How do you know if your insulin has gone off? Does it smell bad? Does it look bad?
The question of insulin being off is indeed a preemptive one. Of course, there are certain ways to examine the insulin, but still one can never be completely certain that, the insulin being used is in fact ok to use. There are a few precautions that can be taken to make sure that the insulin isn’t ineffective. These steps are:
(1) Always checking the expiry date on the vial. Is it expired or not?
2) Is it cloudy in appearance with clumps that don’t disappear even after rolling the vial in between your palms?
3) Did you store it in a very hot or very cold environment?
(4) Does the insulin look stringy?
(5) Has it changed colour?
A few other things to consider, which could affect the performance of the insulin are:
(6) Has the insulin vial been opened for more than 28 days, stored either at room temperature or in the fridge?(depending on which insulin type you have, the number of days differ)
(7) Has the rubber on the vial been punctured several times, due to only small amounts of insulin been used?
If all checks are made correctly, then it will help you avoid using insulin that has gone off.
So, what do you do, when you think you’ve made all these checks and the insulin seems fine? Of course you use it just like I did a few weeks ago…..
I decided to change my pump site and used an unopened vial I had left over from my Summer vacation. As usual, I inspected the vial to make sure that it was still in date, that it was not cloudy in appearance with clumps and I knew that it was stored in the fridge.
During my vacation, I transported my insulin in a Frio bag. When I arrived at my destination it was significantly hotter so I then put my vials directly from the Frio bag into the fridge. Keep in mind the FRIO bag can be used for up to 52 hours and it will maintain the temperature that the insulin vials need to be at. However, when I initially went to put the vials in the fridge, it seemed warmer than it should be, so I adjusted the dial and waited . The fridge cooled down so I put my vials inside. This one vial was never opened and remained in the Frio bag and then in the fridge throughout the entire vacation until I returned home.
I changed my site, bolused, had my breakfast and off I went to take my son to school. I came home, checked my blood sugar and it was 9.5mmols/l.
Hmm! Ok, that’s great for a workout.
I worked out and what usually happens is that my sugar will drop. In this case, my sugar was 16mmol/l. I decided to give myself a bolus to bring my sugar level down. I waited and tested it 15 minutes later, only to find out that it had now jumped to 20mmol/l. I then thought that maybe it was the site, where I had put my insert and that maybe I should change it. So, that’s exactly what I did. I got a new insert, syringe and used the same vial of insulin. (At the time I didn’t realise that the cause of my high sugars was in fact due to this insulin vial.) I changed my site and decided to bolus again to bring my sugar down. I waited a further 15 minutes and checked my sugar level, which now read a shocking 25mmol/l on my blood glucose meter.
What on earth was going on?
It wasn’t until then that I had the thought that, maybe this vial of insulin wasn’t good. I decided to do my checks again.
(1) I looked at the expiry date 07/2017. It was in date so that wasn’t the problem.
(2) It was stored in the fridge and the fridge is in good working order and it was kept at the right temperature. Plus I’d transported it correctly throughout my vacation.
(3) It wasn’t stringy.
(4) It hadn’t changed colour.
(5) The vial had not been opened and therefore it still had the orange cap on it and of course it did not have any punctures in the rubber.
(6) I took a good look at the insulin, it seemed ok. I then decided to take a good look at the vial whilst holding it in front of a light and then I realised it was cloudy with a few small clumps in it. I then rolled the vial a few times in between my palms and the clumps remained . The insulin had gone off, which would explain my crazy high blood sugars. I throw the vial away immediately. I didn’t quite understand, when the vial had, had a chance to go off. I had taken all the necessary measures to ensure it would be ok, but I guess it must have been affected at some point.
To bring down my sugar I took a syringe and a new vial of insulin and injected 6mmol/s directly into my leg. I checked my sugar after 15 minutes and it had started to fall and it had come down to 23mmol/l. It then took nearly the entire day of bolusing and checking my blood sugars before they came back into a range that I’d concider good. I felt absolutely drained from all the elevated blood sugars I’d experienced that day. I had ketones in my urine, but thank god they slowly disappeared as my sugar came back down.
If you suspect that your insulin is indeed ineffective after doing all the checks, I would get rid of the vial immediately and open a new one. Remember, once a bottle of insulin is opened, not all insulin has the same open expiration date. For example Novorapid, once opened must be thrown away after 30 days for a 10mL cartridge and 28 days for a 3mL cartridge and penfill.