From Glen Burnie, Maryland, USA:
My granddaughter was diagnosed with type 1 diabetes in September 2001. She is currently taking NPH and Humalog, in the evening and morning. During the daytime, she uses the NovoPen Jr. containing Novolin. We have been leaving an extra NovoPen in the nurse's office at school to be used at lunch times. When the one month is up, the nurse sends home the cartridge. Is it okay to use that cartridge at home? It has been refrigerated constantly, but the nurse says it is out of date, even though the expiration is one year out. Or, should we throw it away? It seems like such a waste because there is very little usage out of the cartridge. What are your thoughts on this? This week she has remained extremely high, over 450 mg/dl [25 mmol/L]. I have given her extra insulin to bring her down, to no avail. She went to bed last night with a reading of 522 mg/dl [29 mmol/L]! She was given eight units of NPH and three units of Humalog. In the mornings she has been in the 90s mg/dl [5.0 to 5.5 mmol/L].
As for recommendations for the recent elevated glucoses, you should talk to the child's diabetes care team perhaps their Certified Diabetes Educator or other RN or MD.
Wasteful insulin is a valid concern. The manufacturers say that as long as the insulin has NOT been used (i.e., a needle has not been inserted into the rubber stopper), the insulin is good while kept in the refrigerator until the stamped expiration date. Once the rubber stopper has been disrupted, then the manufacturers usually will give a 28 day potency allowance. Is the insulin still good? MAYBE. It probably has "some effect." It may even have good potency, but the company will not guarantee that.
Insulin is probably too important to risk on partial potency. Nevertheless, in a significant pinch, I'd probably tell nurses or families to go ahead and use it under special circumstances. But again, you should ask your child's diabetes team. The caveats include that the insulin is not irregularly cloudy, clumpy, crystallized, frosted, frozen, etc.
[Editor's comment: You may wish to discuss with your granddaughter's diabetes team switching to a HumaPen Luxura HD so that you/the school nurse can administer Humalog not Novolin (Regular) insulin. Regular insulin is not as fast acting as Humalog, thus you may not see the results you desire. BH]
Original posting 13 Jan 2008
Posted to Insulin
Last Updated: Tuesday April 06, 2010 15:10:16
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