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Diabetes Disaster Averted #38: Younger Athletes — Keep it Cool!

I have an insulin pump patient 12 years of age who is a competitive soccer and baseball player. During practices and games, her sugars were trending high (375 plus) which many times took her out of her games….

What she and her mother didn’t realize was that the insulin in the pump cartridge was being exposed to the outside warm weather and with the pump band also sitting against her overheated body, the insulin was rendered ineffective. In addition, she sometimes removed the pump and set in on a bench.

After they called me about what to do, I explained that patients, especially children, who carry around their insulin or use an insulin pump during warm weather, have to be very careful with how they store their insulin, especially when involved in any type of physical activity. When temperatures reach the 80’s (Fahrenheit) and the insulin is in a pocket or next to the body, the insulin temperature can rise above the recommended levels and will become ineffective.

I advised the mother to consider putting a small cooling pack in the body pump band and to have a cooler with an insulin-friendly coolant in the dugout to drop the pump into whenever her daughter was not wearing it.

Lesson Learned:

Keeping the insulin pens and vials insulated when outdoors in warm weather can protect patients from ineffective insulin. Using a cooler or insulated wallet for vials and pens, and an insulated wallet for insulin pumps can protect the insulin from becoming over-heated when outdoors for an extended period of time or when involved in physical activity. The insulated wallet will keep insulin at room temperature even when exposed to high temperatures.

Note: Use of ice packs with devices is not recommended because they can render them useless (I have had experience with our meters not working after being stored against ice packs and have had patients that have had the same problem when storing their meters in their coolers. I never used one with our pumps because of the chance they could stop working, too. I know that insulin cannot be frozen because it ruins the insulin as well) Cool packs like the FRIO are much better because they keep the devices “cool” without freezing them.

Gabrielle C. Skelton, Nutritionist/AADE

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We’ve included some additional information from the insulin manufacturers about storage temperatures for insulin products once they have been opened or used. Help your patients keep cool this summer!

Lantus: Open (In-Use) Vial or Pen:

Vials must be discarded 28 days after being opened. If refrigeration is not possible, the open vial can be kept unrefrigerated for up to 28 days away from direct heat and light, as long as the temperature is not greater than 86°F (30°C).

Levemir: Open (In-Use) Vial or Pen:

After initial use, may be used for up to 42 days if it is kept at room temperature, below 30°C (86°F). In-use cartridges and prefilled syringes in-use must NOT be stored in a refrigerator and must NOT be stored with the needle in place. Keep all cartridges and prefilled syringes away from direct heat and sunlight.

Apidra: Open (In-Use) Vial or Pen

Vials must be discarded 28 days after being opened. If refrigeration is not possible, the open vial can be kept unrefrigerated for up to 28 days away from direct heat and light, as long as the temperature is not greater than 77°F (25°C).

Humalog: Open (In-Use) Vial or Pen

In-Use (Opened) Room Temperature, 28 days, refrigerated/room temperature. (Below 86°F [30°C])

Novolog: Open (In-Use) Vial or Pen

Keep in the refrigerator or at room temperature below 86°F (30°C) for up to 28 days. Keep vials away from direct heat or light. Throw away an opened vial after 28 days of use.

Humulin R/Regular Open (In-Use) Vial or Pen

In-use (opened): The Humulin R U-100 bottle you are currently using can be kept unrefrigerated as long as it is kept as cool as possible [below 86°F (30°C)] away from heat and light. In-use bottles must be used within 31 days or be thrown out, even if they still contain insulin.

Humulin N Open (In-Use) Vial or Pen

In-use (opened): The Humulin N bottle you are currently using can be kept unrefrigerated as long as it is kept as cool as possible [below 86°F (30°C)] away from heat and light.

For more information on insulated wallets go to www.rx4betterhealth.com.

Report Medication Errors to ISMP:

Diabetes in Control is partnered with the Institute for Safe Medication Practices (ISMP) to help ensure errors and near-miss events get reported and shared with millions of health care practitioners. The ISMP is a Patient Safety Organization obligated by law to maintain the anonymity of anyone involved, as well as omitting or changing contextual details for that purpose. Help save lives and protect patients and colleagues by confidentially reporting errors to the ISMP.

Report_Now

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