Need help navigating life with diabetes? You can always Ask D'Mine...

Welcome back to our weekly Q&A column, hosted by veteran type 1 and diabetes author Wil Dubois.

Today Wil's answering several questions from our mailbag, spanning from safe insulin storage temps to stroke recovery to expired supplies, to yeast and bacterial infections. What fun!

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

 

Olga, type 2 from Oregon, writes:Following up on your recent piece on insulin temps, in-use insulin pens, per Novo, are NOT to be kept in the fridge. Do you guys know why? Is there risk to the insulin from being taken from room temp to fridge back to room temp? Does opening an emergency pen, using it once and then putting it back for thirty days somehow start the usability clock of 28 days? Argh! Thanks for any insights :-D

Wil@Ask D’Mine answers: Actually, the times are a changin’ on this front. More on that in a sec. The original reason for the advice, which, granted, was worded much more like a restriction, was more pragmatic than medically necessary. Basically, there are two practical reasons not to re-refrigerate the insulin pens you’re using: Cold insulin stings when you inject it, and bubbles tend to form inside pens when they are stuck back in the fridge.

That’s one side of the coin.

The other side of the coin is that once the insulin cartridge in the pen is breached by a needle—first touched by the outside environment—the clock is ticking on how long the insulin lasts, and keeping it cold doesn’t slow the count down, so there’s no benefit in putting it back in the fridge.

But there’s no real harm either. And in fact, Novo is in mid-process of changing this recommendation. While it remains on the older prescribing info (PI) sheets, as with Levemir, it has already disappeared from Tresiba’s PI. 

For more on this subject, the folks at MedAngel have a nice little article on the history of this recommendation (and the history of confusion around it!).

 

Abraham, type 3 from New Jersey, writes:My wife has diabetes, and had a stroke that impaired her speech, and her legs are swollen. Please, what can be done that will bring a quick solution to this challenge?

Wil@Ask D’Mine answers: Damn. That sucks. I’m so sorry to hear that this happened to her. Strokes are truly wicked, and, sadly, there’s no quick solution. It will take time, perhaps a lot of time, and it will be baby steps all the way. The only encouragement I can give is to tell you that she’s crossed the first hurdle: Surviving. Apparently, about a third of strokes are fatal in the first place. For survivors, there are a lot of factors in play, as no two strokes are alike, but generally initial rehab lasts 5-6 weeks. Going forward, whatever improvement in movement you’re going to see will happen within the first half year, but continued recovery—especially in the area of speech—is still possible for two years.

As for the swollen legs, just make sure that all her docs know that what she’s suffering is something new as many older people with diabetes suffer swollen legs. That said, it’s apparently a common post-stroke occurrence, although typically only on the stroke side of the body, and it’s one of the things that can be improved with physical therapy.

Last thing: This is hard on her, but perhaps doubly hard on you as her caregiver. Be sure to get as much help as you can from family and friends, and join a stroke survivor caregiver support group near you

 

Deb, type 2 from New York, asks:How effective are the FreeStyle Lite strips if they expired two years ago?

Wil@Ask D’Mine answers: Probably close to zero, and they’ll be least accurate in the zones where you need the most accuracy: High readings and low readings. While test strips appear to be electronic devices, they actually use enzymes, which are biological substances that can, like all biological things, die in time—which is why strips have an expiration date. Can you push the date a bit? Sure. But not that far. If they are more than two months past their expiration date, pitch them into the trash.

 

Antoinette, pre-diabetic from Georgia, asks:Will I keep having constant yeast and bacterial infection and odor because of my use of meth while being pre-diabetic?

Wil@Ask D’Mine answers: Uhhh…. OK. You got me on that one. While yeast infections are a common annoyance for female PWDs with poor blood sugar control, they’re not that common for women with prediabetes. And even with women who have full-blown out-of-control diabetes, a “constant” yeast infection would be rare. 

So something else is going on with you. 

Could it be the meth? It might. Although not well studied, there’s at least some evidence that meth has a negative impact on the immune system, so that could theoretically result in super-frequent yeast infections. This is a tough prescription to take, but getting yourself clean will help. The body has an amazing ability to bounce back. But you also mentioned bacterial infections. It would seem that your immune system is out of whack. 

Not to scare the heck out of you, but have you been tested for HIV/AIDs?

For some pretty complex reasons, meth can turn your body into an AIDs incubator and accelerator, if exposed. And in my research on your question I discovered that the perfect recipe for really frequent yeast infections is HIV + a low white blood cell count (CD4) and apparently these HIV/low CD4 yeast infections don’t respond well to typical over the counter remedies, although there are nuclear options from the prescription pad that can knock them out. But before you can get those, you’ll need to know if you have HIV.

So please get yourself tested. Right away.

 

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: you still need the professional care of a licensed medical professional.