Need help navigating life with diabetes? You can always Ask D'Mine! Welcome again to our weekly Q&A column, hosted by veteran type 1, diabetes author and educator Wil Dubois. This week, Wil has some advice on what to do if your insulin pump breaks down and also how to keep insulin cool when it's very hot outside.
Lisa, type 1 from New Mexico, asks: Why is it that the frickin' insulin pumps always crap out at the worst possible moment? Last year I was doing field work down near Belize when my Medtronic pump kicked the bucket on me. I had to stand on the roof of a building (in the rain) to get a cell phone signal, and even then could barely hear the people on the other end. The result was that I had to take shots of fast-acting insulin every four hours, and had to cut my research short. Yes, yes, yes. I know, I know. I should have had a backup plan and had Lantus or whatever with me. How would you equip yourself, or plan for such a trip, Oh Wise One?
Wil@Ask D'Mine answers: So if I were going to Belize, and I can't imagine myself so lucky, I'd forget the Lantus and just carry a spare pump with me. By the way, that odd noise and loud crashing sound you just heard in the background was 93.8% of the Certified Pump Trainers in the country collectively gasping and dropping their morning coffee cups. (The other 6.2% are sleeping in this morning.) Why the shock? Because my advice to you isn't a "proper" backup plan. In case all you pumpers forgot, or never knew, those of us on pumps are supposed to have, and carry (!), all the injection supplies you might need for just-for-in-case your pump craps out.
Of course, most of us don't do that.
Why? Well, it's bad enough carrying all the extra supplies you need to carry every day (spare cartridge, spare infusion set, spare batteries or charging cable, glucose, cinnamon whiskey, and medical alert) without also lugging a vial of Lantus insulin around with you everywhere you go. Plus, it goes "bad" after 30-days of being carried at room temperature, and then you have to throw it out. Odds are you'll never need it, anyway. For our non-pumpers out there, just know that a type 1 on a pump would only use a basal insulin if the pump died. So it serves no "normal" use for it for us at all.
Oh, and top of the hassle and the waste, is the cost. Some insurance companies aren't too wild about paying for something they know there's only a remote chance you'll use, so that might mean more out of pocket for you, or at the very least, yet another co-pay.
But isn't a spare pump waaaaaaay more expensive, you ask? Nope! Just call your pump company and ask for a vacation loaner. Med-T will loan you a spare if you are going anywhere internationally, or even over to Hawaii or up to Alaska. If you wear a Roche pump they have a similar program. If you live in Canada, Animas will loan internationally-traveling Ping users a spare pump. I couldn't actually find a USA program online, but I have a hard time believing Animas Canada would have the program and Animas USA would not. Ping users: Call the toll-free number on the back of the pump and talk to their customer service people.
Insulet tells me they don't have an international loaner program for PDMs, but that they will offer a back-up for a "reduced price"... So while all the other pump companies seem to care what happens if a mishap occurs overseas, you're out of luck if you are an internationally-traveling Pod user who suddenly needs a new PDM on the fly. WTF, Insulet!? Even the new kid on the block, Tandem, will loan you a traveler's pump. You should take a hint from all the other players out there.
Whatever the pump company, remember that these programs aren't for a trip with the kids to Disneyland. These are designed for pumpers going places more than 24-hours from a white-truck-delivered-emergency-replacement pump. Oh, and also remember that if you don't return the pump when you get home again, you'll have to pay for it! Fair enough. Still, what could be a better backup plan far from home than a whole spare pump?!
Just be sure to carry a printout of your full pump program with you so you can enter the settings into the loaner if the shit hits the fan. Lisa, if you'd had a spare you would have been safe and sound, out of the rain, calmly entering your numbers into your backup pump instead of standing on the roof in the rain shouting into your cell phone. And you wouldn't have had to cut your trip short.
So, as American Express might say: Spare pump — don't leave home without it!
Ariana, type 1 from California, writes: Hello! I'm wondering if you have any advice on how to deal with extreme temperatures for insulin pens. I use the NovoPen Junior (I'm 31 years old, it's just more accurate for me) and the last time I went to the beach, my insulin degraded in the heat while in my bag. Besides being expensive to constantly travel with multiple back-ups, it makes me nervous about taking hikes or going to the beach far from my back-up insulin—a cooler in the car is not always an option. There's a plethora of insulated pouches out there but it seems like all of them have received complaints about not working. Any advice? PS: I read your column regularly so I feel like I'm corresponding with a celebrity :)
Wil@Ask D'Mine answers: Oh gosh. Now I'm blushing. The first reader says I'm wise, and now you make me a celebrity? Thank you for the compliment and thank you for being a regular reader!
Well, I guess if I've been elevated to the status of celebrity, this will border on being a (non-compensated) celebrity endorsement, but I use the Frio system whenever I travel in heat. Ummm... OK, that sounded vaguely pornographic. I meant to say "when I travel in hot weather."
But you're right Ariana, there are a plethora of options out there, so why did I choose Frio? I'll tell you in a minute, but first let's review the plethora. Traditionally, there are two ways to keep insulin cool when you're out in the heat: An insulated container that keeps cold using ice; or an insulated container that generates cold with electricity.
Most common are pouches and insulated bags of various sizes and shapes that hold some sort of ice pack. In my experience, there are three problems with these. First, the ice pack makes them heavy. Second, in serious heat, they don't work for long. And third, once thawed, you need a place to re-freeze them, plus they take forever to re-freeze. Well, OK, not forever, but overnight—and that might as well be forever if you are, say, camping in the Mohave. Or Belize.
Less common are the electrically-cooled units. These tend to be portable fridges or rigid coolers, not pouches. Traditionally, these plugged into your car and were bulky and heavy. Not exactly the right thing for a walk on the beach. That said, I do need to give a nod to the Climapak from Kewl Innovations. If Steve Jobs had designed an insulin cooler, this seems like what he would've come up with. It's good-looking, small, and allegedly keeps its cool with a re-chargeable battery for 3-5 days, depending on how hot it is. What's not to love? The Steve-Jobs-like price tag, that's what. It costs about the same as an iPad Mini. Needless to say, I don't have one, have never test-driven one, nor even held one in my hands. It sounds cool... pardon the pun... but it's so expensive, I couldn't justify trying one out myself. Still, I thought you should at least be aware of it.
But back to my choice of the Frio. I like it because it's simple, it's cheap, and it always works. How well does it work? Well, if it's 100° F in the shade, a Frio will keep your insulin at a safe temperature—not necessarily cool, which is why some people may mistakenly think they don't work—for a minimum of 45 hours! I've even left one in my Jeep for hours in the New Mexico summer sun with no problems. And here's the best part: It's powered by water. Yeah. You heard that right. Frio works differently from anything else. It's low-tech high-tech. What "powers" the Fio is a substance called cross-linked sodium polyacrylate, which is simply a super-absorbent polymer substance. Yeah. OK. It's the same stuff that's in Pampers, but don't dwell on that aspect. Besides, you already knew that having diabetes is a shitty experience. Anyway, these crystals turn into a gel when they are wet. As they dry out again, the slow evaporation keeps the contents of the pouch in a safe zone. It sounds soggy, but it isn't.
This makes the Frio pouch quickly re-useable on long, hot journeys. If it starts to dry out, just splash it in water to "recharge" it. No power needed. This also makes them handy as part of an emergency kit! As icing on the cake, the Frio folks make the pouches in a variety of sizes, shapes, and colors. They even make cases for insulin pumps.
One word of warning, however. When you get your first Frio you'll feel like you've been ripped off. A Frio is basically two cloth bags. One is empty. The other has a tiny bit of rock salt sewn into it. WTF? Don't get hot under the collar, this will keep your insulin cool. The "rock salt" is the polymer I mentioned in its dry form. Once wet, the crystals expand a LOT, and turn into a funky, squishy gel. Your insulin goes inside the gel pouch, and that pouch goes into the outer pouch and you're ready for the road! When you aren't using it, the gel dries out and reverts back to "rock salt."
Oh, wait. I forgot there's one last way to keep your insulin cool. I read somewhere that a nice chilled Mint Julep can also double as an insulin cooler. I think I'll try that out on my next trip...
This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.