Does Insulin Expire Storage Safety And How To Tell If Your Insulin Has Gone Bad
Being a pharmacist, I have often been asked if its safe to use expired insulin and how to tell if insulin has gone bad from exposure to heat or cold.
Medications have an expiration date because their stability cannot be guaranteed, based on clinical studies, past that date.
Taking a chance on eating an expired food product is one thing its quite another taking a chance on insulin that may not work at maximum capacity, and therefore may cause harm to your overall health.
What Is This Medicine
INSULIN GLARGINE is a human-made form of insulin. This drug lowers the amount of sugar in your blood. It is a long-acting insulin that is usually given once a day.
This medicine may be used for other purposes ask your health care provider or pharmacist if you have questions.
COMMON BRAND NAME: BASAGLAR, Lantus, Lantus SoloStar, Toujeo Max SoloStar, Toujeo SoloStar
How Long Should Insulin Be Used Once A Vial Is Started
Diabetes Care
Martin M. Grajower, Charles G. Fraser, John H. Holcombe, Marci L. Daugherty, William C. Harris, Michael R. De Felippis, Olga M. Santiago, Nathaniel G. Clark How Long Should Insulin Be Used Once a Vial Is Started?. Diabetes Care 1 September 2003 26 : 26652669.
Editors comment: The commentary by Dr. Grajower has such important clinical relevance that responses were invited from the three pharmaceutical companies that supply insulin in the U.S. and the American Diabetes Association, and all of these combined in this commentary. The commenting letter and individual responses were authored separately and are completely independent of each other.
Diabetic patients treated with insulin, whether for type 1 or type 2 diabetes, are prone to often unexplained swings in their blood glucose. These swings can vary from dangerously low to persistently high levels. Most diabetic patients, and most physicians, will adjust insulin regimens so as to avoid hypoglycemia at the expense of hyperglycemia. Among the textbook reasons for variable glucose responses to any given insulin regimen are 1) site of administration, 2) exercise, 3) bottles not adequately mixed before drawing the insulin , and 4) duration of treatment with insulin .
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Expiration Date Mentioned On The Paperwork
This is the expiration date insulin users pay less attention to. Patients may experience fluctuating blood sugar levels after having used insulin that passes this expiration date.
The moment unopened insulin that has been refrigerated is taken out of the refrigerator and opened, it has a 28-day life span before it expires.
This means that opened insulin has to be discarded after 28 days of opening. This is the general recommendation made by insulin manufacturers that comes in the thick paperwork, which few people read and are unaware of.
To put it into a clearer picture, assume the expiration date of the insulin that is mentioned on the bottle/pen says May next year, but you opened the insulin on January 1st this year. Since the bottle is opened, you should discard the insulin by January 28th, which will mark 28 days after the insulin has been opened.
Had you not opened the insulin at all, it should be discarded before the unopened expiration date, which would be May next year in this example.
Unfortunately, this also means that one might have to throw away insulin, which may be disappointing given the high insulin prices. For example, assume the insulin vial has about ¼ or ½ of the insulin remaining after the 28 days. There is no option but to throw it away.
Can Expired Insulin Be Harmful
You shouldn’t use expired insulin. “I recommend to never use insulin if it’s expired, under any circumstance,” Fernandez de Fiore says.
When your doctor prescribes you insulin, they will give you a certain dose and potency. If the insulin has broken down, it will be less potent, and not give you the blood sugar control you need. This could lead to high blood sugar, or hyperglycemia.
There are also a few conditions that can cause insulin to expire early. This can happen if the insulin is not stored properly or has been exposed to room temperature or light, both of which can degrade the insulin.
Before you inject insulin, you should check the insulin’s appearance. If you notice any of the following signs, it should be returned to the pharmacy.
- Discoloration or cloudy appearance to regular insulin
- Clumps in the insulin
- “Frosting” or crystals on the inside of the vial
In order to make sure that your insulin doesn’t go bad before it’s expiration, following these storage recommendations, says Fernandez de Fiore.
- Store unopened insulin in the fridge at a temperature between 36 and 46 degrees Fahrenheit
- Store opened insulin that’s being used at room temperature, between 56 and 80 degrees Fahrenheit
- Store insulin out of sunlight
- Never freeze insulin or keep it in a hot area, like the glove compartment of a car
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Where To Donate Expired Insulin
If you are not going to risk using expired insulin, the issue then becomes what can be done with it.
When I think of the people who cannot afford or struggle to get it, it just feels wrong to toss it out, Spector says.
Groups and programs like Life for a Child and Insulin for Life cannot, by law, accept expired insulin.
Other options do exist, though.
- Many doctors and clinics are unable to take any donated insulin once its opened or at all, given the uncertainties of whether its already been compromised by the time theyd receive it. But this policy does depend on the particular doctors office or clinic, so its definitely worth calling around to ask.
- Local animal hospitals may also accept expired insulin, depending on their policies and where they are located.
- Private hand-offs are also possible. With the insulin affordability crisis in America, a growing black market has materialized where people within the community regularly donate various types of insulin to each other directly, or through grassroots efforts. The #insulin4all hashtag on social media is full of requests, as well as networks of people who focus on getting insulin donations to those in need. While this isnt technically legal, given that prescriptions should be not shared with those who are not prescribed, it is common within the D-Community, and points out providers should be aware of these underground networks, to understand their patients resources and potential risks.
Where Should I Keep My Medicine
Keep out of the reach of children.
Unopened Vials:
Lantus vials: Store in a refrigerator between 2 and 8 degrees C or at room temperature below 30 degrees C . Do not freeze or use if the insulin has been frozen. Protect from light and excessive heat. If stored at room temperature, the vial must be discarded after 28 days. Throw away any unopened and unused medicine that has been stored in the refrigerator after the expiration date.
Unopened Pens:
Basaglar KwikPens: Store in a refrigerator between 2 and 8 degrees C or at room temperature below 30 degrees C . Do not freeze or use if the insulin has been frozen. Protect from light and excessive heat. If stored at room temperature, the pen must be discarded after 28 days. Throw away any unopened and unused medicine that has been stored in the refrigerator after the expiration date.
Lantus Solostar Pens: Store in a refrigerator between 2 and 8 degrees C or at room temperature below 30 degrees C . Do not freeze or use if the insulin has been frozen. Protect from light and excessive heat. If stored at room temperature, the pen must be discarded after 28 days. Throw away any unopened and unused medicine that has been stored in the refrigerator after the expiration date.
Vials that you are using:
Lantus vials: Store in a refrigerator or at room temperature below 30 degrees C . Do not freeze. Keep away from heat and light. Throw the opened vial away after 28 days.
Pens that you are using:
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Using Insulin Past Expiration Dates
The reality is, many do use insulin past the expiration date.
For Elena, whos had T1D for 19 years and struggles at times to afford co-pays, using expired insulin is way better than rationing, she says. She stretches each vial as long as she can.
I admit, also, to finding one in a purse and just thinking, Hmm, Im going to try this, she says. It was fine. But I also checked my blood sugars a ton more while using it.
Which is sage advice. Should you choose to stretch insulin, experts say , you should amp up your glucose oversight.
Guidelines For Proper Insulin Storage
All insulins must be stored with care to ensure that they remain safe and effective. Improper storage could result in the breakdown of insulin, affecting its ability to effectively and predictably control your blood sugar level.
Depending on the type of insulin you are prescribed, there may be some subtle differences in how best to store it and how long it will last once open. Ask your doctor or diabetes educator for specifics on how to store your own insulin prescription.
Here are some general rules that reflect best practices for properly storing insulin:
Finally, if you have any doubts, start a new vial or pen to avoid unpleasant surprises.
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What Happens If Insulin Isnt Refrigerated
Storing insulin appropriately is important to make sure its able to do its job in the body.
Insulin keeps your blood sugar levels from getting too high. So, having enough insulin is important to avoid hyperglycemia . Early hyperglycemia symptoms can include feeling thirsty, urinating frequently, and blurry vision. More serious symptoms can include confusion, weakness, and shortness of breath.
If insulin isnt stored correctly, it can spoil and become less effective. If your insulin isnt effective, you could experience hyperglycemia.
Can I Use Insulin After 28 Days
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. Moreover, can I use Lantus after 28 days?
Long-term storage stability .Lantus should be stored in a refrigerator to maintain the labeled expiration date. In the absence of refrigeration, unopened vials of Lantus should be discarded after 28 days.
Also Know, is expired insulin safe to use? When insulin has expired, it is not safe to inject. If the insulin has expired, don’t use it. Once you have begun using insulin , the insulin can remain at room temperature for the number of days you will be using it.
In this manner, how long can you use insulin after it expires?
Never use insulin if expired. The expiration date will be stamped on the vial or pen. Remember if not in the fridge, the date on the vial or pen does not apply. You must throw away after 28 days since outside the fridge.
What happens if insulin is not refrigerated?
This is because freezing temperature will break down the insulin. So the insulin will not work well in reducing your blood sugar levels. So discard frozen insulin and replace it with fresh supplies.
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What Are The General Storage Recommendations For Insulin
Most insulin manufacturers recommend storing your unused insulin vial or pen in the fridge at temperatures between 36°F and 46°F.
Dont freeze your insulin or place it near the cooling element in the fridge . If your insulin freezes, you shouldnt use it even after its thawed. Once frozen, insulin may not work as well.
Store your insulin away from heat and light for the same reason: heat and light can break insulin down. Dont store your insulin in your car or in warm areas of your house, like near the stove.
Products To Help Store Insulin Safely
Just as new insulins have rapidly been developed, more efficient methods of keeping insulin safe have evolved as well.
Three such products have now come forward with unique and simple ways to carry insulin products with you, whether it be on short hikes, or traveling the world.
MedAngelis a handy smart thermometer for medications that need to be stored at certain temperature ranges. You keep it next to your insulin and it will alert you on your phone if the temperature is out of range. You can customize the temperature range for your specific medication, which is great.
Frio Cooling Packs can work up to 5 times longer than ice packs and seem to keep insulin products at a more consistent temperature. They can last up to 45 hours or more and are easy to store and use, coming in a variety of styles and colors. They require soaking in water before use as instructed on the website.
TheVivi Cap is a cooling device for insulin pens. It simply clicks onto an insulin pen instead of the cap and with the push of a button, the device then works to keep insulin at the proper temperature for as long as you need it to. No ice packs or preparing necessary. The battery lasts as long as the device, which can be active for several years.
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How Can I Tell If My Insulin Is Spoiled
Always check the color and consistency of your insulin before you use it. If your insulin is spoiled, it might look different than it normally does. For example, if its usually clear but is now cloudy, it may be spoiled.
But, it’s not always so obvious. Spoiled insulin may look the same as unspoiled insulin. Thats why its important to know how to store your insulin.
How To Store Insulin
Proper insulin storage is important to ensure that the insulin stays effective.
Avoid exposing insulin products to extreme temperatures. Insulin is a protein and this makes it subject to degradation when temperatures are too hot or too cold. Additionally, keep insulin products away from direct sunlight as this can also cause a breakdown of the insulin.
Proper insulin storage is so important that the FDA recently took action to ensure that Insulin pens must always be dispensed in their original boxes so that instructions for the proper use and storage of insulin are always included. This means that your pharmacy is not allowed to give you just 2 insulin pens from a box of 6 pens.
Insulin that is not being used should be stored in the refrigerator at 36°F to 46°F , a safe distance away from the back and top of the refrigerator where cooling elements may cause the temperature to approach freezing.
The refrigerators butter compartment or produce drawer is typically a good option for insulin storage.
Update: A new study from 2021 shows that insulin stored at 77° to 98.6°F for four weeks showed the same stability as insulin stored at the currently recommended pharmaceutical protocols of 36° to 46°F until opened.
Any insulin vials or pen that are in use can be stored outside of the refrigerator at temperatures up to 86F or 30C .
The reason for storing in-use insulin at room temperature is that cold insulin can produce a more painful injection.
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What May Interact With This Medicine
- other medicines for diabetes
Many medications may cause changes in blood sugar, these include:
- alcohol containing beverages
- steroid medicines such as prednisone or cortisone
- sulfamethoxazole trimethoprim
- thyroid hormones
Some medications can hide the warning symptoms of low blood sugar . You may need to monitor your blood sugar more closely if you are taking one of these medications. These include:
- beta-blockers, often used for high blood pressure or heart problems
- clonidine
- guanethidine
- reserpine
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
How To Use Lantus Vial
Read the Patient Information Leaflet provided by your pharmacist before you start using this medication and each time you get a refill. If you have any questions, ask your doctor, diabetes educator, or pharmacist.
Follow all package directions for proper use/injection/storage of the particular type of device/insulin you are using. Your health care professional will teach you how to properly inject this medication. If any of the information is unclear, consult your doctor or pharmacist.
Do not inject cold insulin because this can be painful. The insulin container you are currently using can be kept at room temperature . Wash your hands before measuring and injecting insulin. Before using, check the product visually for particles, thickening, or clumps. If any are present, discard that container. Insulin glargine should be clear and colorless. To avoid damaging the insulin, do not shake the container.
The dosage is based on your medical condition and response to treatment. Measure each dose carefully, and use exactly as prescribed by your doctor. Even small changes in the amount of insulin may have a large effect on your blood sugar. If you are using the cartridge form of this insulin and a special injecting device with a digital display, take care to read the display right-side up. If you read the display upside-down, you may inject the wrong amount of insulin. Ask your pharmacist if you are unsure how to properly use this type of injecting device.
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How Do I Store Unopened Insulin Bottles
Store newly purchased, unopened bottles of insulin in the refrigerator in their original carton to keep them clean and protected from light. When you’re ready to use a bottle of insulin, you can remove it from the fridge and generally keep it at room temperature for up to one month. But the sterility and potency of an opened bottle of insulin are affected by the number of insulin injections per day, the volume of insulin remaining in the bottle and exposure to light and agitation. For this reason, it’s important to discuss your insulin dosage and storageand review patient information available on the insulin manufacturers websitewith the doctor treating your diabetes. You should also check opened bottles of insulin carefully for discoloration or particles. Never store insulin in the freezer or in direct sunlight and always be sure to check the expiration date. By Joyce A. Generali, M.S. FASHP, R.Ph., director of the University of Kansas Drug Information Center and the author of The Pharmacy Technicians Pocket Drug Reference From our sister publication, Diabetes Focus, Summer 2011 Publication Review By: the Editorial Staff at HealthCommunities.com Last Modified: 11 Sep 2015Continue reading > >