[Frogwatch]

My 17 yr old daughter is type 1 diabetic and generally manages it well testing up to 9 times a day and giving herself injections whenever she eats anything. She normally carries her insulin pens (Lantus and NovaLog) in her pack and we had never thought this could be a real problem until this year.
A couple weeks ago on vacation, she began saying her insulin wasn't working and her blood sugars were going waaay up. We rushed into town and bought two new pens (seriously expensive as our health plan initially would not cover it) and discussed it with the pharmacist who told us they could not guarantee efficacy of Insulin that went over about 85 degrees for any length of time. YIKES. I'll bet the temp of her pack rarely goes below 85.
She is really into wilderness packing so this is an issue. On a long sailing trip where I rarely have ice it would be an issue.
So...............
We make a pouch of closed cell neoprene to hold the pens. It has an insert pocket to hold a tiny bag into which one pours some dry crystals and then some water. This causes cooling for a couple of hours enough to keep the temp below 85. The crystals can be either regenerated by heating or disposed of as they are truly harmless and cheap. The weight of enough crystals for several days is very low.
Thoughts?

 

[RichH]

How about a wide-mouthed thermos bottle (dewar flask) instead of the closed cell neoprene?

 

[Minnewaska]

Is this an onboard or general question? I wouldn't think your bilge would ever go above 85 degs, although, I would naturally use a sanitary container.

 

[pdqaltair]

My wife has been diabetic for 40 years and we've sailed and camped lots.

1. Temperature. While cool is good, it it temperatures >100 that are the real risk. My wife wears an insulin pump and it is NORMAL for that insulin to be at 98 degrees for the several days it takes to go through a cartridge. That is the design. For a few days I would not worry about non-superheated temperatures. If there is no fridge, the cabin floor or bilge should be fine. She has cooked insulin in a closed car, so I know what you are speaking of.

2. Monitors. The greater risk is the testing unit. They can be lost; I once found one by the side of a trail in the Wind Rivers, days from any road. They can get wet; we once took a rogue wave over the deck and soaked her monitor; since we were same days from any easy port and all of the others were breaking (huricane further off-shore) it caused some tension and a call to the CG regarding which inlets were navigable. Carry a spare if you are far from help.

All that said, we do keep the insulin in a cooler when practical. But mostly, we just avoid leaving it in the car. While the cool-pack is neat, I doubt it matters for 2-3 excursions if care can be exersized. However, I would NOT bet that the temperature of a backpack in the sun would not be like that of a car in the sun. I bet it got very warm.

 

[SVAuspicious]

The pellets sound interesting.

For the boat or a car how about a small Peltier cooler? Something like ThinkGeek :: USB Thermoelectric Cooler & Warmer ?

 

[deniseO30]

There are some mfg out there that makes a small thermoelectric "case" that fits the vials and holds the syringes and can be carried in a pocket or handbag.

 

[Frogwatch]

Thanks for all the replies.

Yes, the thermos bottle is our interim solution.

We were surprised that this happed because we live in FL and EVERYTHING is above 85 degrees all the time and this incident happened in WYOMING. I know the interior of my boat gets waaaaaay above 95 degrees. Is the bilge below 85 degrees? I dunno, N. Gulf of Mexico in August/Sept?

Am very familiar with Peltier coolers and they are energy hogs.

She is planning to hike the Apallachian Trail so she needs a good solution. Yes, the demise of her tester has been a problem so she carries a low tech back-up for that. She does not want a pump because her cousin had one that failed and nearly killed her.

 

[pdqaltair]

^^ My point about the pump was to illustrate temperature stability for a few days at body temperature is acceptable. Many users wear them agaist their skin. It was NOT a few days of exposure to 85-90 that cooked the insulin--there must have been a brief exposure to higher temps. Even 20 minutes in a really hot car can do it.

Pumps are not for everyone. They require meticulous attention to detail, and it is always possible to have a failure, either pump or conection (infusion set can pull out or leak). My wife has worn one for 20 years, and while there have been a few incidents, nothing more severe than those that sometimes uccured when she was on shots. The worse senario is generally a stopage at night, which can start ketoacidocis, since the insulin used is very short acting. But since the delivery at night is slow, it is not too serius if noticed in the morning. It helps if the person does not live alone, and even better to sleep in proximity to a responcible person. Yes, I know she's just 17, I'm just keeping it real. I've given lots of sugar, ocational glucagon, and called ambulances. It's been better on the pump have before, but not perfect. (My wife is 50, diagnosed at 15.)

 

[gptyk]

Look at frio insulin cases - methinks they're simple chem reaction cooled devices just like the pouch you made - that's a pretty good solution for the backpacking problem.

My son was Dx'd T1 at 3, is now 15, been on a pump since he was 6 or so. 3-4 days at body temp is fine. (as mentioned before) We've had lots of delivery failures, but never had the insulin go bad when pumping. We DID have insulin go bad when using pens - just because they last so much longer and thus have more chance to be exposed to heat.

Our rule is to always have a backup insulin delivery device and meter. In addition, we have a vial of lantus in the fridge just for the possibility that the pump goes dead for a long time. Our Dr's office will give out meters like they're candy, so we always have a few spares. It's a pain when we have to switch brands cause it takes a few visits to get 4-5 meters that all use the same strips laying around again.

There's failures with every system - pumps, basal/bolus with pens, or oldschool NPH/R from a syringe. When we end up with an unexplained high, we always switch delivery method and insulin source until we figure it all out. Hence have backups - be it on a hike or boating.

I'm amazed that getting replacement pens was a hassle. Most health plans understand that T1 folks are going to go through quite a bit of insulin and that it's kinda necessary.

 

[hellosailor]

Froggie-
You can get the one-shot cold packs (I call them slap packs) dirt cheap on Amazon, like $10/12 5"x9" packs. Those are "crystals" plus fluid that mingle when you hit the pack, probably the same or similar to what you are using.
If you're not going to use electric (peltier cooler and solar cells or lithium primary batteries?) then that's the only option AFAIK. And the old fashioned thermos bottles, with a delicate GLASS liner instead of all stainless, last way longer. As long as you don't drop them. Much as I like stainless, I have a dear old Thermos that everyone thinks must be a pint or a quart. Nope, it only holds 12 ounces, thick fat old GLASS thermos bottle inside. And it keeps my coffee hot all day long, way better than even the brand name steel.
I'd double-check to make sure that putting the insulin in direct contact with the freezer packs wouldn't harm it, i.e. if it started to freeze up in the contact areas.

 

[Frogwatch]

Our biggest problem with getting insulin pens and test strips is that she really does test 9-12X a day and we have to prove to the insurance company every three months that she does so.
Two years ago, she tried one of the first continuous monitors but didn't like it because it required being calibrated 3X a day and it had alarms that constantly went off at odd times. I hear they are now better and connected to the pumps to actually act as a sort of artificial pancreas.
The cooling things you can buy at pharmacies and on Amazon typically contain Ammonium Nitrate which when mixed with water absorbs heat. The ones that get warm typically contain very fine iron that releases heat when it "rusts" in water. The cooling ammonium nitrate reaction could be reversible if you could dry the ammonium nitrate (do not try this). I doubt I could get a permit to simply sell powdered ammonium nitrate for this gadget.
However, there is another totally innocuous ammonia compound (Urea)that can also be used and I wonder it is not used more. Compare the MSDS on ammonium nitrate and Urea and the ammonium nitrate one is 10 pages long whereas the urea one basically says "No problem". Urea is available by the ton for nearly nothing. The urea can be recharged by heating the solution on a stove till the water evaps with no danger at all. One can carry a couple ounces of dry urea to keep insulin below 85 for days just by adding water.

While we are on the subject, I have to add a plug for a new product being developed by a friend for type I diabetics. It is called Elovate15 and consists of a condom sized pack of 15 gms of pure glucose in a fine powdered form that dissolves instantly on the tongue. It works much faster than almost anything else and supposedly be absorbed directly in the mouth. My daughter says the small packets can be easily carried under spandex so nobody knows you have them. On at least two occasions use of the Elovate15 has allowed her to keep rowing when she had a low whereas almost anything else would be too slow to act.

 

[hellosailor]

Wait a minute, you would buy urea? I thought you could process that out of urine.

But hey, you can buy ammonium nitrate at any farm supply store in those dirt cheap 50 pound bags. As a side benefit, after you've bought ten bags, you get free FBI protective surveillance on your home and boat. (VBG)

 

[Frogwatch]

I'd think that if you tried to carry Ammonium Nitrate on an airplane you'd immediately go on the 'no fly" list whereas urea is harmless.

 

[Frogwatch]

Even better, try explaining to the Coast Guard why you have a huge sack of Ammonium Nitrate next to your diesel fuel tank and you are sailing up next to a natural gas unloading facility.

 

[pdqaltair]

...
However, there is another totally innocuous ammonia compound (Urea)that can also be used and I wonder it is not used more....

Because has ~ 1/2 the heat of solution of ammonium nitrate and is, in practice, about 25% as useful. It just doesn't get very cold.

 

[Frogwatch]

My table shows a greater heat of solution for urea.

 

[Frogwatch]

I may have mis-read the table for heats of solution because I see that it is urea oxalate that seems much better than Ammonium nitrate. Urea nitrate is also much better but it is also a high explosive. I have not yet seen an MSDS for urea oxalate but will look.

 

[pdqaltair]

Ice is the standard in cooling because it answers most of the questions.

Need longer life, and don't need 32-40F temps?
* Use frozen sports bottles. They stand up to repeated freezing and last much longer than ice.
* Insulate the frozen bottle in addition to placing it in an insulated container. This will slow melting dramatically. A neoprene cozy. It will still keep the container below 80F and last a long time.
* A couple of frozen bottles in a 1/2 gallon insulated drink container can work very well. Place a couple sandwiches and fruit in the top and it provides for a pair for day in a very compact package. No mess.
* A wet sock can do the trick if the wet bulb is below 85F.

The heat of fusion of water (330J/g, or >400J/g if you consider that freezer ice is far below freezing) and the enthalpy of solution of ammonium nitrate (24KJ/mol, 300J/g) are the same; for sailing ice is better. The sole advantage of cold packs is they can be triggered in the field.

 

[VallelyJ]

Haven't read all the posts so this may be redundant--
What about keeping it in the water? You might be able to trail a watertight container on a stainless steel line, weighted as needed to keep it six or so feet deep in cooler water. Look for instance at gear used for fishing downriggers.
In salt water I suppose some larger fiish might mistake it for food but I'd imagine that could be dealt with and the risk of loss might be less than that of known high temps in the boat.
Another thought: condensation cools things--maybe keeping the container in the bilge wrapped in a wet cloth?
Good luck with it.
John V.