Posted by on Friday 1 April 2011

Not cool - insulin storage problem

I'm still waiting to write that post extolling the virtues of Colin, my Accu-Chek Expert, but even his shrewd bolus-calculating savvy was not up to coping with the BG craziness of the last seven days.

Things just went bonkers.

And it made me realise that this is not unusual. Since I started putting a lot more effort into my diabetes a year and a bit ago I've noticed a definite repeating pattern in what I previously thought was just diabetes randomness:

1. Finally work out the rules
2. Good numbers for a few days. Yay!
3. Wow that was an AMAZING day. Woo hoo!
4. Errrrr hang on where did that come from
5. Right something's definitely not right here...
6. So the rules have changed again then. Great, thanks for that.
7. Erm... try this?
8. Nope. That was annoying.
9. What about this?
10. Right OK not that either...
11. OK that's looking a bit better
12. Definitely on to something here...

....aaaaand repeat. Given enough trips around the cycle the doses/ratios/splits/timings begin to repeat themselves and off we go again.

But this one wasn't like that. This one was off the scale.

Looking back over recent records I'd had a spectaculatly good patch. Over a fortnight with 75% of readings between 4 and 8 (including several 1hr/2hr post meals). Anything over 10 was a bit of a surprise. I was also having almost no hypos during this period. In short it felt like I was winning. It felt amazing.

I started having a few hypos to tentatively dropped my Lantus by 1u to see if I'd settle just a notch higher up. I only lasted 2 days first with a prefectly acceptable 6.9 average, the second constantly fighting highs and averaging at 10.8.

The next two days, Lantus back up by 1u were not too bad, but the following few days were a complete disaster. Countless corrections were having little or no apparent effect. One morning despite a 2u correction the previous night (at 14.x) I woke to 16.6. I went for broke decided on double my usual breakfast insulin:carb ratio +20% for 'stress', injected 8u and waited for it to come down. 5 hours passed and I still hadn't eaten anything other than a lump of cheese (hoping to trick my liver into cancelling any DP action). BG stayed above 9.0 right up until lunch. The following day saw me needing 10u for a single slice of breakfast toast (that's 5x my usual amount)!

While waiting for our new fridge to be delivered, I posted a moan on a forum describing recent events, and suggesting that the Diabetes Gremlins had perhaps snuck in at night and replaced the Lantus in my cartridge with water. Someone happened to ask if there might be any problem with the way the insulin had been stored. Hang on a minute... "While waiting for our new fridge to be delivered...".

And then it all fell into place. Our fridge has been a bit flaky for some time, maybe even a year. Mostly keeping things cool, sometimes getting a little enthusiastic and getting really cold, other times appearing to warm things up, but never actually completely broken. The light had stopped coming on a week or so ago and we'd decided that enough was enough and ordered a new one. I was down to the last cartridges in the box of both Lantus and Humalog and it seems that the fridge's repeated misbehaviour had substantially affected the insulin's potency. The box of Lantus was the older of the two, so my guess it that it was pretty much shot. The newer Humalog left to fight the BG battle on its own at half-strength. Another one to add to the 'watch list': Count carbs, consider food absorption properties, check basal level, consider level of activity, rotate sites, make sure fridge is working.

I've ditched the suspect cartridges and with nice new fresh ones things have quickly returned to normal. Well today at least.


  1. Hi Mike

    I really understand where you're coming from... and it's one of those "lightbulb" moments for me too! I've been steadily increasing my Levemir for weeks now and whinging about "increasing IR" but what else has changed? Well, I normally keep Levemir in a Frio once in use. I haven't soaked the Frio for weeks! Plus it's been sitting on top of a chest in our bathroom, near the radiator and right in the sun through the window. So thanks for the insight... off to soak the frio!

  2. Tee hee! Glad it's not just me :)

    One of the problems of constantly shifting goalposts I guess. Hope your levels begin to behave as mine did with a nice fresh cartridge in place!

  3. Thanks for all your posts on the Accu-Chek expert. Your blog certainly has the best info about it, and i'm looking forward to reading your next post about it.

    I've just got mine. Don't think i've got all the settings quite right yet but getting there!

  4. Thanks Jon

    Yes looking at our recent stats it seems we get quite a few visitors interested in finding out a bit more about the Expert. Just had my first sore throat/cold since using it so was able to try the + x% for illness setting for the first time. Not bad on the whole! Good luck with getting yours set up to suit you.

  5. Can I ask what percentage you went for on the illness setting? I know it's going to be different for everyone but i've no idea what number to start at with for that and the -% for my gym sessions!

  6. I've got two exercise settings -20% (for approx 45 minutes in the gym) and -10% for general wandering about and/or meals following a heavier gym session if I seem a bit more insulin sensitive for the rest of the day. I'll also 'top up' with an occasional fruit pastille or two before/after the gym depending on levels before I started.

    Illness I tried at +25% which worked pretty well apart from the mornings, though of course 'illness' is not exactly a level event so who knows what'll happen next time!

    Good luck finding your own settings. It took me a good few months to get it pretty much right, and I'm still occasionally tweaking now!

  7. This post made me chuckle!

    I very much liked the Steps 1-12. So true!

  8. My 13 year old son has just been given an Accu-check Expert and so far it seems pretty impressive. Its been interesting to see the variations from the novorapid dose it has suggested to what we've worked out manually. I do feel that there is much more to it than we have discovered from the very basic training session that my son received!

  9. Yes I've been very impressed with its recommendations once I got it set up. It struggeld a bit when the 'rules changed' but then if it's only recommending based on the settings/levels you've provided and once those change those settings need tweaking again. I'm playing with using some of the 'health' settings to cover those times when the usual doses temporarily stop working which should bring the % plus and minus to aim at mid-range back into play again rather than my slightly more crude 'add on a unit or two' approach :).