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Super Advisor
leehr
Total Posts: 2,167
Registered on: ‎11-01-2009
Helpful Response

Insulin and Heat

[ Edited ]

Interesting topic how heat and insulin mix or not!  It seems that it is known by Lilly for some time that especially Humalog has a problem with heat.  Years ago Lilly told me to always keep my insulin refrigerator, even the open vial due to varying results I experienced while on MDI method.

 

Now on a pump I also believe that the last few weeks of difficulty with control is due to the time span to change the infusion set.  So I now change every two days with better results and OREGON is NOT even warm - yet! 

 

I believe there may be a correlation between my experience  of warmer insulin stored in pump and this heat issue. What do others of you  think? 

 

Below  is a link to an article I found that might help a bit with understanding this heat and insulin issue. ( I could not find a date on this article but it sounds pretty much what I was told over 35 years ago about Humalog and storage by Lilly .pharmascuetcals.

``

LINK: http://www.diabetesnet.com/about-diabetes/insulin/rapid-insulins/humalog-and-heat

[Link edited by Forum Moderator 1, removing an extra http: from the IP address.]

 

Joan


* Type 1 Diagnosed for 56 years as of Nov 2013
* 50 Year Type 1 Medalist Award from Joslin Diabetes Clinic (Harvard Medical School)
* Medtronic Paradigm Revel 523 insulin pump as of March 2011
* Insulin: Humalog
* Food Allergies: milk, yeast, corn
* Hashimoto's thyroid disease
* A bit of arthritis
* One kidney due to benign Angiomyolipoma.
* Volunteer Community Disaster Co-Coordinator
* Hobbies/Interests: Wildlife Naturalists, artist, gardening, music
Super Advisor
ndali
Total Posts: 517
Registered on: ‎11-10-2009

Re: Insulin and Heat

Agreed. In the warmer months, I change my pump every 2 days because of the ineffectivemess of the insulin
Diagnosed T1 January 1987
Pumping since 2001
Diagnosed Raynaud's January 2010
Diagnosed Lupus January 2013

trisha01
Total Posts: 5,999
Topics: 295
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Blog Posts: 59
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Registered on: ‎10-31-2009

Re: Insulin and Heat

[ Edited ]

Joan,

 

I find it interesting that you posted this. For the past two months and for a long time to come, I've been forced to change from Novolog to Humalog. Upon drawing insulin into the syringe, I've noticed something - not sure if it is tiny particles from the vial, or something with the syringes (BD's). I would imagine though, that it is the Humalog, as I've seen nothing similar when I draw up the Lantus. My Bg's have been higher, than when I was using Novolog. Since last summer, I keep both vials out of the fridge - except when it is really hot and I'm going out in the car (I use ice pack then). Not any issues that I could tell, by having done this with Novolog and Lantus.

 

Two different vials of Humalog have been opened, within two weeks of each other, and both vials did the same. The other noteable difference, is that with the first vial opened, it was staying in my system for more like 4-1/2 to 5 hours, vs the 3-1/2 to 4 hours with Novolog. This second vial of Humalog, is acting more like Novolog did, with the timing of duration. But still little thingys with it. The timing issue, could also just be my body getting used to the Humalog, and not the insulin itself.

 

I forgot to look for a date, but there was one sentence that - if this is a current article, is incorrect. That sentence is:

"Insulin pumps may be especially prone to unexpected highs because they use only Humalog." Even though I don't pump, I know that any of the rapid acting insulins, work with the pump. This (quoted sentence) well may have been the case, when pumps first came out, but I wonder if there was some bias in that report?

 

Trisha




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and Pump Supplies Help ~ Kidney Damage Info ~


mollythed
Total Posts: 5,330
Topics: 73
High Fives: 799
Solutions: 98
Registered on: ‎10-31-2009

Re: Insulin and Heat

[ Edited ]

trisha01 wrote:

"Insulin pumps may be especially prone to unexpected highs because they use only Humalog." Even though I don't pump, I know that any of the rapid acting insulins, work with the pump. This (quoted sentence) well may have been the case, when pumps first came out, but I wonder if there was some bias in that report?

 

Trisha


Trisha, I took thar to mean that a person using a pump with Humalog was completely dependent on the rapid acting insulin for both basal and bolus needs; they had no Lantus or Levemir as basal insulin to help even things out if the Humalog had become less effective.

 

I'll be switching from Novolog to Humalog too when I finish using up the Novolog I have on hand, so I've been looking at comparisons of the two..  I've seen information like this:

  • Lispro (Humalog): Onset, 0.25 hours. Peak, 0.5-1.5 hours. Duration, 6 - 8 hours. Give 15 minutes prior to or immediately after meal.
  • Aspart (NovoLog): Onset, 0.25 hours. Peak, 1 - 3 hours. Duration, 3-5 hours. Give 5-10 minutes prior to meal.

(See http://www.medscape.com/viewarticle/426921_2)

 

That seems to fit with your experience that Humalog lasts a little longer. Up till now, I've been paying more attention to the idea that it gets started sooner.


"Molly"
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Novolog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





trisha01
Total Posts: 5,999
Topics: 295
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Blog Posts: 59
Solutions: 69
Registered on: ‎10-31-2009

Re: Insulin and Heat

[ Edited ]

mollythed wrote:

trisha01 wrote:

"Insulin pumps may be especially prone to unexpected highs because they use only Humalog." Even though I don't pump, I know that any of the rapid acting insulins, work with the pump. This (quoted sentence) well may have been the case, when pumps first came out, but I wonder if there was some bias in that report?

 

Trisha


Trisha, I took thar to mean that a person using a pump with Humalog was completely dependent on the rapid acting insulin for both basal and bolus needs; they had no Lantus or Levemir as basal insulin to help even things out if the Humalog had become less effective.

 

I'll be switching from Novolog to Humalog too when I finish using up the Novolog I have on hand, so I've been looking at comparisons of the two..  I've seen information like this:

  • Lispro (Humalog): Onset, 0.25 hours. Peak, 0.5-1.5 hours. Duration, 6 - 8 hours. Give 15 minutes prior to or immediately after meal.
  • Aspart (NovoLog): Onset, 0.25 hours. Peak, 1 - 3 hours. Duration, 3-5 hours. Give 5-10 minutes prior to meal.

(See http://www.medscape.com/viewarticle/426921_2)

 

That seems to fit with your experience that Humalog lasts a little longer. Up till now, I've been paying more attention to the idea that it gets started sooner.


 

Molly,

 

That would be correct - your first sentence; however...the article specifically referred to Humalog (Lispro), meaning that Humalog (Lispro) was the only named insulin to go in the pump, but not Apidra (Glulisine) nor Novolog (Aspart). ALL three of the rapid acting insulins, can be used in the pumps, unless the pump mfg, states otherwise.  The 6 -8 hour duration is for Regular, not for the rapid acting insulins.

 

From the Merck Manual Professional, is the following chart.....

 

 

Table 3

Onset, Peak, and Duration of Action of Human Insulin Preparations*

Insulin Preparation

Onset of Action

Peak Action

Duration of Action

Rapid-acting

     

Lispro, aspart, glulisine

5–15 min

45–75 min

3–5 h

Short-acting

     

Regular

30–60 min

2–4 h

6–8 h

Intermediate-acting

     

NPH

About 2 h

4–12 h

18–26 h

 

3–4 h

8–12 h

12–18 h

Long-acting

     
 

4–8 h

10–16 h

16–20 h

Glargine

1–2 h

No peak

24 h

Detemir

1–2 h

No peak

14–24 h

Premixed

     

70% NPH/30% regular

30–60 min

Dual (NPH & R)

10–16 h

50% NPH/50% regular

30–60 min

Dual (NPH & R)

10–16 h

75% NPL/25% lispro

5–15 min

Dual (NPL & lispro)

10–16 h

70% NPA/30% aspart

5–15 min

Dual (NPA & aspart)

10–16 h

*Times are approximate, assume subcutaneous administration, and may vary with injection technique and factors influencing absorption.

Lispro and aspart are also available in premixed forms with intermediate-acting insulins.

NPH also exists in premixed form (NPH/regular).

NPA = neutral protamine; NPH = neutral protamine Hagedorn; NPL = neutral protamine lispro.

Rapid-acting insulins, including lispro and aspart, are rapidly absorbed because reversal of an amino acid pair prevents the insulinmolecule from associating into dimers and polymers. They begin to reduce plasma glucose often within 15 min but have short duration of action (< 4 h). These insulins are best used at mealtime to control postprandial spikes in plasma glucose.

Regular insulinSome Trade Names
HUMULIN
NOVOLIN
Click for Drug Monograph
is slightly slower in onset (30 to 60 min) than lispro and aspart but lasts longer (6 to 8 h). It is the only form for IV use.

 

********

Before I forget, under Long Acting shown in the table .... where it shows Glargine - this is Lantus. Detemir is Levemir.

 

********** 

I know that you take other meds, so you will want to check this next area out...it shows pen in the url link, but the entire insert is for all of the Lilly Humalog products: 

 

http://pi.lilly.com/us/humalog-pen-pi.pdf
drug interactions

 ********

Back to the pump stuff....

 

http://www.insidehumalog.com/Pages/index.aspx
Humalog Use in a Subcutaneous Insulin Infusion Pump: Humalog should not be diluted or mixed when used in an external insulin pump. Change Humalog in the reservoir at least every 7 days. Change the infusion set and insertion site at least every 3 days

 

The article link that Joan posted, shows that it can be dliuted - unless it was referring to MDI's rather than the pump. In another section of the Humalog site, it shows that it can be diluted - contradicting itself in the above quote.

 

Doris (joinem) from the old original boards, ALWAYS diluted her Humalog. Lilly is the only place that makes the dilutant for Humalog. She was doing MDI's and not the pump. The article url of Joan's link, gave a dilutant name, however, I didn't see a name for it, on the Humalog site.

*******

 

Also on the Humalog.com site, it had this information on storing it...

 

How should I store Humalog?
•Unopened Humalog should be stored in a refrigerator and can be used until the expiration date on the carton or label.
•Humalog should be stored away from light and heat. Do not use insulin if it has been frozen.
Opened vials should be kept at room temperature or in a refrigerator. Opened cartridges or prefilled pens should be kept at room temperature.  

********

 

Molly, if it will be of help to you, I can send you via postal mail, the actual insert in my Humalog box. Shoot me a PM if you want it. I have more of them.

 

Trisha

 




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and Pump Supplies Help ~ Kidney Damage Info ~


Super Advisor
leehr
Total Posts: 2,167
Registered on: ‎11-01-2009

Re: Insulin and Heat


Hi Trisha - you are absolutely correct that pumps can use other than Humalog. Geeez!  :smileyembarrassed:  I missed that one!

I believe it must have been a typo as in other articles with similar descriptions by Lilly did not make this statement.  So, even the professionals make an error now and then!  Glad you said something.  My eye sight is not the best right now. Have had a H!@#%^!  of a month; so weak I can  not stand up or do anything; I am OK today though.. See the doc Tuesday. Another challenge coming up I guess! 

 

It is odd about how insulin affects us.  I am allergic to  Novolog  and can not use any of the insulin pens.  I found that keeping the pen out on the kitchen counter caused high BGs. What a mysterious world we live in!

 

This element  of warm weather apparently has been going on since Humalog first came on the market.  As I said I went on Humalog as soon as it was available to the public.  It worked for awhile with no issues developing and I still use it.  I have never found any thing floating in an open or unopened vial.  However, now using a pump I still must open a new vial every 24 days.  And I change my infusion set every two days; a suggestion by my pump supplier.

 

I wanted to try Aprida but doc says not yet but gave no reason.  Perhaps he felt fewer changes best at this time.  Its been a year on the pump and although no lows anymore still have some high BG levels; no known reason - yet!  I will not wait long before "nagging him" about better results!

 

Enjoy the warm weather; the Oregon coast will get another week of solid rain!  We had 4 inches of wet snow last week a long with plenty of rain. Tonight the temp will drop to about 30-31; strange for the coast.

 

Joan

 

 

 

.

 

 

 

 

 

 


* Type 1 Diagnosed for 56 years as of Nov 2013
* 50 Year Type 1 Medalist Award from Joslin Diabetes Clinic (Harvard Medical School)
* Medtronic Paradigm Revel 523 insulin pump as of March 2011
* Insulin: Humalog
* Food Allergies: milk, yeast, corn
* Hashimoto's thyroid disease
* A bit of arthritis
* One kidney due to benign Angiomyolipoma.
* Volunteer Community Disaster Co-Coordinator
* Hobbies/Interests: Wildlife Naturalists, artist, gardening, music
trisha01
Total Posts: 5,999
Topics: 295
High Fives: 571
Blog Posts: 59
Solutions: 69
Registered on: ‎10-31-2009

Re: Insulin and Heat

[ Edited ]

Joan,

 

The temp thing was also covered on the Humalog site. It did say IF the temp was above 86 degrees, that it needed to be changed out in 14 days. My dining room, where I keep mine out, has been staying at 78 degrees, so it is still ok there.  There are probably more factors that go into this temp deal, than what it takes for us to count carb grams, etc.

 

You mentioned your eyes (hope they are better now), makes me wonder if I'm having more trouble with mine. But, as I wrote, it doesn't look that way (particle thingys) when I draw up Lantus.

 

If you are having gastroparesis issues, the Apidra may work better for you. That is the only rapid acting that Kelly can use. You may have seen that on her website already, plus she used to speak of it quite often.

 

Get to feeling better Joan! I hope you are ok, and that you are feeling better tonight. Have you had the flu? Maybe your allergies acting up? My alllergies have been giving me so much trouble, that I've been having difficulty breathing. The allergies seem to be worse for everyone this year!

 

Let us know how it goes for you, and good luck on Tuesday. (((((((((( HUGS ))))))))))

 

BTW, I'll take a blizzard, any day over warm weather!

 

Trisha




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and Pump Supplies Help ~ Kidney Damage Info ~


Super Advisor
leehr
Total Posts: 2,167
Registered on: ‎11-01-2009

Re: Insulin and Heat

[ Edited ]

Hi Trisha (and Molly) !   Well......... I think it depends more on the individual as to the results any one of us will see with any type of insulin or equipment or amount of carbs etc!  The charts are an average.   We all know that some methods and medications affect us in a different manner.

 

Just for interest --  Humalog doest not last me more than 4 hours and begins to work within 10 minutes of injection most of the time.  If my BG is high then it is slower to do its job (even with the pump and a constant basal of Humalog)  

 

 I pay no attention to the charts; I pay attention to what my system tells me and my doctors.  At the same time,  I realize that the charts may help some people, and may be information that others need to know.

 

Is comparing type of insulin something like comparing apples and oranges! :smileywink:

 

Have a fun week!

Joan

 


* Type 1 Diagnosed for 56 years as of Nov 2013
* 50 Year Type 1 Medalist Award from Joslin Diabetes Clinic (Harvard Medical School)
* Medtronic Paradigm Revel 523 insulin pump as of March 2011
* Insulin: Humalog
* Food Allergies: milk, yeast, corn
* Hashimoto's thyroid disease
* A bit of arthritis
* One kidney due to benign Angiomyolipoma.
* Volunteer Community Disaster Co-Coordinator
* Hobbies/Interests: Wildlife Naturalists, artist, gardening, music
mollythed
Total Posts: 5,330
Topics: 73
High Fives: 799
Solutions: 98
Registered on: ‎10-31-2009

Re: Insulin and Heat

Trisha,

 

Thanks for the offer of the insert, but I already have boxes of Humalog pens sitting in the fridge, because when I merely asked my pharmacy how soon I would be able to fill the Humalog (I had just gotten three months of Novolog shortly before the change in formulary.) they actually went ahead and filled the Humalog Rx.  When my husband picked up his meds, they gave him my Humalog.  Suddenly I had six months worth of rapid acting insulin in the fridge.  You can read that story at My Insulin Prescriptions


"Molly"
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Novolog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





Super Advisor
Pam01
Total Posts: 2,080
Registered on: ‎11-02-2009

Re: Insulin and Heat


leehr wrote:

Interesting topic how heat and insulin mix or not!  '

Now on a pump I also believe that the last few weeks of difficulty with control is due to the time span to change the infusion set.  So I now change every two days with better results and OREGON is NOT even warm - yet! 

 

I believe there may be a correlation between my experience  of warmer insulin stored in pump and this heat issue. What do others of you  think? 

 

Joan


Joan - I found this exact same thing the summer I first went on the pump. My Endo also suggested I change the pump every 2 days. She suggested it might have something to do with the humalog being in plastic reservoir that made it more affected by the heat.  The summer we were out on the boat, so I was in the direct sun more than the past 2 ?? years. (how many years have I been on the pump?)  I haven't found my bg going up on the 3rd day on the pump anymore.

Pam

Diagnosed Type 1 at age 16 months, over 45 years now
Minimed pump and cgm since July '09. Metformin (insulin resistance), levothyroxine(thyroid), losartan (BP)

I have traveled cross country, and to Canada, UK, Kenya, Mexico, Jamaica, Equador/Galapagos islands, and lived in Egypt for a year.