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Medical Forum / Diseases and Disorders / Diabetes / March 2006Insulin used for more than 28 days. Bad idea ?
i use humalin I for my night background insulin it's a 300ml cartridge in a pen injector. i use between 4 & 7 units each night. so with the 2 units test the daily use is say an average of 7.5 so one cartridge could last 40 days, but the makers say to throw away after 28 days of being first used any idea what happens if one had broken this rule and used the cartridge for 40 days or even a bit longer. does the humalin I break down and be less sensitive or effective. could ones sugar readings rise higher than normal ? would appreciate the opinion of the group as. type 1 from 21.6.99 (humalin/humalog) > i use humalin I for my night background insulin > [quoted text clipped - 11 lines] > > as. type 1 from 21.6.99 (humalin/humalog) all drugs have an expiration that is very conservative. I'd be shocked if you had a problem using your insulin for an additional 12 days. In fact, I'd BET you won't have a problem unless you are not keeping it near room temperature. Dave anonymouse wrote in message ... >i use humalin I for my night background insulin > [quoted text clipped - 11 lines] > >as. type 1 from 21.6.99 (humalin/humalog) Humulin I (Insulin "Eye", a.k.a. NPH) is a human insulin. As such, it is very stable, usually much more stable than the manufacturers' lawyers will admit. I have used Humulin U (a similar insulin) for years. I emptied a vial every six weeks with no sign of any problems UNTIL I went hiking in Florida and exposed the vial to 95 degree temperatures. The symptom of degradation I saw was very high fasting blood sugars. If you refrigerated it, you probably could get six months use out of it. However, refrigerating opened insulin pens is tricky since changes in temperature from cold to room temperature to cold can induce the pen to suck in air and form a bubble. If that happens, you have to remove the air bubble if you want the highest accuracy in your doses. Regards Old Al thx for your thoughts so far. it looks like i can't blame this for my sugars going up slightly in the mornings, which has now mysteriously corrected itself the only thing i did since was stick to 28 days useage thought it might be that as >i use humalin I for my night background insulin > [quoted text clipped - 12 lines] > > as. type 1 from 21.6.99 (humalin/humalog) anonymouse wrote in message ... >thx for your thoughts so far. it looks like i can't blame this for my sugars >going up slightly in the mornings, which has now mysteriously corrected [quoted text clipped - 5 lines] > >as I read your "Insulin I" as Insulin Isophane also known as NPH. NPH is a very difficult insulin for a T1 to use. It has the highest Coefficient of Variation (COV) of any basal insulin on the market. That means fast today, slow tomorrow, medium speed next Tuesday. If you've been able to produce stable T1 sugars with NPH for six years, pat yourself on the back. . .you're doing a good job. It took me 3 frustrating years to force my HbA1c down below 6.0 using "Godawful-NPH" However, the odds are against you getting away with it forever. Lantus and Levemir are a lot easier to use, mostly because they are slower and have lesser COV. Regards Old Al that's brilliant al, as i have tried lantus and didn't like it but doc says i will be on it at some point. seeing him next monday so i'll mention this cov aspect. my hba1c runs around late 6's best wishes. as > anonymouse wrote in message ... >>thx for your thoughts so far. it looks like i can't blame this for my [quoted text clipped - 26 lines] > Regards > Old Al anonymouse wrote in message ... >that's brilliant al, as i have tried lantus and didn't like it but doc says >i will be on it at some point. seeing him next monday so i'll mention this >cov aspect. my hba1c runs around late 6's . . .(snip). . . >> I read your "Insulin I" as Insulin Isophane also known as NPH. NPH >> is a very difficult insulin for a T1 to use. It has the highest Coefficient >> of Variation (COV) of any basal insulin on the market. That means >> fast today, slow tomorrow, medium speed next Tuesday. . . . [quoted text clipped - 4 lines] >> Regards >> Old Al If you want to plow through research papers which quote measured COV for the big three: NPH, Lantus and Levemir (Detemir), see below. BTW, I vote for Levemir so far. I am trying it (and liking it) as part of a pre-release clinical trial. It's supposed to be generally available in my area in early April. Original Paper http://www.diabetesincontrol.com/issue183/InsulinDetemir.pdf “. . .the mean durations of insulins detemir and glargine are 14 and 22 hours respectively. . .” Condensed for Popular Press http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=1 “. . .A study presented at the 18th International Diabetes Federation Congress in Paris in August 2003 reported that among 54 persons with type 1 diabetes given NPH, detemir, or glargine insulin on 4 occasions with glucose infused to maintain euglycemia, the coefficient of variation of the glucose infusion was 46% to 68%, 23% to 27%, and 36% to 48%, respectively, suggesting that the degree of within-subject variability was least with detemir.. . .” [The above sentence, an example of moderately mysterious use of the English Language, translates to: Within-Subject COV NPH = 46 - 68% COV Lantus = 36 - 48% COV Levemir = 23-27% ] I think I saw some person to person COV quoted in these papers but I'm more interested in within-subject COV, i.e. what one person can expect from injection to injection to injection. More on COV http://care.diabetesjournals.org/cgi/content/full/24/2/296 “. . . . The high individual variation in absorption rate is one of the major drawbacks related to current therapy with NPH (3,16). A smaller intrasubject variability in fasting blood glucose was observed with insulin detemir, although 65% of the subjects had to apply two injections. The lower variability together with the reduced action peak (9) could be an important advantage and facilitate strict metabolic control. More reproducible and predictable glucose levels throughout the night would minimize the risk of hypoglycemia and provide better glucose control in the early morning hours. Because treatment with insulin detemir resulted in higher mean serum glucose levels during the time interval 23:00-06:00, earlier administration and/or higher dosing might optimize therapy further. . . . .” Regards Old Al >thx for your thoughts so far. it looks like i can't blame this for my sugars >going up slightly in the mornings, which has now mysteriously corrected [quoted text clipped - 3 lines] > >thought it might be that In the frig I have a vial of Novolog which I started using on 6/4/05 and it is still good. The last time I used it was on 2/25/06 and it stopped my morning spike like it always does. The darn stuff lasts a long time. I think it is utterly foolish to dispose of insulin in 28 days since it is so expensive. _____________________________________________ http://www.healthdiabeticsoftware.com/ Free we get all our stuff free over here (hence taxes are higher though) so it's not so much bother to throw out. wasteful though as there must be plenty of bodybuilders who'd wish to have it ! as >>thx for your thoughts so far. it looks like i can't blame this for my >>sugars [quoted text clipped - 12 lines] > _____________________________________________ > http://www.healthdiabeticsoftware.com/ Free >>> the only thing i did since was stick to 28 days useage >>> [quoted text clipped - 5 lines] >> long time. I think it is utterly foolish to dispose of insulin in 28 >> days since it is so expensive. I am using one of the discontinued basal insulins, which is supposed to be stable for a long time. But I just had a vial go bad on me. It was subtle. I started feeling like crud a week ago with higher blood sugars, but I figured I was coming down with something since I felt so rotten. It was only a week later when my fasting blood sugar was back to where it had been before I started the insulin for a few days that it hit me maybe the insulin had stopped working. I read up in Bernstein about what to look for when checking insulin for deterioration (little crumbs on the side of the vial) and sure enough, there they were. I pulled out a new vial and it didn't have the crumbs. When I used it yesterday my blood sugar went right back to where it should be. I hadn't been keeping it in the fridge since I'd read it wasn't necessary, but I'm keeping the new one there. I also reused a needle or two which turns out to be a great way to cause the stuff to precipitate out. I'll be more careful with this new vial as I'd like to make it last. I did a bunch of reading on how long insulin lasts and it looks like the newer analogs don't hold up as well as the older human insulins. 45 days might be the outside limit for Lantus. That's the number of days that Novo Nordisk puts on opened Levemir pens, so I suspect you can get another week or two out of them. But after that, if your blood sugars aren't what you expect, the insulin would be the first thing to look at. BTW, though my insulin clumped, Bernstein also says insulins can go bad without showing any physical changes. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control jenny, who or what reference is this Bernstein ? thx 4 post, interesting as >>>> the only thing i did since was stick to 28 days useage >>>> [quoted text clipped - 41 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control > jenny, who or what reference is this Bernstein ? > > thx 4 post, interesting Bernstein is Dr. Richard K. Bernstein, author of "Dr. Bernstein's Diabetes Solution". Dr. Bernstein, who was diagnosed with Type 1 diabetes in the 1940s, was an engineer who got access to one of the first blood sugar meters back in the 1970s. After he learned how the carbohydrates he ate affected his blood sugar, he went to medical school and became a doctor in order to be able to get people to listen to his ideas. Since then he has been treating diabetes for decades in a private practice at Mamaroneck NY. The people at Albert Einstein School of Medicine Department of Endocrinology who I have met as part of another study told me they have enormous respect for Dr. Bernstein (who is a graduate of their medical school in NY.) When the first edition of his book came out in the mid 90s, his advice was considered very radical. He urged blood sugar targets far lower than the ADA, warned that the low fat high carb diet was killing people with diabetes, told people with diabetes to cut carbohydrate intake way down, and urged the use of a MDI style insulin protocol combined with low carb intake. Now, a decade later, his advice is very close to mainstream and getting closer with every new dietary study. I found his advice on how to fine tune insulin dosing extremely helpful at a point where my doctors had thrown up their hands and told me they had no clue how I should dose because my diabetes (a form of MODY) is so atypical. This book is on my list of books everyone with diabetes should read, whether or not they decide to follow any of Bernstein's advice, because he discusses so many topics that get short shrift elsewhere and in a manner that respects the reader's intelligence. Here's a link to it on Amazon: http://www.amazon.com/gp/product/0316099066//104-2674487-5997567 >>>>> the only thing i did since was stick to 28 days useage >>>>> [quoted text clipped - 40 lines] >> http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood >> Sugar Under Control  Signature--Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control hey, thx. i'll look it up best wishes as >> jenny, who or what reference is this Bernstein ? >> [quoted text clipped - 81 lines] >>> http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood >>> Sugar Under Control |
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