Insulin Pens And The `fridge

[tejbat6]

has anyone been away from a source of refrigeration for more than a week?
How did you cope or what did you do?
I ask, because I will be riding the Irish equivelent of Lands End to John O`Groats next year.
adding up the time spent riding to and from ferries and the ride itself I shall be fridge free for about 3 weeks, or longer if my old bones creak too much 🙄
I will be camping, not B&B as I did on LEJOG 10 years ago

I am T2 and on Metformin tabs and Novamix30 insulin (pens)
My diabetic nurse told me at todays visit that I should bin the pens after a week without refrigeration😱
One thought is to get new supplies at Irish GP`s every 7 days
anyone know if its free as in UK (I am 68 tomorrow)
OR, take a couple of prescriptions with me to `cash in` as required.....Q: are they valid in Ireland..probably not
Any ideas???🙂

 

[Pumper_Sue]

Hi and welcome to the forum.
Your nurse is nuts 🙄 it's 28 days out of the fridge before bining.
Just in case it's a hot sunny summer haha perhaps invest in a frio bag for your insulin.

Ps Happy Birthday for tomorrow

 

[Northerner]

Hi tejbat6, welcome to the forum 🙂 I agree with Sue - unless you plan leaving the insulin in direct sunlight or next to the campfire they should be fine at 'room temperature' for 28 days. When do you plan to do your trip? You should be able to take enough along from the UK for your trip. Frio bags are useful for keeping them cool, or keep them in a steel vacuum flask in cold water 🙂

 

[tejbat6]

Thanks Northerner and Sue...just the info required
"28 days"...... sounds much better
and my small vacuum flask should do the trick, just the right size
Late spring is pencilled in, give it time to warm just a little and hopefully the ferries will be slightly cheaper🙂

 

[Northerner]

Thanks Northerner and Sue...just the info required
"28 days"...... sounds much better
and my small vacuum flask should do the trick, just the right size
Late spring is pencilled in, give it time to warm just a little and hopefully the ferries will be slightly cheaper🙂

Sounds like quite an adventure! 🙂

 

[Copepod]

Three weeks is well within 28 days, so you should be fine, as long as you keep insulin out of direct sunlight, and away from heat, fires, engines etc. Presumably you'll be camping at least some nights in campsites, for access to showers if nothing else? In which case, you could ask about putting your not yet in use cartridges in theri fridge?

As Republic of Ireland is part of the EEC, you should carry your EHIC to have access to medical services at the same rate as local residents. If you don't have one already, then apply from link here: http://www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/about-the-ehic.aspx

Malin Head to Brow Head (near Mizen Head) is a fair journey, so plenty of miles / km to enjoy 🙂

 

[themaevequeen]

I am interested if anyone has experience without fridges because I am going on a 3month trip through India, Hong Kong , Bali, Australia, New Zealand and China and will not have a fridge available at all the places I'm staying. I'm on Levemir and Novarapid and am confused as to whether the time out of refridgeration is an aggregate time or not or how to calculate it.

 

[Copepod]

Welcome to the forum, themaevequeen.

Many people like Frio pouches for keeping items cool out of fridge. They need to be able to evapourate to work properly, so keeping wrapped in waterprook bag, inside rucksack means they can't work.

However, I prefer a cheaper and more robust method - a small stainless steel vaccuum flask, to which I can add cool water, even icecubes and water mixed together. Obviously, you can't carry water through airport security, but if you swill the flask round with cool water before discarding, the inside stays pretty cool.

I always work on the principle of aggregate time out of fridge - most patient information leaflets say insulin is OK at room temperature (usually defined as 8oC [top temperature for fridges] to 28oC), but if you ask the company specifically, many will admit that you can keep insulin out of fridge longer than that. Obviously, it's very important to keep insulin out of direct sunlight, nowhere near fire, engine (eg under bus, but you wouldn't want to place important items there, due to risk of theft) etc.

I've easily managed month long trips to Costa Rica, plus 3.5 months in Chile, Falklands and South Georgia, shorter trips to Middle East & North Africa etc, with only intermittent access to fridges.

Obviously, things like appropriate vaccinations before depature, malaria prophylaxis, travel insurance, knowledge of reciprocal health agreements UK / Australia / New Zealand, knowledge of local languages etc are vital for an enjoyable trip.

Have a great trip.

 

[themaevequeen]

The vacuum flask seems a really good idea. Part of the difficulty is just the volume as I need to take 8 5-pen boxes. We were also wondering if my daughter could keep half in her fridge and bring it out when she comes for a holiday with us in Australia but were not sure if security would let her carry insulin in hand luggage if it's not for her. That said I travel to and from Morocco several times a year and have been for some years and no-one at security has yet had any interest whatsoever in ny insulin.

 

[Northerner]

The vacuum flask seems a really good idea. Part of the difficulty is just the volume as I need to take 8 5-pen boxes. We were also wondering if my daughter could keep half in her fridge and bring it out when she comes for a holiday with us in Australia but were not sure if security would let her carry insulin in hand luggage if it's not for her. That said I travel to and from Morocco several times a year and have been for some years and no-one at security has yet had any interest whatsoever in ny insulin.

Why not get a reusable pen, like the novopen echo, then you only need room for cartridges - much smaller than pre-filled pens! 🙂

 

[Copepod]

Another vote for using a multi-use pen (actually, take 1 pen for each short & long acting insulin, plus 1 spare and / or a couple of spare syringes in case pens fail). However, I'm not sure you could fit 40 x 3ml cartridges in a 1 litre flask - you'll need to experiment.

As I've always used cartridges and multi-use pens, sometimes I forget that not everyone uses this practical scheme. By the way, cartridges are much easier to fit into flask if you separate "foil" into singles, instead of a strip of 5 cartridges.

You can also obtain insulin at local resident prices in Australia / NZ under reciprocal health agreements, although it takes a bit of effort to register with an appropriate presciber, then take prescription to chemist etc.

 

[themaevequeen]

I thought of cartridges but there are pros and cons because NovoNordisk say that although the flexi-pens are licensed for the countries I'm going to the cartridges aren't. Thought I'd discuss it with my diabetic team when I return to the UK. (I'm currently in sunny Morocco watching the BBC weather reports smugly). I think the flask and my Beloved's idea of having our daughter bring out some is good; I'll try and contact the airline to see what they say.
The other thing i was going to discuss with the team at my December review but sounds like some of you guys may have experience of is Time Zones and bolus insulin?

 

[Copepod]

The good thing about basal bolus regime is that you can have as many or as few boluses (short acting insulin) in a day, however long is the day. So, just inject when you eat, whether that's once or 5 times. For basal (long acting) insulin, you will have to gradually change the interval longer or shorter than once every 24 hours (assuming you have one long acting insulin each day) or twice in every 24 hours (if that's your pattern of use).

I find a digital watch that has dual times is useful - leave one time on time zone you are leaving and one on where you are at present or where you are heading.

I'm not sure what the significance of whether the pens and / or cartridges are licenced in the countries you are visiting is - there should be no problem taking the items into the country (it might be an issue for eg narcotics or drugs which can be misused illegally, but insulin isn't in those categories), although you wouldn't be able to buy / be prescribed replacement items if you lose yours.

Do talk to the airline (or airlines - there's likely to be some code-sharing in a round the world ticket) AND also airports through which you pass. And remember that security levels can change rapidly if the need arises.

 

[DeusXM]

Time zones shouldn't affect your bolus insulin very much, although you may find your ratios can get a bit confused. As for your basal, you've got two options - inject at the right UK time, or adjust so you're taking it at a sensible time.

By way of example, I am writing this while in Thailand which is 7 hours ahead of the UK. Usually I take my basal at 6pm UK time but that's 1am here which isn't very practical. So I've been taking my basal 2 hours earlier each day (4pm, then 2pm etc) so that now I've arrived, I'm taking my basal at a sensible time. I'll obviously have to adjust it back as I return home.

 

[themaevequeen]

Yes I meant basal, I'm not sophisticated about this and just think of them as orange and green. A two hour adjustment would propbably work; we do deliberately stay put for a while rather than go the full 11hours in one go but the london-singapore-dehli-uidapur leg arriving their time 2days their time after we set out is daunting. I've no idea when I'll get fed but as you say bolus(orange) makes that easier.

 

[DeusXM]

Don't worry about it too much - the important thing to remember is to keep a 22-24 hour gap between basal jabs at all times, assuming you take your basal once a day.