Insulin pump

[rising_creek]

Planning a tour from Seattle to Atlanta. Mostly camp. How do I keep insulin at safe temp in warm weather? How can i ship pump / cgm supplies to myself on the tour (warm showers or general delivery thru post office or...)? Can I claim less than my full script of humalog insulin so not to hav too much on tour? Thanks

[HikeBikeCook]

Could you transfer your prescription to a national chain of drug stores and pick it up in small batches? What is the suggested storage temp? I have a rear rack bag I use for tools, tubes, etc., that is actually a cooler bag designed to hold a six pack. I got it from LL Bean 20 years ago. I would think you could add extra insulation and add ice along the way. Ice melts and causes a mess, but if is in a separate bag and behind you maybe it will be less of a problem. 

[ray b]

Planning a tour from Seattle to Atlanta. Mostly camp. How do I keep insulin at safe temp in warm weather? How can i ship pump / cgm supplies to myself on the tour (warm showers or general delivery thru post office or...)? Can I claim less than my full script of humalog insulin so not to hav too much on tour? Thanks

These are all good questions, and I don't mean to punt, but as an academic endocrinologist, I usually ask my team of diabetes educators (which includes a PharmD) what they think.

I'll note that outside the body, insulin can last a long time at 90 degrees. The bigger risk for potency is freezing. I've camped in the winter with patients with type 1 diabetes who literally keep their insulin on their body at all times.

The current recommendations from the manufacturers, as you know, is that insulin can be stored in unopened or opened vials at up to 86 deg F for 28 days. A simple insulated pouch should do the trick, but as you know, if you are on the mailing lists, there are a lot of companies who would be happy to sell you cooling gel packs, temperature controlled caps, and other things to keep the worry level down. One of my favorites is the small Frio wallet that will hold three vials of insulin and is activated by water. https://www.frioinsulincoolingcase.com/product/extra-small-wallet/

If you're going to hit Atlanta in the summer, you might want to ask your educators what they recommend. As you know, Atlanta is also the original home of Team Type 1 which is now Team Novo Nordisk. If you're making this kind of a ride, you have every right to reach out to them to ask for advice.

I usually recommend getting prescriptions into a national chain of pharmacies like Walgreens or CVS to allow you to refresh your supply of insulin (and catheters, CGMs, etc.) as often as you want.

Yes, any pharmacist will allow partial fill on any prescription.

[Westinghouse]

There are thermal bags. You should be able to get ice along the way, but with what degree of sureness and regularity is anyone's guess.

[rising_creek]

Thanks for the info. All the input is most appreciated & needed =)

[canalligators]

Adventure Cyclist April 2019 had its lead story about touring with Type 1.  It had a number of hints and tips, including dealing with insulin.  Members can access previous issues.  I remember the article being factual and having practical advice.

I paid attention for possible future reference, as I’m a controlled T2. 

Have you thought out power for your pump?  I’d think today’s power packs would have enough reserve power.

[David W Pratt]

What Canalagators said. Also, ask the pump manufacturer. They may have had similar requests, or know of other users who have done similar.  They could be terrified that something will go wrong, or delighted that their pump enables such independence.  good luck.

[rayed]

Any recommendation for the long tours with the type 2?

[canalligators]

Well you know everybody’s different, that’s characteristic of the disease.  I’ve asked dietitians; their answer was to quantify your own needs: meter readings during long rides.  I can (and will) tell you my experience, but everyone is unique.  And almost no dietitians are expert on endurance sports.  Maybe seek out one who advises a marathoner.

I researched storage requirements for meds other than insulin.  Manufacturers recommended temp under 85F.  My doc (internist) and pharmacist told me not to worry about it.  I considered resupply monthly on a three month trip, but in the end, just carried the whole trip’s supply.  I did keep them in a lightly insulated bag, buried in the clothing pannier.  If you’re concerned or your pharmacist recommends it, you could resupply from home, use a national chain, or drop ship.  GPO works well.

In my case, the DM is controlled reasonably well in daily life, with diet, exercise and meds (not insulin).  On my trip, daily mileages were very challenging.  After two months, my A1C went from 7.0 to 5.6 and I’d lost 26 lbs. - despite eating a lot of food of all kinds.  On my dr’s. advice, I discontinued one of the meds.  Your doc might also reduce dose.

[ray b]

Any recommendation for the long tours with the type 2?

If one makes insulin, then 2 to 6 months on the bike with a good diet is a great way to cure type 2 (metabolically mediated) diabetes.
After some years of type 2 diabetes and high sugars, the pancreas no longer makes much insulin. A patient with type 2 diabetes that requires insulin should see notes above.
If in doubt, that is why they made diabetes specialists and educators.

[Alessa3322]

Type 2 diabetic here. I had only one tour, but I'm glad to share my experience.
The first things I packed were a blood glucose monitor and spare batteries, lancets, test strips, and my diabetes pills (I decided to buy an extra pack of Victoza online beforehand). I used a small dry bag for this stuff.
I carried a 12 oz or 6 oz Cola for when I feel the blood sugar dropping.
I needed to snack on something every hour.
Also, think about your meals beforehand. Maybe you can choose the places you are going to eat at when planning the route.

[ray b]

I should note - if one is on any medications that can cause hypoglycemia, the effects of exercise and those medications (insulin and sulfonylureas) are more than additive.

Take a continuous interstitial glucose monitor. They are illegal to use while racing, but indispenable on the road.

[staehpj1]

I have no experience with carrying insulin, but I will say that stuff in panniers wrapped in clothing has stayed way below the ambient temperature during the heat of the day for us on tour even with black panniers.  My companions on the TA had a water bladder in a front pannier with a hose and bite valve to drink from and the water stayed relatively cool even on 100 F days.

You might experiment with carrying a pannier with a thermometer inside to see how warm it gets.  A kitchen remote probe thermometer might be a good way to check.  You could also use one on tour to see how your medicine was fairing and get some ice if you needed to.  I suspect you can get by without ice.

[canalligators]

I usually carry fig bars as my quick sugar source.  Figs are higher in glucose than many snacks.  They seem to give me a good boost with quick recovery.  YMMV.   I carried glucose tabs but did not need to use them.  And of course, I carried my meter with new batteries.  I checked AM fasting daily, and also used it several times for spot checks when I felt I was going low. 

Extra test strips are temperature sensitive, and should be kept in the insulated bag with your meds.

[David W Pratt]

A bottle of water in the pannier will come to the temp of the pannier, but will stay at or near that temp for the few seconds it takes to put a thermometer in it.  You can try this to estimate the insulating properties of your panniers.
Good luck.