Wil Dubois

Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week, Wil answers a big question about the "complications" that sometimes arise when using mail-order service to get our sensitive diabetes supplies... Read on.

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Jordana, D-Mom from New Jersey, writes: Recently my insurance company has insisted that our diabetes supplies come via the mail. So now I find myself entering the world of mail-order diabetes supplies, UPS, and our miserable East Coast weather! Too hot, too cold—how does this affect our supplies? Test strips, Dexcom sensors and insulin all arrive at my doorstep now. Sometimes they sit there for hours until I arrive home. Sometimes I am there when they arrive, and the delivery person hands me a box where even the cardboard is cold from sitting on a freezing truck! How does this cold weather affect these supplies?

My insulin arrives in freezer packs already, appearing to be on the verge of being frozen. My test strips and sensors arrive and they feel cold, very cold. I didn’t even use the sensors from a pack that arrived 2 weeks ago. The thought of going through the process, effort, and pain of putting the sensor into my son and it not working was more than I could bear. So I put that box aside and marked it “cold.” I haven’t used the test strips yet because I’m working through my old warm ones. The insulin seems OK so far. I’m more concerned about the insulin in the upcoming summer months, actually. It can be 90-100 degrees here, and that poor Styrofoam box is either sitting on a hot truck or on my hot doorstep. Ugh. I’m trying to order my supplies after looking at the 10-day forecast. This is probably a little nutty, but if the weather looks moderate, I will jump on my orders and try to get a few months' supply. But of course, the day the supplies finally arrive, the weather has already changed... and all my weather-obsessive behavior is useless. Thoughts? Am I over-worrying about this? Are these supplies tougher than I think? They all have “store between this temperature and that temperature” marked on them. Should I pay attention to those numbers? 


Wil@Ask D’Mine answers: We covered both frozen insulin and baked insulin in these pages before, so you can go back and read those two posts for details, but briefly, as long as the insulin hasn’t actually frozen solid, it shouldn’t cause any trouble. In the summer months, remember that the insulin doesn’t need to arrive cool to the touch, it just Extreme hot and coldneeds to be not hot. And don’t underrate those Styrofoam boxes with their cool packs, as they really do keep the killer heat at bay pretty well. Despite our universal worries about this, heat damaged mail-order insulin is pretty rare.

But naturally, deep winter or middle of the summer, if a new vial of insulin works poorly, pitch it and start a new vial. (Damaged insulin tends to be “weak” rather than fully “bad,” leading to modestly elevated, vexing blood sugars, and sluggish multiple corrections.) I suppose it wouldn’t hurt to set up your stock rotation so that you always make sure to have at least one vial from a previous shipment in reserve before you crack into the first vial of a new shipment.

Now, I don’t recall talking about CGM sensors and test strips in temperature extremes, so we’ll focus on that part of your question today, along with the possibly nutty concept of ordering based on weather forecasts.

Let’s start with those “store at” temp ranges. Have you seen Disney’s Pirates of the Caribbean? In one scene, the plucky heroine of the tale calls out the pirate captain and accuses him of violating the Pirate Code, to which he responds “the Code is more what you’d call ‘guidelines’ than actual rules.”

So too are the temperature ranges of our D-gear. Our supplies are tougher than you’d think and the storage guidelines are more likely written by the lackeys in the legal department than by the eggheads who developed the supplies. Of course there are limits. No blast-furnaces please, and dropping any diabetes supply into liquid nitrogen is sure to have a bad outcome—but realistically the kinds of real-world temperature exposures and durations our supplies are likely to be subjected to are unlikely to ruin them.

Let’s consider those Dexcom G4 CGM sensors as an example. The happy orange box gives us a storage range of 36-77 degrees Fahrenheit. Does that mean if the expensive little bastards get warmer or cooler they crap out on us? Nonsense.

Don’t be afraid to stick that sensor that got cold into your kiddo. Low temp isn’t a CGM Mail Orderkiller. In fact, back in the day, the first generation of CGM sensors had to be kept cold. I travelled with coolers, and on one business trip had to fill a hotel sink with ice to create a safe haven for my spare (three-day life) sensors. In those days the sensors arrived in something that looked like a huge, complex, multilayer Styrofoam sarcophagus. Ugh! My diabetes is single-handedly responsible for filling the local landfill to capacity.

So what about on the temperature high end? Consider the operating temperature of a CGM sensor. It’s 98.6 degrees Fahrenheit, right? ‘Cause that’s the normal operating temp of the human body, and you insert the sensor into the human body where it is “stored” 21.6 degrees higher than the Dexcom Pirate Code allows for. I wear mine for two weeks, no problem. And at that point it’s my skin giving out under the adhesive, not the sensor, that’s failing. This guy wore one for 28-days.

And what about test strips? Actually, there is some scientific evidence that storing strips in the fridge can make them last longer, contrary to the advice you usually see. The Pirate Code for my Presto strips is 46 degrees to 86 degrees. The problem is the meter won’t work at temps as low as 46, giving an “Error 4” code and eating strips. On the other end of the thermometer, my house never gets below 86 degrees all summer long and the strips perform just fine.

Still, all of that said, does it make sense to watch the weather and try to order around good weather windows? You know, there’s a reason that meteorologists don’t brag about their success rates. On any given morning it’s nearly impossible to predict accurately the temperature that afternoon, much less 10 days out. Sure, I think most 48-hour forecasts can paint a general picture of the weather that’s around the corner, but any farther out than that is just guesswork. There are just too many variables. It’s like trying to predict your blood sugar a week in advance.

So my opinion? Yeah, I think you’re a little nutty, and that weather-obsessive behavior probably isn’t benefitting you, unless you’re thinking of getting into meteorology after your D-kiddo grows up and flies the nest. (But I hear there’s better money in mail-order pharmacy work.)

So unless they are predicting a hurricane, a blizzard, or a record heat wave, I think you should just place your order when you need it and trust in the fates, and the Pirate Code, to make things work out.


Disclaimer: 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.

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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.