set as needed, reuse the tubing.
The backpacking trip sounds wonderful!

Thank you. I think we’ll give it a trial run at home. If it presents a problem, we can solve it quickly and not be experimenting out on the trail.

Yes, his trip does sound wonderful. I wish I could go. On second thought, it’s a group of eight 13 & 14 year old boys, so maybe not!

Ha! I always tell my husband he has the sense of humor of a 13 year old (farts, burps, gross puns etc.) Good thing I love him so much cause I don't think he's gonna grow out of it...

For my daughter I fill a cartridges full and use it (and the same tubing) until empty. Her infusion set changes happen separately and this system works great for us. We don't reuse cartridges. I think we waste less insulin this way as we aren't changing tubing and priming so often. If it's really hot on your son's trip maybe he'll see rising numbers eventually and that would be his cue to put in a new cartridge with 'new' insulin that he's carrying in a cool pack.

I recently did a big backpacking trip in the very hot southwest (late August/early September). I did prefill a couple of cartridges and I did also change the infusion set and leave the reservoir in because there was enough insulin to last me for another infusion set cycle.

BUT, I did notice that the insulin became less effective by about the 5th day. It still worked, just not as well. My BGs began to creep up a bit, but thankfully this worked out well because the activity I was doing was so intense that I didn't experience any significant lows. Now, we were in temps that were regularly in the upper 80s. Down in the canyon it didn't get below 70 at night, although at the rim it dropped down into the 50s.

His TDD is about what mine is. When I was hiking/camping, there were some days where I didn't need more than 15 units, which was AWESOME.

I did prefill 2 reservoirs and stored them in a Frio pouch, along with my extra insulin.

A few (unsolicited) backpacking/D tips:

  • He should make sure to take some long-acting insulin with him, just in case anything happens to his pump.
  • He should take a least 2 vials of fast-acting insulin with him. If he's in a National Park, he should be able to store an additional vial at a nearby medical center/clinic. If you call ahead, they will happily lend some fridge space (I do this all the time). It's good to have back-up insulin somewhere else, just in case something happens to your pack.
  • When backpacking, he should stash his pump in a Spibelt or some similar thing and also inside a plastic baggie. This will keep the pump safe from water, dirt, and anything else that can mess it up. When you're out in the wilderness, you DO NOT take chances with something that keeps you alive. I know how boys are and I know they don't think about this stuff, but tell him that it's better to be careful than have something happen that can ruin the trip.
  • He should check his BG more often than usual. Store test strips also in their containers and then within Ziplock bags. If they get wet or exposed to a lot of humidity, they get ruined.
  • If he's going to be near water or splashing through creeks or potentially out in the rain, he should get a dry sack (you can get them at any camping store) that is made for kayaking. In there, he should keep his meter and other supplies. He should also bring a spare meter.
  • Heat and lots of exercise WILL make your BG drop and can make it drop fast. He should have Gu gels and many other kinds of light-weight fast-acting glucose with him. I use jelly beans a lot when backpacking because I can just take a few at a time (Jelly Bellies have about 1g/carb per bean).
  • Glucagon - bring two kits. He should carry one and the adult he is with should carry the other.
  • Bring ketone sticks and make sure he knows when to use them and what to do should he start passing ketones. Ensure that he knows what to do should he start passing ketones (rest, water, carbs).
  • If he will be camping in an area where bears or other animals are an issue, he should have a small bear canister that he can keep in his tent to store gel and juice.

Sorry if this is more than you needed. I go backpacking a lot and have learned a few tricks backpacking with D. It definitely adds an element of difficult to any backpacking trip, but that just makes the experience more fun (when you do it successfully, at least!)

I go camping often, and I try to re-fill before our trips but I still need to re-fill every so often. The worst thing you can do is fill his cartridge enough for 3 days and expect nothing to happen, lol. I guess because this has happened to me before I am suggesting you have a back-up, and back-up for your back-up. So if I go camping for 3 days, I bring 2 infusion sets and reservoirs, you never know what will happen.

Being outdoors in those temps too, I would be worried about insulin degrading. What I use for my pump is a frio pack, a little more bulky than I like but it keeps the pump cooler than 90 degrees. You can also buy frio packs for your insulin vials. Let me know if you have any questions.

Thank you for sharing these tips - they’re awesome & very helpful. He will be carrying a full set of supplies, with extras, including Lantus and Glucagon plus plenty of stuff for lows. His dad is one of the adults on the trip, so Dad will carry another full set of supplies AND we’ll leave a full set of supplies at base camp. Absolute worst case, he could get back-up supplies in a few hours in the event that everything both he and his dad are carrying fails. Plus, all of the adults on the trip and at least two of the boys, including the one he is tenting with, know what a low looks like and how to help.

Fortunately, my son is an experienced hiker (he’s working on his Eagle scout badge) and we’ve had the chance to experiment with some demanding day trips. He’ll get one chance to do a two day, one night trip with a full pack in a few weeks, so that will be a good trial run. Several days of back to back hiking with a full pack, though, will be a whole new animal and it will be trial by fire. On the plus side, he’s an athlete, so he’s gotten really good at assessing his needs during various activities and responding accordingly. He’s very independent (with support) and responsible with his diabetes management, so I know he’ll take care of himself, and I don’t have that to worry about.

Again, I really appreciate the information. I know everything will be fine, but I will worry much less if I know we’ve thought through and discussed all the issues we can think of. If you think of anything else that would be helpful, I’d appreciate the opportunity to learn from your experience.

Thanks. Yes, I’m a big believer in back ups & back ups for the back ups!

My son hikes & camps a lot, so he’s got a good system down. This will be the longest, most intense trip to date, so I want to make sure we’ve thought through and prepared for anything that could come up.

My cartridge question actually came up because I was imagining how filthy his hands are going to be after 12 days in the mountains with no shower! I was thinking site changes will be hard enough, but the less he has to handle his insulin with his grubby hands, the better!

If you are concerned about his site coming out, when I used to play soccer and go to overnight camps, there was this liquid "glue" that kept the infusion sites intact for 3+ days. That stuff is amazing. It isn't IV Prep, you can see what you can get from your pump company.

I know this is old - but I thought this may help - I go a fair bit of tramping (the NZ term for hiking), my profile photo is from near the top of the Routeburn Saddle.
I carry a little bottle of dishwash liquid (as you need to clean your cooking equipment and plates each night (all the stuff we do is self sufficent, and use this for hand washing, and I also carry a ziplock bag with a few wet wipes, either standard or disinfectant for water free hand cleans, if I need to change out a site where there is no water. As I do some alpine/subalpine tramping, there isn't always water/creeks near by. I also routinely reuse cartridges - once you draw out the insulin, you never push it back int he bottle - if you need to get ride of bubbles, remove the cartridge and air shot, don't push it back into the bottle.

This may be a stale thread, but I too have a couple of things you might find helpful:

HibaStat makes a towelette-style wipe that comes in individual packages. Very handy for site prep in the rough country.

We don't carry the bottles of insulin to refill the reservoir. Instead, we carry an insulin PEN with a couple of extra cartridges. The cartridges are 300 units, which lets you fill a reservoir completely with plenty left over. And of course you still have the pen as an option for backup if the pump goes out.

I had not thought of switching to pen cartridges for that sort of thing - here you can get the cartridges for the resuable pens so they're nice and small. My pump takes 315 units, hence why I went to the 10ml vials, but I'll remember that for my next silly buggers holiday (those holidays where you spend so much time walking with all your stuff on your back, that you need a holiday afterward to let your legs recover!).

By chance is he going to Philmont? I have no useful advice, but my brother has gone there for the past few years first as a boy scout, then eagle scout, then leader. It's an awesome hike I hear! I hope he has fun!!