Attention Insulin Users
Having insulin that works properly is, as you are well aware, crucially important to you and for that reason I have put, at the very beginning, information about it's storage temperature that is applicable on any journey, no matter what it's duration.
Being an insulin user you will generally have been given these guidelines -
Unopened vials of insulin, cartridges and preloaded pens can be stored in the fridge, NOT the freezer, up until the expiry date printed on them.
NB - Remember the expiration date on the vial applies to refrigerated storage only.
However once opened they can be kept at room temperature for up to 30 days.
This advice is a bit woolly because it does not tell you what 'room temperature' they are referring too.
What works well in the UK for instance may not work at all in the soaring temp of the Australian Outback or in, say Finland, where the temps can be well below freezing.
Also, different types of insulin are stable at different temperatures.
Here is more about the Temperature range for most insulin
Insulin cannot withstand temperatures below 2deg C (36deg F).
Insulin loses it's effect if kept at temperatures above 25deg C (77deg F) for a period of time - Insulin manufacturers say that insulin will remain viable for up to a month at 25deg C (77deg F) but should not be used after this period.
Insulin is inactivated fast at temperatures above 35deg C (95deg F).
It pays to remember that a closed car, coach or bus on a hot sunny day can reach temperatures of around 50deg C (120deg F) both inside, in the glove compartment, and in the boot (trunk) and that the same car, coach or bus can get to below freezing in really cold climates.
Likewise the cargo hold of an aeroplane flying at high altitude can get to well below freezing.
Something I certainly never thought of but which has been brought to my notice just lately, the UK being in the middle of a heat wave - temperatures on the Underground trains can reach well over 50deg C if the weather upstairs is really hot, so if travelling on any form of underground transport in very hot weather check the viability of any insulin you may have with you, in vial or pen form, before your next injection.
Bright light also affects the stability of insulin. It lasts longer, even in higher temperatures, if it is kept in the dark.
Humidity and vibration are other factors that can also affect insulin.
So what to do with your insulin......
1. Carry it in a wide necked vacuum flask that has been cooled down with ice before the insulin is put in. Do NOT leave the ice in the flask with the insulin! Line the thermos with something like a wet facecloth, which will help keep it cool and also prevent breakage of the vial or the thermos if they are subjected to jolting. Putting the insulin vial in a plastic bag will stop it getting damp.
2. Use a polystyrene container. If you use those frozen plastic ice packs in the container then be careful that the insulin is not in direct contact them as it may freeze. If you freeze water in plastic bottles and use these instead of the frozen packs, following the same rules, you will get the added benefit of cold water to drink when they melt.
3. Use a container made especially to keep insulin cool. Perhaps the most popular is the FRIO Wallet, which is designed to keep your insulin cool and safe for up to 48 hours, even in temperatures of 100deg F (37.7deg C). The wallet is made up of panels containing crystals that, when immersed in water, become a gel. The water that evaporates from this gel over a period of time keeps the wallet and it's contents cool.
This really does work folk. Back in Africa, on what have now become known as 'safaris' we use canvas water bottles in much the same way. Fill them with water, hang them outside your vehicle and the passing air causes evaporation and thus cooling.
In the case of the canvas bag you loose quite a bit of the liquid to evaporation but what is left is wonderfully cool. The gel is a more sophisticated and less wasteful advance on this old tried and trusted method.
Frio offers a number of different sizes to choose from. More info can be obtained from:-
FRIO UK in the UK and US,
DiabetesExpress in Canada,
CoolerConcept in the US ,
Medica.co.nz in New Zealand.
There are also specialised containers available from Medicool. These include the Medicool Insulin Protector Case, which uses refreezable cooler packs to keep insulin cool for up to 16 hours and the Medicool ProtectAll which, when placed in a fridge or in a bucket of ice for a couple of hours prior to use will keep your insulin cool for up to 12 hours.
These are available from:-
4. In cold climates you can keep your insulin warm by using an insulated case or by carrying it under your clothing, close to the warmth of your body.
5. Keep your insulin out of direct sunlight. Don't be tempted to carry it, say, in the 'easy to get at' outside pocket of a backpack because this will tend to get the full force of the sun.
Wondering if you would know if your insulin was okay?
If in any doubt, check your insulin before you use it.
Rapid and short acting insulin are clear. If they appear cloudy, a slightly different colour (usually brownish) or have bits floating around in them then they have been heat damaged and should NOT be used.
Intermediate- and long-acting insulin always look cloudy but if they have changed colour of have clumps floating around in them then they are no good. They may also become grainy and bits may stick to the side of the vial giving the vial a frosted appearance- throw them out.
Getting supplies in foreign countries
Just because you can get, say, U-100 strength insulin or bovine insulin in your country does not mean it is available in all countries.
Differences in medication names, brands and dosages are best discovered before leaving for another country. Even first world countries may not use exactly the same stuff. I believe that the UK insulin is different in suspension and ratio than that in the USA.
What countries use which insulin?
I tried hard to find out which countries use which insulin - after all it should not be all that difficult should it? Believe you me I found it almost impossible to get up to date data.
The best I can offer you is an old, 1994, list of countries that used U-40 insulin.
Algeria; Austria; China; Czechia; Egypt; France; Germany - some regions only; Hungary; Italy; Japan; Kenya; Korea; Morocco; Nigeria; Poland; Russia; Spain
Slovakia; Syria; Turkey; Tunisia.
I am sure many of the countries on this list have now changed to U-100 but if you are planning to visit any of them I would check with your travel agent and doctor to see if they have any more recent advice.
If you are one of the rare people who use U-500 insulin you are likely to have a much greater problem obtaining it anywhere outside your home country. Even in the US the pharmacy needs to organise to get it from the manufacturer, which usually takes 2-3 days. You will definitely have to take it with you and discuss with your doctor a contingency plan in case of emergencies.
If an emergency situation occurs and you have to buy local insulin that is different from what you are used too remember that it is the number of UNITS of insulin that is important, not the volume.
U-40 means there are 40 units of insulin per cc, while U-100 is 2.5 times as strong, with 100 units of insulin per cc. You need to take your prescribed units of insulin, not a particular number of cc's.
It is a good idea to buy a syringe that is calibrated to and matches the type of insulin you get, as this makes life a lot easier and avoids mistakes. The units marked on the syringe apply to a particular insulin strength, so using the correct syringe allows you to measure your dose accurately.
Using a U-100 syringes with U-40 insulin can result in your taking much less insulin, or using a U-100 insulin with U-40 syringe can result in you taking much more insulin.
The colour codes that appear on insulin bottles and syringes are NOT a universal standard and differ from country to country. Make sure you are getting the right stuff.
You also need to be aware that weaker insulin, like the U-40, is absorbed faster and insulin levels after half an hour can be as much as 20% higher than with U-100.
Using unfamiliar insulin means you need to carefully monitor your blood sugars.
If you can only get vials of U-40 insulin but there are insulin pen cartridges available then it is possible for you to buy these, as insulin pens world-wide are U-100.
You will need to draw the insulin out from them - remember not to inject air into the cartridge as you would into a vial.
Then again, if you are a pen user you need to know that not all countries use pens and you may have to resort to syringes in an emergency. Make sure you know how to do this.
Also some places will not be able to offer you a choice in the length of pen needles. They often only keep the standard length of 12.7mm.
As the length affects the speed at which your insulin acts you need to take this into consideration if forced to buy a different length needle.
It is not only insulin that can be a problem in foreign countries. Oral medication may be called something different, be available only in different strengths or even worse, may not be licensed for sale in another country at all.
Even your favourite brand of Sweetener may not be available. Stevia, for instance, so popular with our US friends, cannot be bought anywhere in the EU.
One needs to try and take enough supplies to last the whole time you are away but.....
Remember that universal law - 'what can go wrong, will'.
If you are going away for a very long period of time it is possible that you will just not be able to take enough supplies with you.
There is also the chance that something may go wrong with the supplies you have taken - I know of a woman who placed her insulin in the fridge, the fridge malfunctioned and her whole supply was frozen solid and had to be thrown away.
She had no prescription with her, the village was a small rural one with no hospital and the doctor was away.
She had to go on bent knees to the tiny local chemist shop where the owner, luckily, was not only very understanding but was also able to supply her, not with the insulin she was used to, but with one she could use until she managed to get to a larger town.
I say she was lucky because in some developing countries many of the pharmacies have little or no electrical power and thus have no means of refrigerating insulin, which means they do not carry it.
At the 18th International Diabetes Federation Congress it was stated that only 30% of pharmacies in Brazil had enough electrical power, which meant 70% of the pharmacies there did not carry insulin.
If you are going to a place which has no fridge you are probably going to need to buy new supplies sometime during your stay.
Then there is the chance of having your supplies accidentally lost or even stolen.
So if you are going away you may well need to find some way of getting the correct supplies.
There are varies ways of doing this.
1. You can get hold of the company that makes your insulin (their contact address and telephone number should be on your insulin pack) and see if they would be prepared to send a supply to some pre-arraigned collection point in your destination country.
For instance if you use Hypurin beef or pork insulins, which have been withdrawn in many countries, these can be obtained, with a doctor's prescription, directly from the manufacturer and they do export out of the country.
Their address and contact number is:-
Wockhardt UK Ltd,
Ash Road North,
Wrexham Industrial Estate
Wrexham LL13 9UF
Wales
U.K.
Toll Free Phone: 011 800 667 55 555
Fax: 011 44 197866923
The Insulin Dependent Diabetes Trust in the USA gives all the information about how to get it.
I understand, though I have no personal experience, that in the UK John Bell and Croyden, Pharmacists, Wigmore Street, London will courier insulin and other drugs to you if you send them a doctor's prescription. You will, however, be responsible for paying the courier charges.
It is very possible that there is such a service in other countries as well.
(Remember though that in a less developed country not only may there be no courier service, there may be no reliable postal service either!)
2. If your supplies have been lost or stolen and you need stuff in a hurry the first port of call should be the emergency room of a local hospital, if there is one available. They can usually give you enough supplies to see you through until you can make other arrangements.
Find out from them, if possible, the names, addresses and phone numbers of suppliers in the main cities of the country you are visiting.
You can also phone the diabetes organisation of the country you are in and find out from them the best way to obtain new supplies.
Details of such organisations are available from
the International Diabetes Federation.
Of course you will have to find out such details before you go on holiday - here's that 'pre-planning' bit again.
3. Always carry a prescription letter from your own doctor, listing by both generic and brand name the medication you use. Don't forget to include on the prescription letter such items as blood glucose testing equipment and syringes.
4. Before leaving home become a member of the International Association of Medical Assistance to Travellers. This organisation has a network of doctors around the world who have been trained in the USA or Europe and who will give travellers competent care. The organisation will supply you with a list of these doctors and where to find them. Membership to the organisation is free.