Out of Insulin, Too Early to Renew — What To Do?
Disasters Averted Diabetes in Control August 30th, 2016
It is not unusual for people to have difficulty keeping insulin from freezing or getting overheated. A patient, with type 1 diabetes for 17 years, had glucose that did not respond to his rapid-acting insulin as it usually does.
He had two new vials in the refrigerator. He took a new vial out of his refrigerator earlier in the day, and started using it a few hours after he took it out. Had high post prandials that did not respond as usual to correcting. He had enough experience to wonder if perhaps something was wrong with his new insulin, so he thought he’d try another vial. He saw it was frozen. He had put the two vials at the back, where for many refrigerators it is colder. He thought back and wondered if the first vial looked any different, but remembered, he did not look closely at it.
He then went to get a new prescription filled at his pharmacy, but was told insurance would not cover it at this date; it was too early. It was cost prohibitive for him to pay out of pocket ~$300.00/vial. He contacted a diabetes health care provider (hcp) who offered him two sample vials to cover him until his prescription would once again be covered. He corrected and his glucose lowered. Disaster averted! (Thank heavens we don’t have this problem in the UK!)
Not everyone has the luxury of having a hcp who has samples available in such a timely manner. If their hcp even had them, what if it were a weekend, or another time that the hcp did not have access to the samples? I reached out to certified diabetes educator, Laurie Klipfel, RN, MSN, BC-ANP, CDE, to see if she could offer any pearls of wisdom.
“This was a recent discussion on an AADE list serve with many good suggestions. The best suggestion was asking the healthcare provider if samples were available. My next option would be to see if the insurance would make an exception under the circumstances (but this may take time).
Someone with type 1 needs their insulin and cannot wait a day or two. The next option is to see if a diabetes educator could contact a rep for samples (their prescribing healthcare provider would also need to be involved). My next option would be to see if there were coupons available online from websites like: http://www.rxpharmacycoupons.com, or other websites. As a last resort (but may be the fastest option in a pinch), if a patient was not able to afford the analog insulins such as Novolog, Humalog, or Apidra, I might suggest discussing with the healthcare provider if using regular insulin instead would be an option. Though the analogs match insulin need to insulin much better than regular insulin, taking regular insulin (especially when using a generic brand such as Walmart’s ReliOn brand) can be a much cheaper option and would be much better than not taking any meal dose insulin at all.
It would be beneficial to explain the differences in action times and suggest taking regular insulin 15-30 min. before the meal and beware of potential hypoglycemia 3-5 hours after injection due to longer action of regular. Of note, you do not need a prescription for regular, NPH or 70/30 insulin.
“I would also agree with suggestions made on the list serve for keeping the insulin in the door of the refrigerator and using a thermometer in the refrigerator. If the temperature in the refrigerator is not stable, it may be helpful to have the thermostat of the refrigerator checked.“
Lessons Learned:
Teach patients:
People who have diabetes, especially type 1 diabetes, need to have and take insulin that is effective.
If you have type 1 diabetes, you are in danger of DKA. Know what it is, how to prevent, recognize, and get help for DKA.
A back-up plan for insulin gone bad or not available.
To double check insulin when taken out of the refrigerator for the “feel of the temperature” of the insulin. Do not use if hot, warm, or frozen.
To know what their insulin should look like, clear or cloudy. Avoid it if crystals, clumps or anything unusual is noted.
The onset, peak, and length of action of insulins they are taking, as well as replacements if needed.
If insulin is not available and can’t get insulin within hours, to visit the nearest ED or urgent care center.
Anonymous
Anonymous
Diabetes Diet 
In the US we have a 3rd option. For the most part if a person is part of social media platform a mention of I do not have insulin will produce many offers of friends and many they do not know who offer to help out. Many of us have helped in the past and are especially willing to pitch in for someone who is out of insulin. We pitch in to take care of those who are without.
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I’ve read a few articles about lack of consistency in insulin strength, potency in other words. Here in America we are prevented from getting overseas (foreign) meds by law. One of the reasons given is to prevent that exact problem. The “we can’t control their products so can’t of guaranteed quality” is no longer a valid argument. Why pay a massive price increase for meds that aren’t as secure as promised? If we were allowed to us lower cost meds from other countries, the high cost of meds in the USA would disappear overnight. Meds here in the states cost nearly 5 to 7 times, not percent, higher than UK or other countries. It is a sad reality that if you have enough money, ironically money from the same drugs they over price, you can buy politicians and then the laws those individuals write. I have had incidents were my sugar levels were for some reason out of whack. I always chalked it up to being sick or having an infection. After hearing about this potency issue I now have my doubts as to the real culprit.
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Someone I knew was having difficulty with blood tests which were being invalidated. The problem turned out to be that the doctor was sending the samples to the lab in an unrefrigerated van, in midsummer, in Texas.
Even if the pharmacy stores it properly there’s no knowing what may have happened to the insulin before it arrives there. I wonder if this might be the reason for a lot of variability as recently publicised.
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