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Autumn
01-15-2010, 04:53 AM
Two days ago I purchased 2 vials of insulin. I usually buy 2 at a time.

Insulin I purchased had expiration of 2/10.

I read on line about the expiration dates on insulin. I read the strength will become less after time, even if it has not open. Is this correct? Usually vials are a year or more from expiration when I get them. One replaced today does not expire till 2012. They would not replace one that had the box open, even though seal was not broken. Is this insulin still as effective as it should be? Should I just consider a loss and go right to the 2012 vial?
Thanks!

k9diabetes
01-15-2010, 04:21 PM
I know people who have used insulin past the expiration date, primarily because the insulin they were using had been discontinued and they couldn't buy any more of it. Since their dogs didn't do well on any of the other insulins available, they stockpiled it and extended its use past the expiration for quite a while.

It's not like the insulin will magically cease to work when it hits that date. They just say that it will be good at least that long.

Rather than going straight to the 2012 bottle, I would use the one that's nearing its expiration date first as you are currently still using it within it's expiration date.

And then if you see that it's a problem, you could switch to the 2012 bottle. Chances are good the bottle you have that's about to expire will work just fine.

Natalie

eileen
01-15-2010, 06:02 PM
I completely agree with you Natalie. Regulations say that there must be an expiry date on the insulin so that it can be guarateed until this date. There is no way it will, as you put it, " magically cease to work..."
I would imagine if the unopened vial had been stored properly in the fridge it will still be good long after the printed date.

Eileen/Mil

Autumn
01-16-2010, 04:35 PM
I didn't think it would magically cease to work. I just read that it could be less effective after time.... even close to the expireation date.

I was just checking the forum for thoughts on it, as I was unsure. I didn't want Autumn's numbers going to high.
Thanks

k9diabetes
01-16-2010, 07:58 PM
Hi Anna,

It (and other products with expiration dates) really shouldn't degrade before its expiration date as long as it's handled properly - which can definitely be a problem with insulin. A couple of hours in subzero temperatures left out on the loading dock would be enough to damage bottles of insulin.

How much longer it's good after that is a question.

There is the debate on the Vetsulin presentation where they said their tests of problem vials were only on the older vials that were approaching their expiration. But they really don't know yet whether there is a problem with the Vetsulin and, if there is, what the problem is. So it's all pretty much conjecture at this point.

Then there's opened versus unopened. Which is a bit of a misnomer because flipping the plastic lid off a bottle of insulin, while technically "opening" it, doesn't expose the insulin to needles, air, etc. But every time you use it, you expose the bottle to those things and the more often you do it, the more exposure there is.

I've kept backup vials of Regular in the fridge for a long time with no degradation. They are "open" but they are not being accessed and so no exposure to contamination. They've kept for many months that way.

If the bottle doesn't perform properly, then I would take it back to the pharmacy and ask them to replace it.

Natalie

eileen
01-16-2010, 08:47 PM
My opened vial of Humalog is now at it's 70th day and still doing as it should. It sat for about 3 weeks without being used.

I believe clear insulins such as R, Novolog and Humalog have the potential of lasting much longer opened than others where mixing is required.

Eileen/Mil

Autumn
01-21-2010, 04:12 AM
Thanks you :)

k9diabetes
01-21-2010, 12:39 PM
I was going through Dr. Nelson's FAQ from the Web Seminar on changing from Vetsulin and came across something interesting related to insulin potency.


Question: Once a bottle of insulin is opened – regardless of type – how long do you feel is safe to use the product without compromising the integrity?

Answer:
If the insulin is stored and mixed properly, it will usually be good to the last drop. Recommendations to change every month are coming from the human side and are related to concerns with sterility of the solution more than loss of insulin action.


http://www.aahanet.org/education/graphics/VetsulinQ&A.pdf

eileen
01-21-2010, 01:56 PM
hmmm, that's interesting, thanks for posting the link.

I know speaking from personal experience in treating Mildred with NPH over the past 5 1/2 years I begin to see her numbers climb at about 30-40 days on a vial. There is no way I could mix her insulin any more thorough.

In briefly reading the article I see he also says that there is the possibility of NPH being taken off the market in the future. This would seem to be a statement that could scare some. NPH being a human insulin with countless numbers depending upon it I would think there is no immediate worry. That is until a 'better' insulin may be developed somewhere in the future.

Eileen/Mil

Patty
01-21-2010, 03:53 PM
I used to use a bottle of Humulin NPH past 30 days as I believe insulin can be used beyond that time. But last year I started seeing a trend in rising bgs after/around day 25-30. Now as a precaution I open a new bottle on day 25. It just wasn't worth adding another reason for Ali to "wobble" into our mix.

Now I had a bottle of Humalog (a clear rapid acting insulin) for 6 months rarely used in the fridge as a "just in case," and when I needed to use it during our Lantus trial it worked just fine. I purchased other bottle during this time and found the same results with the new bottle as the old.

I do think there's a difference in how long the clear vs. cloudy suspensions keep.

Patty

eileen
01-21-2010, 04:10 PM
I concur with your thoughts Patty. I find the need to replace Mil's NPH every month now with her Humalog lasting much longer.

Your mention of keeping a vial of Humalog for 6 months is interesting...my current vial of Humalog is at 2 1/2 months and still with good results.
With the price of Humalog I am seeing just how far it will stretch as in the past I have replaced it every 60 days.

But, as I stated previously and what you state now...I do think there's a difference in how long a vial can last based on whether it is a clear insulin or one requiring mixing.

Eileen/Mil

k9diabetes
01-21-2010, 10:02 PM
There have been rumors of NPH's imminent demise for years. It is an old insulin product with no patent protection so not much profit with few people using it anymore.

Do I think it will eventually go away? Yes.

But that could be next month or next year or next decade. Or longer.

Fortunately, FDA now requires insulin manufacturers to give six month's notice of a discontinuation. So when it does happen, we all will have six months advance warning.

When Humulin L, which was also a very good insulin for dogs, was discontinued, people with dogs who didn't do well on anything else stockpiled every bottle they could get their hands on. A few people literally had refrigerators full of it.

I hope... that other products will have been developed by then. And/or that the pet market or low-income markets will be large enough for someone to stay interested in producing it for a long time to come.

At the seminar I attended this last spring on pet diabetes, the presenter was tossing out the idea that NPH was going to be discontinued literally within a month or two of that date. He was discouraging someone who asked about changing from Vetsulin because it wasn't working from trying NPH because "why bother when it will be discontinued a month from now." That was in March 2009.

So I confronted him regarding his basis for that statement - he couldn't give me one. When I said that six months' warning would be given, he didn't know about it. And then he basically hinted that Vetsulin sales reps are the ones who had him convinced that it would be discontinued any day now. I think a lot of vets have been told that.

The reality is that eventually most old insulin products will be replaced by something newer. Sadly, it's almost never good news for pets.

Until the day the last bottle leaves the shelf, though, I say use what works as long as it's available. It doesn't do any good not to use it just in case it will disappear from production. About the only chance we have of saving it is creating a demand for it!

Natalie

mydirls
01-22-2010, 05:54 PM
This was an interesting topic. I wonder if the recommendation to disgard the insulin after opening after 30 days is just a marketing strategy. I have never used a vial of NPH N longer than 30 days. My girl has been just fine with her BG numbers. I just threw it away as recommended to prevent any harm. The information on the Q&A on canine diabetes was an eye opener in some points. I never heard of giving a dog only 1 injection of a NPH a day. I always was told and read it is to be 1 injection every 12 hours.
Very interesting.

k9diabetes
01-22-2010, 06:26 PM
I have only ever seen one dog who was said to be regulated on one injection of NPH a day.

Theoretically, because pretty much all dogs are started on NPH twice daily, there could be some dogs who get 24 hours of duration from it but they were started at low doses and the doses overlap to still create a good profile.

Natalie

O'Riley
03-30-2010, 06:22 AM
Eli Lilly's Humulin N package insert says nothing close to what their technical rep at Eli Lilly told me today: That unopened and unrefrigerated Humulin N is only good for 28 days from the date of manufacture. Unopened and continuously refrigerated (has never been brought down to room temperature), Humulin N is good until the expiration date stated on the vial. Once the vial is punctured, it is only good for 28 days (doesn't matter if it's been refrigerated, or kept at room temp). It CAN be kept at room temp after it is punctured, however room temperature is now defined by Lilly as 68-77 degrees F, and proper refrigeration temperature range is 36-46 degrees F (also contrary to their package insert).

The tech rep is filing a report with their safety department to report these package insert errors.

I then called CVS Pharmacy where I purchased our Humulin N 30 days ago, and the pharmacist assured me that their insulin is delivered to them refrigerated, and is kept refrigerated until the customer picks it up. I told the pharmacist that if I had relied solely on their CVS label that they stuck on the insulin box, I would have blindly thought the insulin was good for one year from the date I purchased it from CVS. In reality, according to the technical rep at Eli Lilly, the vial I used today is actually no longer any good (it was first punctured over 28-days ago).

I'm going to carry a small cooler with me next time, since refrigeration of unopened bottles is the key to potency.