Travel tips with insulin/insulin pens

Type 1 and LADA
21

Lots of caffeine today, so long reply

I live in a hot climate and travel to hot climates. My cooling device recs are below, but one thing I will add is also don’t forget to pack something for if you get nauseous or dehydrated in the heat. Being severely dehydrated and having to deal medical staff in foreign country is an experience I never, ever wish to duplicate again - so now I never travel without some sort of powdered electrolytes/rehydration packs now.

For cooling recs:

Like others above, I’ve used Frio for years, and they have seen me through many, many trips on multiple international destinations with no fridge at all. Tip: take a few shapes and sizes and bring several “non-activated” (read: dry) spares with you. More on that below.

Lately in an annoying trend, in some airports I’ve noticed on the past several flights I’ve taken that I’ve been getting flack from uninformed TSA agents who try to tell me I cannot have gel packs that aren’t completely frozen.

So I’ve started doing a few things differently in particularly irritating airports, I will pack my “dry/non-activated” Frio packs in my backpack, but will bring all the insulin in a plastic zip lock gallon freezer bag until I’m through security. Then after security I will immediately activate Frio packs with cold in large plastic cup (yes, bring extra paper towels just in case) - eg all after I’m through security but before boarding. I did this for a long, surprisingly hot plane ride too/from/through southern Spain and it worked great.

For US flights: If the Frio gel packs are already activated before I go through security - and if get any s*** from the TSA agent, I’ve started carrying a print out from TSA web site page highlighted in bright yellow the section that says "Note that medically necessary gel ice packs in reasonable quantities are allowed regardless of their physical state of matter (e.g., melted or slushy) with or without the presence of breast milk. Please notify the TSA officer at the checkpoint for inspection"
Gel Ice Packs | Transportation Security Administration (tsa.gov)
They either look baffled and apologetic and let me through, or they just give a hard stare and warn me for next time.

Caveat - this may/may not work in some US airports, depending on level of “stern” [read: a****le!) of said TSA agent. On one unpleasant occasion the TSA agent threw away my Frio gel pack, but handed me the insulin. Hence the reason for carrying a few non-activated/dry spares in the backpack.

Don’t Do This: Also, I do NOT recommend arguing with or getting cheeky with ANY agent in ANY international airport, particularly those where guards are armed with machine guns.* Just sayin from personal experience - that was looooong afternoon

More Cooling Recs:

When going to very hot climates, in addition to Frio, my all-time favorite combo is my Artic Zone combined with the [AllFamily Nomad] which is small and stays frozen for several hours (Portable Cooler for Insulin & Medications – 4Allfamily)

My other go to is the [Tourit Cooler Backpak] many times

I use the backpack with either my Nomad above or with the [Fridge to Go)] which is smaller and lightweight, good for shorter flights

Also have the AllFamily Voyager, but its way heavier, good for longer trip/ and cooling fan has been helpful for situation with no fridge/ no AC - which I pack in my larger suitcase . This can be a pain to carry but worked great for several hours on the beach in the hot sun.

I’ve found most of the foreign hotel have been very kind when I ask them to refreeze the AllFamily - just remember to get it before you leave the hotel

Hotel Fridges are unpredictable! note on Frio - if the gel is activated, I do NOT recommend storing them with your insulin inside in ANY hotel fridge. I’ve had the Frio crystalize and freeze in two hotel fridges in the US - and the insulin was ruined. Thank god for the amazing pharmacist at Walmart down the street who sold me some Regular and NPH with no prescription and no questions asked.

Have a great trip!

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22

Thanks so much for this very thorough reply. I think my biggest concern is dealing with TSA and keeping insulin cool in the hot sun. Thanks for all the help in those two areas. It’s great you carry the TSA info with you directly from the website. Thanks also for the helpful links!

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hammerNutrition.com or roadrunnersports.com

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24

I buy mine from the manufacturer or from Amazon. For a while now, I’ve bought Clif Shot, partially because they were cheaper - I’m using them for quick sugar only - but realize the higher-rated GU are now cheaper.

Amazon.com: Energy Gels - Sorted by Average Rating

The only issue I have is that sometimes when using them I overshoot my target range, since it is approximately 100 calories of sugar, but that would depend on how your body responds.

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25

I use Frio packs here in Florida and find them effective and easy to use. I also make sure to divide up my supplies and not put them all in one bag. I have never had a problem in any airport in the US. One thing I will never go without now is a Gvoke Hypopen. Just last week I became very ill from food (salmonella) poisoning and vomited/dry heaved all night and could not keep even tiny sips of 7Up down. Using a HypoPen saved me a call to the EMTs when my blood sugar started dropping rapidly. They are expensive but have on 2 occasions been lifesavers for me. Love to hear everyone’s suggestions….so helpful!
Enjoy your trips!

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26

I suggest you consider BreezyPacks (BreezyPacks.com). These containers keep your insulin, EpiPens and other medicine safe from the heat. Unique active materials cool down your medicine and keep it below 30°C / 86°F when out in the heat, and freeze overnight at room temperature.

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Insulin freezing at room temperature is the LAST thing you want!

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I’ve never heard of a Gvoke Hypopen. Does it require a prescription? Is it injected glucose? Sounds very helpful when sick.

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Does it ever freeze your insulin?

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I will rephrase the following: “Unique active materials cool down your medicine and keep it below 30°C / 86°F when out in the heat, and freeze overnight at room temperature.”

Instead of using the word “freeze” substitute the words “turn to a solid”.

This special material starts to melt around 86°F. As it melts, it absorbs heat which keeps your insulin from getting warmer. Also, this special material will return to its solid form at room temperature. YOU DO NOT PUT BreezyPacks IN THE FREEZER.

I hope this helps.

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31

Yes, it does require a prescription and is injectable glucagon. Mine came in a pack of 3 and was $107.50 with Medicare insurance. I’ve never needed it in almost 50 years of living with diabetes, but things can change. I went extremely low 3 times during the night on my pump (which is why I am now on MDI). Twice the squad came and took me to the ER, the 3rd time my husband used the Gvoke and brought me right out of it. The food poisoning incident is what convinced me to never go without it. Also, being on MDI, I have a couple of times double dosed myself (once I gave myself 10 units of short acting instead of my long acting at night). Just another safety layer!

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32

Ron, these are fantastic! Just bought a BreezyPack for my upcoming trip where it’s going to be 97 degrees : ) Thanks for so much for posting this, I’d never heard of these before!

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Yes! They sound like a good product. Thanks!

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Did you have any ill effects from the glucagon? I appreciate you recommending this. I will definitely get a script filled for my trip. Are there temperature restrictions with glucagon?

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No it’s a horrible translation. I went to the site. I think what they mean by that is that it prevents your insulin from getting too hot or too cold and will work overnight to prevent freezing or overheating.
At least that’s the only thing that makes sense.

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That must be!

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BreezyPacks are designed to prevent your medication from overheating. They are not designed to prevent freezing.

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38

When I was doing MDI and didn’t use ANY kind of insulin protectors I never had a problem carrying open vials for up to a month wherever I went. Sliding scale using a CGM for bolusing covered any small variation. I never worried or thought about potency loss until I started using an insulin pump, which ironically, is able to handle potency changes better than I could manually. (My house isn’t air conditioned and I only refrigerate open insulin vial during the worse hot spells of the summer in Chicago.)

imo, As a tourist traveling for 2 weeks by commercial vehicles, airlines and cruise ships, with your insulin in your carry-on, your highest risk is in the terminals.

I’ve seen several articles about an insulin stored without refrigeration in India during the summer. That’s far worse conditions than most of people in the western world experience. The most common method used to protect insulin in non-AC homes is clay pots with water evaporation kept in the shade.

The articles all concur that unless unopened vials of insulin analogs are frozen or directly exposed to ambient temperatures in excess of 94F, potency degradation over 4 months exposure is less than 5% .

The Lancet Diabetes & Endocrinology Home Page Published online March 29, 2023 has a letter discussing this ( Redirecting ).
I’ve attached it as a pdf.

imo Frio pouches should be more than adequate unless you plan to spend a substantial amount of your time standing in the hot sun, “mad dogs and Englishmen”.

I’ve used them with my pumping insulin, leaving my bags in the car in midday sun while I ate at restaurants and visited relatives. When I got back the car was over 100F, but the Frio pouches and everything surrounding them were still cool to the touch. I never used a hotel fridge or AC in the car, just the vent fan. My insulin TDD didn’t change at all from the time I left home until I after I returned.

PIIS2213858723000281.pdf (213.4 KB)

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39

My experience absolutely reflects this as well, with many years of MDI and often a month or more without access to refrigeration. The past few years with a pump, I’ve seen no increased insulin need over weeks of non refrigerated storage. I use the frio when I travel now because I can. But I don’t worry much.

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40

I had no side effects but some people experience nausea. The last time I used it….it brought my blood sugar up about 125 points ( I was at 50 and dropping with insulin on board and unable to keep anything down without vomiting….definitely an emergency situation) The first time my husband administered to me as I was unconscious and unable to swallow. It is not to be refrigerated but kept at room temperature. Make sure your travel partner knows where it is kept and how to administer ( very simple directions are on the package) There is truly a very small chance you will ever need it but a lifesaver if you do!
You might want to check their website gvokeglucagon.com for any other specifications and maybe discount offerings?

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