Our controversial columnist Wil Dubois is back with another spicy edition of our new diabetes advice 
column, Ask D’Mine.
{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}
You know the answers you get here will be brutally honest and interesting, to say the least.
Robyn from Colorado, type 1, writes: I have traveled a lot over the years with my insulin in tow. Upon completion of each trip I always come to the same conclusion—there has to be a better way to transport insulin in order to keep it consistently cool. I am talking cool where I am confident the potency has not been lost, not ‘so-so cool’ that leaves you wondering: “Is it a bad site, was it that yummy street snack I just consumed, or did my insulin just not travel well?”
Most recently I tried out the Frio Pack which I found to be okay, but would love to know what others are using/doing? I am primarily thinking about long distance air travel, where a refrigerator can be found on the other end within 24-48 hours.
Wil@Ask D’Mine answers: Lots of us don’t use anything, actually. My take is that unless you are traveling in the Amazon rain forest or the Gobi desert, there’s no need to chill your insulin anymore. Modern insulins—in alphabetical order to avoid playing favorites—Apidra, Humalog, Lantus, Levemir, and Novolog do not need to be kept “cold” at all. Nor do the injectable type 2 meds Byetta and Victoza.
Now before everyone pummels me in comments, I’m talking about the insulin you’re gonna use here. You should still keep your unopened inventory in the butter compartment. But don’t chill the stuff you are using. There’s no benefit. Besides, cold insulin stings like hell when you inject it.
Image: Type A Mom Type 1 Kid
In fact, once a vial or pen is open the clock is ticking. You’ve officially got 30 days to use it, and keeping it cold won’t extend its life at all. I say officially, ‘cause you can probably get 45 days out of it (like you don’t have to throw milk out on the “sell-by” date) before it begins to lose its efficacy.
And someone was telling me the other day (I wish I could remember who) that the outfits donating insulin to the Third World find that the older-style insulins are even more long-term stable in warm temperatures. Maybe we haven’t needed cold packs since, I don’t know… Best and Banting? If ever. Makes one wonder.
Personally, I carry a back-up disposable pen of fast-acting in my go-bag in case my pump craps out, or I yank an infusion set, or whatever. After being carried around at room and outdoor temperatures (in New Mexico, mind you) for two months I transfer it into my pump and put a fresh pen in my bag. Even after two months of warm-ish temperature storage, I’ve never had any issues with the insulin.
Ca-clunk! What was that noise? Oh, just the sound of Frio stock falling.
Sorry, guys.
(Editor’s Note: Amy happens to love Frio, in large part because it provides a nice, safe, cushy travel pack for those brittle insulin vials)
Bruce from Kansas, type 1, writes: I’m seriously frustrated. I use the Omnipod and I find it awful. In my last shipment, 8 pods had errors and 5 had occlusion alerts. I tried the Minimed 722, but was disappointed because I had used the Cozmo pump before, which out-classed it, but is now dead and out of warranty. I have not tried Animas, but am afraid to commit in case it turns out to be worse than anything else, and then I’m locked in for potentially forever, as the new thing with insurance companies is that your pump can’t be replace until it dies and is out of warranty.
Are there any current pumps, or pens, that are really low hassle, easy to deal with, and don’t try to kill me? I also need a company that will back it up, if a failure does happen.
Wil@Ask D’Mine answers: Dude, I feel your pain. No one understands us. But if Apple went out of businesses tomorrow and all the Apple users had to buy PCs, they’d understand exactly how we Cozmo folks feel.
There are a couple of options left for you. One, as you pointed out, is the Animas. Some people love it, but I’m guessing if you find the Medtronic user menus frustrating, then you’re really gonna hate the Animas menus. You could look at the Spirit Pump from Roche. It’s rather primitive by the standards of most modern pumps, but has the neat feature that you get two pumps in the box: one to wear and a spare.
How’s that for the ultimate in customer service? Having a spare unit around would solve a lot of problems for us pumpers, wha?!
But before any of you get too excited about the two-for-one pump special, let me point out that the spare Spirit pump really is just a “spare tire.” No kidding! It’s equipped with a self-destruct mechanism like the tapes in the old Mission Impossible TV show. After 180 days of run time—phffiit—it shuts down. The idea is to provide you an instant spare while the company figures out what went wrong with your primary pump and get it fixed.
Pretty much every other pump company promises to “next day” out a full replacement pump if you have a failure, but that can be a really long day. If you don’t have adequate backup supplies you’ll have to run to the pharmacy, if it’s not the middle of the night when the pump fails (and of course when else would one fail?) for some basal insulin. The real problem is: once you’ve been on a pump for any length of time, you’ll have no clue how much basal insulin you used to need. A frantic call to your doctor may be in order.
Here’s another option: If the current batch of pumps turns you off, why don’t you take a break? Take shots for a year, while you wait to see what comes out next.
As to pumps vs. shot therapy, here’s my bottom line: you can have wonderful control on a pump, and you can have crappy control on a pump. You can have wonderful control on shots, and you can have crappy control on shots. It’s the brain of the PWD that makes the tools work. The pump is really just a fancy syringe.
If you’re gonna go back to shots, why not get a smart pen like Lilly’s Memoir? It’s a beautifully engineered metal pen that takes disposable pre-loaded insulin cartridges. But the best part is that it’s got a little LCD screen that lets you look at your dosing history. Because I guarantee, at this very second, six bites into a Big Mac, a PWD somewhere in the world is saying to himself, “Crap! Did I remember to take my insulin?”
Whip out your smart pen. It’ll tell you the day, time, and amount of your last bolus.
Remember that going back to shots isn’t necessarily forever. I’m betting there are a bunch of new pumps held up in the FDA right now, and plenty more on the drawing board. The nice thing about living in a diabetes epidemic is that we’ll have lots of cool new toys to play with!
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
“But if Apple went out of businesses tomorrow and all the Apple users had to buy PCs, they’d understand exactly how we Cozmo folks feel.”
I too thought that the Cosmo software was brilliant. My kids thought the Cosmo pumps looked funny and their mom dressed them funny. They prefer Animas. Go figure. My kids are PCs, the same of it all.
“you can have wonderful control on a pump, and you can have crappy control on a pump. You can have wonderful control on shots, and you can have crappy control on shots. It’s the brain of the PWD that makes the tools work. The pump is really just a fancy syringe.”
Wil, I don’t think this is communicated enough throughout the diabetic world as it is. I do think it’s the brains behind the pump/shot that makes the tools work. Great quote.
(And I just looked down at my Captcha word and it reads: nothelpa the
Well, there ya go.)
Again, loving this new column — and thought that eli lilly smart pen was great!
We LOVED Cozmo. It was a sad day in our house when it was time to say good-bye. I was *SURE* I couldn’t ever love another insulin pump the same. My daughter wears Animas now and I’m pleased to report that I was very, very wrong
LOVE IT!
Great column!
I have worn a Medtronic pump for 25 years and always received great service. Recently went thru several weeks of refractory blood sugars after putting a pet to sleep. I worked hard and so did my endo with no avail. Medtronic sent me very quickly a charger for my CGMS (free of charge) to rule out that my transmitter was dead (It was one of the first). Then after I could not get the transmitter to work Medtronic worked very quickly thru the process to send me a new CGMS system. The day I put it on blood sugars calmed down! Go figure.
70/30 novolog flex pens are only good for 14 days after starting to use them. This can have a direct impact on blood sugars. If you need to confirm this please call Novo Nordisk at 1-800-811-0467.
I already miss my Cozmo and the warranty has yet to expire. I figure I’ll order supplies and keep going as long as I can. I do wish Smiths Medical had sold the technology to another company. For example the disappointing Spirit Pump really needs to be replaced. How about it Roche, I’ll bet you could pick up the Cozmo for a bahgain!
That Lilly pen looks interesting and some patch pens may be available before too long. I’m not sure I want to go the pump route again until I can get one with the Dexcom integrated.
8 pod errors and 5 occlusion alerts? Are you sure you are using it as trained? In 18 months I don’t think we’ve ever had an occlusion alert.
We love, l-o-v-e, LOVE the OmniPod and would never (at this point, given the alternatives) consider any other.
There are so many pluses for us using the OmniPod and as a caregiver it makes life so much easier.
Did I mention we love it?
(Oh, and I would be so freaked out if Apple went out of business. The horror!)
Animas girl here! Love it…no issues and the menu is NOT a problem for us…but get “different strokes for different folks”.
AND…
YES! on the insulin storage question. I only keep cartoned, unused insulin in there…I have insulin at room temp and in Woodchuck for my on-the-go Joe. However…I do live in VT. I think in like AZ or in Qatar…or other places…a ice pack thingy may be needed.
LOVE WIL!!!!!
You wrote: “The nice thing about living in a diabetes epidemic is that we’ll have lots of cool new toys to play with!”
The sad and ironic part of this statement is that those who comprise the diabetes epidemic are Type 2′s, and they usually can’t get the cool toys. I have a pump and a CGM, which I love, and work far better for me than shots, but it’s only because I have a Type 1 diagnosis. And I’m facing having to give up the CGM when I go on Medicare in 2 years, and who knows if they’ll support the pump either.
You don’t get to play with the toys if you don’t have the money!
Viki–
You are absolutely right that mix pens, both from Novo and Ely Lily, have a much shorter shelf life due to being part NPH, a more “old fashioned” intermediate length quasi-basal insulin. Mix could be the subject of an entire column, and if someone is interested you know where to ask! Mix therapy is very far from state of the art, but it’s cheap. Well, cheap by insulin standards anyway. That’s sort of like saying regular gas is cheap compared to premium…
Dunno, but I have definitely had insulin go bad due to heat just being in my purse (I use Novolog), so I carry ice packs or a Frio now if it’s going to be above 80 degrees in my purse.
A low tech solution instead of a Frio that I’ve heard of is to use a pot and a smaller clay pot. Put water in the bigger pot. Then put the insulin into the smaller clay pot and into the bigger pot.
sometimes I throw my insulin into one of those small metal thermoses say, for example, if it’s going to be in my car in the heat. I don’t keep it cold but I’m hoping that it keeps it from getting exposed to super high heat. I don’t think I’ve really ever had insulin go bad from the heat but I do understand trying to remove all the possible confounds to good control.
@Natalie, I only learned recently that I had to go on Medicare at a certain age. An age at which I’m sure I’ll still be working and probably would still have health insurance, except that Medicare is forced on us. And they wonder why the Medicare scheme is broken. I was disheartened to learn from my endo that Medicare doesn’t cover CGMs and getting pump coverage is hard also. I do hope we can things to improve Medicare coverage of items that have become essential for many of us.
RE: The toys. No, we don’t all have access to them.
My HMO has things set up so I can barely afford to stay in warranty with a pump. I love my Animas (traded in my Cozmo) but with the warranty up soon and a fifty percent copay and no chance of trade in or financing (thanks to my HMO’s relationship with a certain third party), what choices do I have?
Forget CGMS, my plan doesn’t cover them for hardly anyone. Forget pods, my plan doesn’t cover them either. When the Solo patch pump (Roche) comes out, it will probably be years before there is a chance of having that covered.
Seriously considered going on injections again, but not sure since A. you cant turn your insulin dose down….. and B. you have to take a lot of injections separately (cant mix long and short acting.)
What to do?
Not sure yet, but definitely feeling that for many of us purchasing the latest technology aint gonna happen.
I’ve been a Minimed pumper for 13 years! How time flies!!! Satisfied for the most part… but just had a second pump with stuck buttons in the past 5 months… so yes the day or 2 on shots. This time it was actually a bit fun… A pump VACATION! It felt incredible to be “untethered” for a few days! BUT all those shots got the best of me… after 3 days I reconnected my new pump (Yes my old one when out on a Sunday night- so got my new one in 36 hours, thank you… and the bottle of Lantus I had in the fridge was just over a year old).. would love to try something without tubing when my warranty is over in October.
Is it the Solo that has buttons on it to bolus incase you forget your controller? That is my biggest hesitation about going Omnipod… leaving home without it! I do LOVE having that pump in my pocket at all times.
On the question of keeping insulin cold, I haven’t done that for active bottles [don't use a pump] in years. Almost never have had a problem. [Type 1 diabetic for 44 years.] Of coursem there’s no reason not to keep unopened botles in the frig.
Regarding the use of pumps at all, I’ve not been able to convince myself there’s a great benefit UNLESS you simply can’t seem to get your blood sugars consistently under control. To me the “winner” of a product will be when a CGM actually works effectively as a standalone product.
Many thanks for the post, I am quite new to insulin so I was not looking forward to doing a long haul flight. However, I have purchased my Frio and feel more confident about traveling, especially since I will taking 3 connecting flights and hanging around at the airports. I was told by my pharmacist to ask the cabin crew to refrigerate the pens. Panic attack! I am soooo forgetful, I would have probably left them behind. I purchased my pens from AIMS (MENA) FZE they distribute in the Middle East.
I find that I have to travel with my insulin on ice if the temperature is above 80 degrees. If I am going to be continually in an air-conditioned environment, I will keep it in my purse. I use Humalog and have done so for 15 years. Before that I used nearly every Lilly insulin on the market but I honestly don’t remember how susceptible they were to heat.
I have been using the Omji Pod for well over 5 years! I love it!
My issue is that the US Congress assigned the Code Numbers PodA 9274 and PDME 0784! I am about to start on Medicare but because of these numbers assigned by the Congress I will not be able to continue with Omni Pod!
I do know that there is a “CONGRESSIONAL DIABETES CAUCUS!” I don’t know if they assigned the disposable code numbers or if some other group in the Congress has done this!
The following are the members of this particular caucus: Rep Ed Whitfield;Rep Diana De Gette;Rep Tom Reed;Rep Xavier Becerra!
There is also a Senate Diabetes Caucus. I’ve been unable to locate the members of this caucus!
I would like to continue with the Omni Pod! I have been a diabetic and followed at the Joslin Diabetes Center in Boston since I was 18 mos old! I don’t prefer the pumps with all the tubing hanging down,I’m sure other females in this group can understand why!
I would appreciate any help I can get to have “MEDICARE COVER THE OMNI POD!”
The Petition is located on My Wall: Jean Devlin Haight on Facebook!