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Insulin conditions
- Thread starter Tom1982
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rebrascora
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No. If the fridge was only open for a day and then closed, it just means that you have 27 days of use from that insulin when you start to use it and to be honest one day is negligible as it is not like the insulin is fine for 28 days out of the fridge and then on day 29 it magically and dramatically becomes ineffective, it is just that it is only guaranteed for 28 days and that some slight degradation may start to occur after that which will render it slightly less effective. So short of you going on holiday and having a power cut whilst you are away, there is no real cause for concern for just an odd few hours or even day or two.
Leadinglights
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You will probably find there is quite a tolerance range of temperature it will be stable as people's domestic fridges are likely to vary a fair bit in temperature.
rebrascora
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The important thing is that it doesn't freeze as that can affect it I believe.
Satan’s little helper
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You will know if it has lost integrity. Order more just incase.
Bruce Stephens
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As others have said, it'll probably be fine. Insulins are quite a bit more stable than they used to be, so at normal temperatures at this time of year unless you keep your fridge in an unusually warm room in the house it'll likely be fine.
silentsquirrel
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No - if you walk home after collecting your prescription it may rise above fridge temperature for some time.
Tom1982
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Brilliant, cheers everyone…. In my head there was some kind of enzyme that starts breaking down as soon as it’s at room temperature! Like a kind of in built self destruct timer and after 28 days that was it done for! And that…… is why you shouldn’t drink 10 black coffees in a few hours
trophywench
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- Type 1
Porcine insulin did used to go off pretty quickly, you knew pretty instantly when it went cloudy or looked liked like there was bits of white fluff floating in it. I assume non natural insulin does something similar but to be honest I don't actually know. Just the odd occasion when I've been thinking this doesn't seem to be working so have decided to lob what's left in the vial, even though it still looks like it usually does, fill another reservoir from a new vial and see if that works better - which it usually does.
SB2015
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- Type 1
I was told that if I have it out for longer than 28 (some are told 30) days it will gradually lose its efficacy. If levels start to wobble with insulin that was in your fridg I would then discard it. I think one day of door open is unlikely to have a big impact.
Bruce Stephens
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Hot off the press!
Under difficult living conditions, pharmaceutical companies' data indicate that it is possible to store unopened SAI and IAI vials and cartridges at up to 25 °C for a maximum of six months and at up to 37 °C for a maximum of two months without a clinically relevant loss of insulin potency. Also, oscillating temperatures between 25 °C and 37 °C for up to three months result in no loss of insulin activity for SAI, IAI and MI. In addition, ambient temperature can be lowered by use of simple cooling devices such as clay pots for insulin storage.
My understanding is that the main mechanism of degradation is denaturation of the insulin molecue. Denaturation happens when the protein unfolds and aggregates, giving the puffy flecks that @trophywench mentioned. The newer insulins may unfold without aggregating, so the solution may remain clear. Insulin acts as a key, attaching to receptors on the cell surface, so if it unfolds it no longer fits the lock and doesn't work.
Denaturation is most likely to happen due to thermal effects. For high temperatures denaturation is very slow below 43C, as proteins have evolved to be stable at normal body temperature. At low temperatures, if the solution freezes ice crystals cause denaturation, so you need to be careful that your insulin is not in a part of the fridge where it might accidentally freeze, for instance, make sure it isn't at the back of a shelf.
Wikipedia has a good explanation of denaturation in general
en.wikipedia.org
Denaturation is most likely to happen due to thermal effects. For high temperatures denaturation is very slow below 43C, as proteins have evolved to be stable at normal body temperature. At low temperatures, if the solution freezes ice crystals cause denaturation, so you need to be careful that your insulin is not in a part of the fridge where it might accidentally freeze, for instance, make sure it isn't at the back of a shelf.
Wikipedia has a good explanation of denaturation in general
Denaturation (biochemistry) - Wikipedia
trophywench
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But you have hit on THE main problem - I do not think modern insulins 'may not aggregate' - I think they definitely don't and hence they continue to just look transparent so the only way of finding out this has occurred is to literally 'try it on the dog' with the dog in this case being one of us. Which is more than a bit too random for me!
My advice stays the same - any doubts - just LOB it.
My advice stays the same - any doubts - just LOB it.
Indeed, the lack of a visual cue of degradation is unhelpful.
I'm keeping my insulin in the fridge door at the moment for this reason. Our fridge is being a bit rubbish(I'm going ask the keting agency to look at it again and say why it's important last time I said something they just told me to do something).
Leadinglights
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You could buy a cheap thermometer to check the temperature of the fridge, many domestic fridges are not very good at maintaining a steady temperature especially those with an auto defrost cycle.
In the lab we couldn't use those for biological material that had to be kept at a specific temperature.
A thermometer is a good idea, however, insulin injectable formulations are somewhat forgiving, so as long as the temperature isn't below 0C it should be fine.
Bruce Stephens
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I must admit having read the Cochrane article I'm even less bothered about keeping insulin outside the fridge, so if I was even slightly worried about my fridge being too cold I think I just wouldn't use it (during most of the year at least).
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