Diabetes · Health and Disabilities · Science

Diabetes Issues: Keeping Insulin Cool When Refrigeration Isn’t Available

The clay pots and devices studied to keep insulin cool. Photo from lifeforachildusa.org.

Type 1 diabetics, and other insulin-dependent diabetics, depend on prescription insulin to stay alive. Insulin, a hormone that the body normally produces in the pancreas, is necessary for proper utilization of carbohydrates. Carbohydrates are the body’s main fuel. Insulin-dependent diabetics, especially Type 1 diabetics, produce little to none of their own insulin. Without insulin, a diabetic will become very sick within a few hours or days, depending on the severity of their diabetes, and death will follow soon after.

Insulin is an expensive, perishable, injectable medication that must be kept at a stable, cool temperature and used before its expiration date. In countries with few resources, life can be very difficult for Type 1 diabetics. Insulin storage becomes a big issue in hot climates without electricity or dependable modern refrigeration.

It also becomes an issue for diabetics in first world countries during times of upheaval, such as natural disasters and war. Hurricanes or blizzards that knock out electricity for days or weeks, combined with extreme hot or cold temperatures, can mean the loss of a diabetic’s entire supply of insulin if they aren’t prepared or are caught away from home. Heartbreaking footage came out of the coverage of Hurricane Katrina, for example, of diabetics who sheltered in the Louisiana Superdome. Before long, some were in very bad shape and in desperate need of insulin.

All insulin-dependent diabetics should have an emergency diabetes go bag prepared with enough supplies inside to last two or three times the length of the typical natural disaster in their area. Packing up nonperishable supplies like extra blood glucose meters, strips, low treatments, and syringes, and putting them in a bag in a closet is easy to do once and forget about until needed, other than restocking expired items once or twice a year. We keep a travel bag stocked for Metamaiden that she uses for regular trips, and would grab if we needed to evacuate.

But insulin can’t be prepacked so easily, or stored during a disaster, especially a power black out, wherever you’re sheltering. It’s even more difficult to store long-term when your home doesn’t have electricity or refrigeration at all. Even when we stay in a hotel room with a fridge, those are too unreliable to risk storing Metamaiden’s insulin in them. When traveling, we’ve solved that problem by using Frio Cooling Wallets, pouches which come in various sizes for storing and cooling insulin.

Purple extra small cooling wallet from medicoolusa.com

Frios come with an outer fabric case, and an inner pouch filled with gel beads. After the gel beads have been soaked in water for about 15 minutes they expand and soften. The thick layer of wet gel acts as an efficient insulator to keep whatever is inside at a stable temperature. The gel pouch goes in the fabric case, then the insulin goes inside the gel pouch. Both pouches have velcro closures. The gel stays wet for days, and can be reactivated with more water when necessary. It can be soaked in a bowl again, but I just run water over it for a few minutes every day or 2.

We’ve kept insulin cool for weeks at a time in Frios, through hot and cold weather, traveling from place to place, moving it from car, to hotel, to car, to house or campsite. Our Frios are an essential part of Metamaiden’s emergency/disaster preparedness. They would work for any small medication or item that needs to be kept at a stable temperature, including medical devices worn on the body, since Frio makes wallets meant to be worn with an insulin pump.

But what about when even a Frio isn’t available? Is there any way to keep insulin safe from extreme temperatures so that it doesn’t spoil prematurely?

There are people around the world who depend on insulin and face this issue everyday. They’ve developed various methods to store and cool insulin, such as immersing the insulin in water inside clay pots. Life for a Child, an organization that works to bring health care and diabetes supplies to diabetic children around the world, who wouldn’t normally have access to adequate care, studied these methods to see if they worked and how efficient they are.

Ten different clay pots, a goat skin, a vegetable gourd and a bucket filled with wet sand, along with two identical cooling wallets, were studied. The study found that all of the devices successfully kept the insulin cool.

RESULTS: During the study period, mean ambient temperature and humidity were 31.0°C and 32.0% in Khartoum and 32.9°C and 39.8% in Bamako. All devices reduced the temperature (P < 0.001) with a mean (sd) reduction from 2.7 ± 0.5°C to 8.3 ± 1.0°C, depending on the device. When expressed as % maximal cooling, device efficacy ranged from 20.5% to 71.3%. On cluster analysis, the most efficacious devices were the goat skin, two clay pots (from Ethiopia and Sudan) and the suspended cooling wallet.

CONCLUSION: Low-cost devices used in less-resourced countries reduce storage temperatures. With more efficacious devices, average temperatures at or close to standard room temperature (20-25°C) can be achieved, even in hot climates. All devices are more efficacious at lower humidity.

I haven’t seen the details of the methods, but knowing what I do about them and the Frio, any method that provides stable insulation using water would help in a pinch. Immersing the insulin in a cooler filled with water, a covered clay pot, or a bucket of water inside a minifridge are ideas to try. Freezer or hot/cold gel packs would continue to maintain a stable temperature once thawed if they stayed someplace stable, like the inside of a minifridge that stayed closed, so they could also be useful to try.

Life for a Child will continue to study these methods and share them with diabetics in resource-challenged countries. Here in countries with more resources, we can take these ideas into account in our own emergency planning.

A young boy from Sudan with the clay pot he uses to store his insulin. From lifeforachildusa.org

Source: Life for a Child Blog, Keeping Insulin Cool

Life for a Child accepts donations to help children with diabetes get the medical care they need: Donate

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