Pumper_Sue
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Just take it out 20 mins before needed solves the problem if there was one in the first place 🙂
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Do you keep your current insulin in the fridge?open it
- Thread starter Radders
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Sally71
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We keep the in use bottle out of the fridge as that's what we were told to do, daughter's insulin requirements have shot up so much in the last couple of years though that we don't have a time issue, one 10ml vial barely lasts 3 weeks at the moment! I was told that the pump must always be filled with room temperature insulin because you are more likely to get bubbles if it is fridge temperature; whether this is actually true or not I have no idea, I have never tried it. If I find I need a new vial and have forgotten to get one out of the fridge I just warm it up in my hands or down my bra for a few minutes before filling the pump. I don't actually see how it could cause a problem if you wanted to put it back in the fridge between uses, and would have thought that would extend the life time. I also think the 28 day rule is only a guideline and you might well get away with more if you are lucky.
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I have to say that has always been my assumption too - that the insulin is good for 28 days at room temp, but that if I put it back in the fridge the '28 day clock' would halt. I hadn't thought about air or anything else having an effect - so that's interesting!
One thing that strikes me @Radders is whether you could use penfill carts instead. I used up my stock of NR carts when I first started on a pump, and while they weren't 100% as easy as a vial, they were easy enough. Penfills are so much smaller you'd have less trouble using them up within the 28 days I would have thought?
I'm not sure that I would be able to fill the pump cartridge with a pen fill cartridge: I haven't tried it but the pump cartridges I use come with an attachment that fits over the neck of the vial. Not sure it would work on a cartridge but you're right that it would solve the problem of wasted insulin, I suspect that might be negated by the additional glass though of the cartridges. I would use two cartridges where I currently use one vial.
I must admit I had thought it would take longer than that to warm up, Sue!
trophywench
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Nah Radders - 20 mins is a max. If it's the summer (or this time of year like me the CH is whacked on) it takes far less - and if you take it out the box and cuddle it in your hand for a minute or two - it's fine. I expect like camera batteries used to be on the school skiing trips my teacher mate used to organise, a well endowed lady - she was much in demand by all her charges as she had a knack with them that she didn't divulge to them - they went under one of her boobs inside her bra! Magic Miss! LOL
Thank you to everyone for your contributions. I've been thinking about the reasons why using it straight out of the fridge might cause bubbles. I seem to remember it being about the sudden change in temperature. That got me to thinking that surely there will be another sudden change by just as much when the pump goes back on my person.
In the fridge: 4 degrees
Room temp: 21 degrees-ish depending on the season, could be more or less
On me: 37 degrees
So going straight from fridge to pump would be quite a large jump I suppose.
Next vial I am going to try keeping it in the fridge and just letting it warm up for 20 minutes as Jen and Sue have suggested. I will then see if it lasts for five refills (30 days) and if it does I will try six (36 days). The deterioration I have noted isn't sudden or catastrophic so I don't think it's a high risk. I just notice that I need rather more to correct than normal and have to do more corrections.
The fact that Apidra is only meant to last 2 days in a pump has shocked me the most! For all the years I have been pumping I have had 6 days out of it, although I did notice some deterioration on the sixth day for a couple of months when I was doing some quite vigorous circuit training. Those days are over now!
In the fridge: 4 degrees
Room temp: 21 degrees-ish depending on the season, could be more or less
On me: 37 degrees
So going straight from fridge to pump would be quite a large jump I suppose.
Next vial I am going to try keeping it in the fridge and just letting it warm up for 20 minutes as Jen and Sue have suggested. I will then see if it lasts for five refills (30 days) and if it does I will try six (36 days). The deterioration I have noted isn't sudden or catastrophic so I don't think it's a high risk. I just notice that I need rather more to correct than normal and have to do more corrections.
The fact that Apidra is only meant to last 2 days in a pump has shocked me the most! For all the years I have been pumping I have had 6 days out of it, although I did notice some deterioration on the sixth day for a couple of months when I was doing some quite vigorous circuit training. Those days are over now!
Update. I think my experiment proved that the 28 days still applies when Apidra is kept in the fridge. I had forgotten the experiment was going on and couldn’t understand why my levels were so bad, then I remembered! I forgot to write the date on the vial when I started it but it must have been getting on for 5 weeks.
It didn’t stop working but was less effective, giving me gradual overnight rises and correction doses that just didn’t seem to do anything. A couple of times I changed the cannula and it seemed to solve the problem, but only for a day or so. This fooled me into persisting a bit longer than I should have! Hindsight’s a wonderful thing.
I still think it takes longer to warm up from the fridge than 20 minutes. I have been filling the cartridge and letting it stand so that the vial is out of the fridge as short a time as possible but the bubbles have time to rise to the top to be primed out. Today I did this and left it for an hour before changing the set, and it still felt cold.
It didn’t stop working but was less effective, giving me gradual overnight rises and correction doses that just didn’t seem to do anything. A couple of times I changed the cannula and it seemed to solve the problem, but only for a day or so. This fooled me into persisting a bit longer than I should have! Hindsight’s a wonderful thing.
I still think it takes longer to warm up from the fridge than 20 minutes. I have been filling the cartridge and letting it stand so that the vial is out of the fridge as short a time as possible but the bubbles have time to rise to the top to be primed out. Today I did this and left it for an hour before changing the set, and it still felt cold.
m1dnc
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No, that's not the reason. It's because the solubility of a gas in a liquid decreases as the temperature increases i.e. the opposite of the solubility of a solid in a liquid which increases with increasing temperature. So when you take the vial out of the fridge and let it warm up slowly any dissolved air or other gas that has been used to flush the vial during manufacture, comes out of solution in the insulin into the gas space at the top of the vial or as bubbles formed when the vial is shaken as the reservoir is filled. If you don't let it warm up properly, that dissolved gas gets transferred to the reservoir and then comes out of solution as bubbles later.
As to the 28-day 'rule', the very rough rule of thumb that chemists use is that the rate of a chemical reaction doubles with every 10 degree rise in temperature. So if you keep the insulin in the fridge at 4 deg and then take it out to a warm room at, say, 24 deg, the rate of degradation of the insulin (which is a chemical reaction) will increase four times. There are most likely other effects that also affect the degradation of the insulin when you start using the vial, such as the effect of introducing air into the vial as the insulin is taken out. The loss of insulin activity is gradual so that at the 29th day it won't suddenly stop working, but as time goes by its effectiveness will be more unpredictable. Best keep to the rule.
Personally, I don't keep it in the fridge after it's been started when I'm in the UK where we don't usually have temperature extremes. But when I'm in a hot climate, I keep it in the fridge and let it warm up for a bit before use.
Thanks David, very informative. I am still a bit puzzled as to why the effect of the temperature difference between room temp and in the pump on my person doesn’t have the same effect as the change from fridge to room temp.
Can you imagine going to Asia on a Motorbike ? No fridge. 4000mile with no probs, was hot when we got there. Road surface was very slippery when wet. We herd a storey of a bloke who was doing a world tour crashed his bike because of a rain storm over there. Wet road & diesel.
trophywench
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I though you were using cartridges and pens then Hobie? Were you there longer than 30 days then? Or did you have bubbles?
trophywench
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So - what is that to do with the subject of the thread?
m1dnc
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I think it's down to the temperature difference. When you take it out of the fridge to room temperature the difference is getting on for 20 deg, but the difference between room temperature and the pump on your belt or in a pocket is pretty negligible in comparison.
my body temperature is 37 C and my pump is normally under clothing so wouldn’t be far short of that, so a very similar rise in temperature I would have thought?
trophywench
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My mate in Cornwall pumps with Apidra too - and ALWAYS has bubbles - and occlusions - with it. I've had ONE occlusion all the time I've had a pump - complete user error - cos I hadn't primed the tubing properly.
Novorapid rules ok! Seriously, Apidra does seem to have many more bubble trouble than anything else. Haven't a clue why though.
Do you invert the vial as you remove it from the fridge or wherever it's been and leave it for 3 or 4 minutes before you stick the reservoir business end up into the insulin? Then fill the res REALLY slowly? then let that stand a bit after?
Novorapid rules ok! Seriously, Apidra does seem to have many more bubble trouble than anything else. Haven't a clue why though.
Do you invert the vial as you remove it from the fridge or wherever it's been and leave it for 3 or 4 minutes before you stick the reservoir business end up into the insulin? Then fill the res REALLY slowly? then let that stand a bit after?
I found that Novorapid was not rapid and had a long and unpredictable tail for me, leading to some very erratic results. I have only ever had one occlusion and that was when I had a steel cannula in my back so was almost certainly insertion error!
That’s a good idea re turning the vial upside down, thanks. I must have given the impression that I suffer a lot from bubbles: I don’t!
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