Regarding Insulin Storage and Switching
between Products in an Emergency
INSULIN STORAGE AND POTENCY
Insulin from various manufacturers is
often made available to patients in an
emergency and may be different from a patient's usual insulin. After a disaster, patients in the affected area may not have access to
refrigeration. According to the product labels from all three U.S.
insulin manufacturers, it is recommended that insulin be stored in a
refrigerator at approximately 35 to 46 degrees F. Unopened and
stored in this manner, these products maintain potency until the
expiration date on the package. However, all of the available
insulin products may be left unrefrigerated (between 59 and 86
degrees F) for up to 28 days and still maintain potency.
As a general rule, insulin loses its potency according to the
temperature it is exposed to and length of that exposure. Under
emergency conditions, you might still need to use insulin that has
been stored above 86 degrees F. Such extreme temperatures
may cause insulin
to lose potency, which could result in loss of blood
glucose control over time.
In any case, you should try to keep insulin as cool as
possible. Try to keep insulin away from direct heat and
out of direct sunlight, but if you are using ice, also avoid
freezing the insulin.
When properly stored insulin again becomes available, the insulin
vials that have been exposed to these extreme conditions should be
discarded and replaced. If patients or healthcare providers have
specific questions about the suitability of their insulin, they may
call the respective manufacturer at the following numbers:
Novo Nordisk: 1-800-727-6500
Switching insulin should always be done in consultation with a
physician. If this is not possible under emergency conditions, the
following recommendations may be considered:
Short-acting and rapid-acting insulins
One brand of regular insulin (e.g. Humulin R, Novolin R) may be
substituted for another brand of regular insulin and for
rapid-acting insulins (e.g., Humalog, NovoLog), and vice versa,
on a unit-per-unit basis.
Intermediate and long-acting insulins
One intermediate-acting insulin product (e.g., Humulin N, Novolin N,
Lente insulin) may be substituted for another intermediate-acting
insulin product on a unit-per-unit basis. Likewise, these insulins
may also be substituted for long-acting insulins (such as Lantus and
Ultralente) on a unit-per-unit basis, or vice versa. IMPORTANTLY,
half of the NPH (or Lente) insulin dose should be given in the
morning and half given in the evening.
Patients using pre-mixed insulin products (e.g., Humulin 70/30,
Humalog Mix75/25, Novolin 70/30, NovoLog Mix 70/30) have two options
- One insulin mix product may be substituted
for another on a unit-per-unit basis.
- If no other insulin mix is available,
patients should first substitute an intermediate- or long-acting
insulin on a unit-per-unit basis relative to the
intermediate-acting component of the mix (e.g., in the examples
above, approximately ¾ of the total unit dose of the mix), always
making sure that the total dose of NPH (or Lente) insulin is split
between morning and evening doses.
- If regular or rapid-acting insulins are also
available, they may be used before major meals along with the
intermediate- or long-acting insulin (dosed as above) in doses
equivalent to approximately ¼ of the total dose of pre-mixed
insulin usually taken before that meal.
- Patients using insulin pumps who must switch
to injected insulin may substitute an intermediate or long-acting
insulin for the 24-hour total basal dose of infused insulin on a
unit-per-unit basis, always making sure that the total dose of NPH
(or Lente) insulin is split between morning and evening doses.
- If regular or rapid acting insulin is also
available, patients should administer mealtime insulin according
to their previous system for calculating their bolus insulin
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Date created: September 9, 2005; Updated June 16, 2008