A common misconception regarding the use of insulin in diabetes is its negative impact on social life and work performance. This negative perception often becomes a barrier in the successful management of the disease. There is a need to create an enabling environment where people on insulin can live a normal, healthy and active life.

Insulin devices
There are now innovative diabetes products available that make it easier to quickly self-inject insulin outside the comforts of your home. In fact, with little planning and practice, you should be able to address your insulin needs as comfortably and as smoothly outside the house as inside it.

Most diabetes patients on insulin use either the syringes or insulin pens. Each has its advantages and disadvantages. Discuss with your doctor which insulin device fits your lifestyle best. Insulin syringes are cheap, simple, and are the most widely available form of insulin delivery. Syringes allow you to combine 2 types of insulin in 1 injection. Insulin pens are portable, discreet, and convenient especially for injections away from home. These are pre-filled, so no need to draw up insulin from a bottle. Pens are easier to use especially for those with vision or dexterity problems. However, they are more expensive and do not allow you to mix insulin types.

While insulin syringe and pen are the most popular devices, other options for insulin delivery exist such as the more novel insulin pumps and jet injections. Regardless of which device you use, you should always read the instructions packaged with your insulin.

Insulin storage and handling
When insulin is not stored or handled correctly, it may not work properly. Here’s a checklist to keep your insulin in good condition at home.

1. Keep your unopened insulin in the refrigerator (2-8 C), preferably in the vegetable crisper. This ensures that your unopened insulin remains good until its expiration date.
2. Never freeze your insulin. Frozen insulin loses potency.
3. Keep unrefrigerated insulin as cool as possible and away from direct sunlight and heaters/ovens.
4. Opened or unopened bottles of insulin generally last for 28 days when stored at room temperature (not to exceed 25 C). A vial is considered “open” if the seal has been punctured. Many people store their open insulin vial at room temperature because cold insulin may be painful when injected.
5. Opened bottles, whether refrigerated or not, should be used within 28 days of opening.
6. Always check the expiration date printed on the label before purchase. The date should allow enough time for you to consume all the insulin in the vial/penfills. Never buy or use insulin past its expiry date.
7. Regardless of the expiry date on the package, discard all insulin 1 month after it has been opened. To help you remember, write the date when it was opened on the bottle.
8. Opened insulin penfills are best stored at room temperature. Storage life of cartridges varies from 7 days to 1 month depending on the type and brand of insulin.

When you’re away from home, here’s a checklist to help you keep your insulin good while in transit to school, work, or during trips.

1. Keep insulin in a cool place. Protect your insulin from extreme temperature by storing it in an insulated container especially during prolonged trips.
2. Always hand-carry your insulin. Never leave your insulin in a car and never pack your insulin in your check-in luggage. The extreme temperature variations can harm the insulin.
3. Carry extra supply of insulin and its paraphernalia to allow for losses or breakages during travel. Bring at least two to three times the amount of insulin and supplies you will need for the whole duration of the trip.
4. Research on the availability of your insulin and devices in your place of destination. Never assume that all types of insulin are available wherever you go.
5. If you are flying, bring a medical certificate indicating that you have insulin-requiring diabetes. Make sure your supplies are clearly labeled. This will facilitate security clearance. If you wear an insulin pump, notify the security officer before walking through the metal detector.

Insulin inspection
If your blood sugars remain high despite following your doctor’s treatment plan, your insulin may have lost its effectiveness. Check if the bottle has been open for more than 28 days. Always check your insulin prior to use for any unusual appearances. Here are ways to tell when the insulin is no longer good.

1. Your insulin, which is supposed to be clear, appears cloudy, thickened, or has solid particles.
2. Your insulin, which is supposed to be cloudy, has clumps or flakes even after rolling it gently between your palms.
3. Your insulin looks stringy.
4. Your insulin has discolored.
5. Your insulin vial/penfills has a frosted look.

When in doubt regarding the condition of your insulin, throw it away and open a new one. Do not take any chances.

Insulin use in school or at work
If you need insulin injections in school or at work, you should let your teacher/employer know about your insulin regimen so that you can work out a schedule to give you time off for monitoring, injection and having snacks. Find a location where you can test and inject. Have all your supplies organized and ready each day and safely dispose your sharps properly.

Be prepared for hypoglycemia by keeping snacks or drinks handy. To prevent a life-threatening emergency, educate at least one of your friends/coworkers to recognize signs and symptoms of hypoglycemia and how to treat it. It’s always good advice to make your coworkers and supervisors aware of your diabetes. Their support can help you balance the demands of diabetes management and work performance.

Insulin when eating out
Eating out with family and friends is an essential part of an active social life and with a little planning, you should have no problem being a part of the fun. If you need to test and inject at mealtime, be sure to carry your diabetes kit. Try to dine as close to your regular mealtime as possible. If your dining-out meal is scheduled at a different time than your usual, talk to your doctor about insulin adjustments. If you take rapid acting insulin, inject only when your meal is served. Test your sugars as usual.

Insulin during trips
Even if you’re on insulin, you can still enjoy the experience of traveling to new places or visiting family and friends. But as with any out-of-routine activities, you will have to plan to make it work.

In any kind of travel, always be prepared for delays. Hand-carry your insulin and supplies with you at all times in an insulated cool container along with some snacks in case of heavy traffic or delayed flights. Select a convenient injection site and wear clothing that makes it easy to reach your injection site. Wear a bracelet or necklace indicating that you have diabetes which facilitates easy identification and early management by health responders in the event of a medical emergency.

When driving long distances, take extra precaution to guard against hypoglycemia which could be dangerous for both you and your passengers. Schedule most of your driving early in the day. Keep your diabetes supplies and sugary foods (hard candy, fruit juice) within reach at all times. Maintain your daily schedule of medication and blood sugar monitoring. Stop every 2 hours to stretch your legs and take a short walk. Be alert for any signs or symptoms of hypoglycemia (dizziness, lightheadedness, trembling, cold sweats, rapid heartbeat, headache, confusion, dimming of vision). If you feel any of these coming on, pull off the road immediately, check your blood sugar, and take your sweets until the symptoms resolve. Recheck your sugar after 15 minutes. Repeat the process until your sugar level returns to normal. Wait at least 15 minutes before driving again.

When flying, bring food to eat on the plane even if it’s a short flight. Flight delays can interfere with your meal schedules. Inject your insulin as instructed by your doctor. Be careful not to inject too much air into your insulin vial which can happen in a pressurized cabin. Changing time zones can impact your regular insulin schedule. Your total insulin dosage is designed to work for about 24 hours, so when flying across multiple time zones, you may need to adjust your insulin schedule. Note that time changes occur slowly when travelling by boat so there is no need to adjust your insulin schedule.

Always discuss your insulin needs and time zone changes with your doctor to fine-tune your dosing, especially if you mix insulin or do multiple injections. In general, when you fly east, you lose time so you may need less insulin. When flying west, you gain time so you may need more insulin.

Check your sugars more frequently on the day of your flight. On long flights, exercise every 2 hours by walking up and
down the aisle. Reset your watch when you land. In your place of destination, you may be eating foods that have unknown effects on your blood sugar so you may want to check your sugars after meals too. Drink plenty of water since vacations usually mean increased sun time and increased activities. Always wash your hands and pack medications to treat common illnesses. Make sure you have discussed sick-day guide with your doctor before the trip.

When you travel, maintaining your regular schedule for insulin injections and blood sugar checks can be challenging. Always discuss your travel plans with your doctor. With careful planning, any trip can go smoothly. Don’t let insulin get in the way of a full and active life.

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