Keep your cool (but not too cool…)

Over the weekend, there was a story in a Queensland newspaper suggesting that there is currently a bad batch of insulin in the fridges doing the rounds, causing erratic glucose levels in people with diabetes. The article was a little confusing because some people were saying they’d noticed high levels they couldn’t get down no matter how much insulin they were using, while others were saying they were having nasty hypos out of the blue.

There has been no TGA announcement about it, but I do know that a few people are concerned – enough to have contacted the media.

This post isn’t really about a dodgy batch of insulin – although if you are concerned, perhaps have a chat with your pharmacist, or contact your doctor and get a new prescription filled.

But the article was the catalyst for this post because when I read the article I started to wonder about insulin storage and wondering if that could be contributing to stories of ‘bad insulin’.

I have a very easy insulin storage system. Unopened insulin sits in the fridge until it’s needed. As soon as a vial is opened, it’s popped into my diabetes spares bag and stays in there, refilling my pump as required. My spares bag is always in my handbag and the insulin vial is probably in there for 10 – 14 days.

I can confidently say that I’ve never had a vial of insulin ‘go bad’ on me and stop working. As far as I know, my insulin is just fine! But I couldn’t tell you if my insulin is being stored at optimal temperatures. To be honest, I’ve always had a pretty lackadaisical approach to inulin storage and suspect that’s because I’ve never had an issue, plus refrigeration is never a problem where I live. But for some people, that’s not the case.

Enter MedAngel. This is Amin:

Amin is pretty awesome. I met him last year at the Roche #DiabetesMeetup and then caught up with him again this year at a couple of diabetes conferences. He’s lovely and smart and is the brains behind MedAngel. He has seen firsthand what happens when insulin isn’t stored properly and problems occur.

The idea behind MedAngel is wonderfully simple: it’s a small, wireless sensor and a mobile app. The sensor is placed alongside insulin (or other medications) and measures the temperature, transmitting to the app which alerts if temperatures are too high or too low for your meds.

When I saw Amin in San Diego at ADA, he gave me my very own MedAngel sensor and, over coffee, showed me how to use it, watching me set up the app. (As I said, he’s smart and sensed my frightful lack of tech abilities.)

I now have a MedAngel sensor in my diabetes spares bag. So far, it’s not once alerted, but we’re in the middle of winter still here, so it will be interesting to see what happens once the weather warms up or when I am travelling to warmer temperatures.

I also popped the sensor in the fridge for a few days. I don’t keep insulin in the butter compartment– I actually keep butter in there (weird, I know), instead it’s always in a small, rectangular box on the bottom shelf of the fridge. Also in the box are paper prescriptions waiting to be filled (so I always know where they are), Glucagon and a couple of long acting insulin pens (usually out of date…) in case of pump failure.

I was pleased that my fridge consistently kept my insulin at a suitable temperature and am now completely confidence that it is safe in there.

However, as it turns out, my fridge is actually not ‘all fine’ for storing insulin. I left the sensor on the top shelf of my fridge in the ‘quick cool’ zone for a day and was getting alerts that it was too cold there for my insulin. The variability in the temperature of my fridge would be concerning if I moved my insulin around, which I have done in the past.

Speaking with Amin, I did start to think about the supply chain and what it takes for insulin to actually get from where it’s made to my fridge. There are a lot of opportunities for there to be issues with temperatures, and even if I’m confident that I have it right once it’s delivered to me, I can’t be confident that it has been kept at the right temperature in all the stages it takes to get to me.

I think there really is an application for MedAngel sensors to be packed in with every single vial of insulin from when it leaves the manufacturing plant and travel along with it all the way to deliver to the person with diabetes from the pharmacy.

Amin gave me with a MedAngel sensor without expectation I’d write about it. I’m writing because I think it’s a useful device. And I also love supporting PWD designing things that make sense for others PWD.