Our controversial columnist Wil Dubois is back with another spicy edition of our new diabetes advice column, Ask D'Mine.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

You know the answers you get here will be brutally honest and interesting, to say the least.

News nuggets from around the diabetes community

NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
State of the Union: It's Time to Cure Diabetes
President launching new precision medicine initiative to better treat, cure diseases like diabetes.
'Robotic Pancreas' Appears On American Idol
Carlos Santana's nephew Adam Lasher shows off Dexcom G4 during live performance.

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Robyn from Colorado, type 1, writes: I have traveled a lot over the years with my insulin in tow. Upon completion of each trip I always come to the same conclusion—there has to be a better way to transport insulin in order to keep it consistently cool. I am talking cool where I am confident the potency has not been lost, not 'so-so cool' that leaves you wondering: "Is it a bad site, was it that yummy street snack I just consumed, or did my insulin just not travel well?"

Most recently I tried out the Frio Pack which I found to be okay, but would love to know what others are using/doing? I am primarily thinking about long distance air travel, where a refrigerator can be found on the other end within 24-48 hours.

Wil@Ask D'Mine answers: Lots of us don't use anything, actually. My take is that unless you are traveling in the Amazon rain forest or the Gobi desert, there's no need to chill your insulin anymore. Modern insulins—in alphabetical order to avoid playing favorites—Apidra, Humalog, Lantus, Levemir, and Novolog do not need to be kept "cold" at all. Nor do the injectable type 2 meds Byetta and Victoza.

Now before everyone pummels me in comments, I'm talking about the insulin you're gonna use here. You should still keep your unopened inventory in the butter compartment. But don't chill the stuff you are using. There's no benefit. Besides, cold insulin stings like hell when you inject it.

  

 

In fact, once a vial or pen is open the clock is ticking. You've officially got 30 days to use it, and keeping it cold won't extend its life at all. I say officially, 'cause you can probably get 45 days out of it (like you don't have to throw milk out on the "sell-by" date) before it begins to lose its efficacy.

And someone was telling me the other day (I wish I could remember who) that the outfits donating insulin to the Third World find that the older-style insulins are even more long-term stable in warm temperatures. Maybe we haven't needed cold packs since, I don't know... Best and Banting? If ever. Makes one wonder.

Personally, I carry a back-up disposable pen of fast-acting in my go-bag in case my pump craps out, or I yank an infusion set, or whatever. After being carried around at room and outdoor temperatures (in New Mexico, mind you) for two months I transfer it into my pump and put a fresh pen in my bag. Even after two months of warm-ish temperature storage, I've never had any issues with the insulin.

Ca-clunk! What was that noise? Oh, just the sound of Frio stock falling.

Sorry, guys.

(Editor's Note: Amy happens to love Frio, in large part because it provides a nice, safe, cushy travel pack for those brittle insulin vials)

 

Bruce from Kansas, type 1, writes: I'm seriously frustrated. I use the Omnipod and I find it awful. In my last shipment, 8 pods had errors and 5 had occlusion alerts. I tried the Minimed 722, but was disappointed because I had used the Cozmo pump before, which out-classed it, but is now dead and out of warranty. I have not tried Animas, but am afraid to commit in case it turns out to be worse than anything else, and then I'm locked in for potentially forever, as the new thing with insurance companies is that your pump can't be replace until it dies and is out of warranty.

Are there any current pumps, or pens, that are really low hassle, easy to deal with, and don't try to kill me?  I also need a company that will back it up, if a failure does happen.

Wil@Ask D'Mine answers: Dude, I feel your pain. No one understands us. But if Apple went out of businesses tomorrow and all the Apple users had to buy PCs, they'd understand exactly how we Cozmo folks feel.

There are a couple of options left for you. One, as you pointed out, is the Animas. Some people love it, but I'm guessing if you find the Medtronic user menus frustrating, then you're really gonna hate the Animas menus. You could look at the Spirit Pump from Roche.  It's rather primitive by the standards of most modern pumps, but has the neat feature that you get two pumps in the box: one to wear and a spare.

How's that for the ultimate in customer service? Having a spare unit around would solve a lot of problems for us pumpers, wha?!

But before any of you get too excited about the two-for-one pump special, let me point out that the spare Spirit pump really is just a "spare tire." No kidding! It's equipped with a self-destruct mechanism like the tapes in the old Mission Impossible TV show. After 180 days of run time—phffiit—it shuts down. The idea is to provide you an instant spare while the company figures out what went wrong with your primary pump and get it fixed.

Pretty much every other pump company promises to "next day" out a full replacement pump if you have a failure, but that can be a really long day. If you don't have adequate backup supplies you'll have to run to the pharmacy, if it's not the middle of the night when the pump fails (and of course when else would one fail?) for some basal insulin. The real problem is: once you've been on a pump for any length of time, you'll have no clue how much basal insulin you used to need. A frantic call to your doctor may be in order.

Here's another option: If the current batch of pumps turns you off, why don't you take a break? Take shots for a year, while you wait to see what comes out next.

As to pumps vs. shot therapy, here's my bottom line: you can have wonderful control on a pump, and you can have crappy control on a pump. You can have wonderful control on shots, and you can have crappy control on shots. It's the brain of the PWD that makes the tools work. The pump is really just a fancy syringe.

If you're gonna go back to shots, why not get a smart pen like Lilly's Memoir? It's a beautifully engineered metal pen that takes disposable pre-loaded insulin cartridges. But the best part is that it's got a little LCD screen that lets you look at your dosing history. Because I guarantee, at this very second, six bites into a Big Mac, a PWD somewhere in the world is saying to himself, "Crap! Did I remember to take my insulin?"

Whip out your smart pen. It'll tell you the day, time, and amount of your last bolus.

Remember that going back to shots isn't necessarily forever. I'm betting there are a bunch of new pumps held up in the FDA right now, and plenty more on the drawing board. The nice thing about living in a diabetes epidemic is that we'll have lots of cool new toys to play with!

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.

 
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.