Is insulin good after 28 days?

[lovepink]

I am a nurse at an elementary school, we have a few diabetics. Every place I have worked, we have wasted insulin after it had been open for 28 days. I had a parent tell me today that their endocrine clinic told them they could use the pen until the insulin was gone, regardless of how long it took. The father apparently used to work in a pharmacy so he is in agrrement of this. I told them it was our policy to change the insulin every 28 days and if their doctor was willing to write a note saying its ok to use the insulin after 28 days then we would do that. They aren't very happy about this... Does the insulin start to break down after 28 days? Or is it ok to continue to use it? I will of course follow our policy, but I am just wondering for my own knowledge lol:redpinkhe

[dansingrn]

This is a question that even the insulin manufacturers struggle with. There are several factors, such as number of injections per day (number of times the rubber stopper is penetrated), temperature, sterility, etc. that can affect (however slightly) the potency of opened insulin. The most practical answer we give our pediatric patients is to use opened insulin pens or vials within 30 days, or monthly. This allows a new pen to be taken to school on the same day of the month each month. There is no practical difference in potency between the 28th and 30th (or 31st) day.

Hope this helps. Here is a link with more details:

http://care.diabetesjournals.org/content/26/9/2665.full

[lovepink]

Thanks so much for your response! I enjoyed the article, lots of good info!

[RN28MD]

If this person has been using the pen over the month period how does thier sugars look like? There could be the answer wether the affect of the insulin has decreased. Is usually changed every month but people do use it longer than a month and they will start to notice their sugars to increase.

[cocoon2butterfly]

Personally, I actually keep pens in my purse in case I have an issue with my insulin pump, and I use them until they are empty - which generally takes more than 28 days because I seldom use it - but they've gotten me out of a pinch every time - I use to the end simply because (personally) it didn't make sense to throw away the insulin when the vials cost upwards of $70-90 each (depending on what type of insulin it was) when the insulin was very clearly effective...I'm on a pump now, and I use about 180 units every 3 days, so the 28 day rule isn't really applicable to me anymore, as the vial's done in 15 days...

In my experience, it is temperature that makes the insulin go bad - refrigerated, okay, room temperature, okay, but it could be opened hours ago, but if you leave it in a 120 degree car in the summer once, you can consider that bottle retired, hehe... :)

[sethmctenn]

@dansingrn Great article. Thanks for sharing.

[classicdame, MSN, EdD]

for risk management purposes I would go by manufacturer's recommendations. Better talk to your supervisor. If you give extra dose because you think the child needs more than what is prescribed you could be in trouble.

[lovepink]

Thanks everyone for your thoughts. I did talk to my supervisor and she said we had to follow the 28 day rule unless their doctor was willing to write a note stating he could use it longer. The family decided to just bring in a new pen... and give me a REALLY hard time about it lol. I understand though, I imagine its frustrating. This child is a new diabetic and he is still in that "honeymoon" phase so its hard to tell exactly how the insulin is affecting him. His blood sugars are really good for a few days and then are very up and down. To cover myself, I am much more comfortable following the manufacturers recommendations...

If "state" came into a hospital and the nurses were using insulin that was dated say over a month ago, would the facility be in trouble? Would the nurses? Does that count as an expired med? The places I have worked before made it seem as if we could lose our license because of it lol.

[classicdame, MSN, EdD]

remember, if the manufacturer cannot claim the product is good after 28 days, how can you make that assumption? I would not want to take the chance, especially on a child. As a diabetic, and one who pinches pennies, I understand the cost is a factor. But something else needs to be sacrificed, not the child's health.

[pmc156]

As a Humalog insulin user, I am discovering what happens when insulin is used past too long past the expiration date. I use insulin 4-6 times/day due to Type 1, and the insulin is not refrigerated. Am finding that in the second month of use, the insulin eventually will completely stop working. Blood sugar with a normal reading at the start can rise into the 350's after eating despite multiple injections to try to bring it down. Eventually when I figure this out and switch to a new bottle, the new insulin works effectively.