How insulin storage, use and lifespan affect your safety

The price of insulin and its impact on lives and early death (primarily reported in the US) has become a daily global discussion for people with type 1 and type 2 diabetes on social media. Often social media posts demonstrate advocacy efforts, and/or peer to peer support or country to country interest (comparisons on price). The insulin affordability crisis on social media also includes discussions about “insulin expiration” “when to throw away” insulin, “hoarding insulin” as a measure against supply issues (including pricing) and gifting insulin pens or vials to those in need. What hasn’t been discussed is how insulin storage, use and lifespan affect your safety.

There is a need now more than ever to increase awareness that storage/lifespan of insulin is an important variable in managing blood glucose levels. In addition, expiration dates on vials are to be taken seriously. When insulin has expired, it is not safe to inject. Living with diabetes takes vigilance on so many fronts and this includes looking out for degraded or out-of-date insulin.  The risks are high if your insulin is no longer effective, including Diabetic ketoacidosis (DKA) and hospitalization. 

What follows are a few general rules compiled for your well-being and safety:

• All insulin when not in use should be safely stored in a refrigerator at 36°F to 46°F (2°C to 8°C).
• All types of insulin are impacted by extreme cold or heat, including direct sunlight. Never allow insulin to be stored in a freezer, a car (or packed in a checked suitcase for air travel). If there are any doubts, throw it out.
• Check expiration dates. If the insulin has expired, don’t use it.
• Once you have begun using insulin (pen or vial with injection, pump), the insulin can remain at room temperature (up to 86F or 30 C) for the number of days you will be using it. Write the date on the “open” bottle when you began; see below for insulin lifespan according to type.
• Pumps come under the same constraints as above (do not leave the device in the car, in heat, frozen temperatures). Pump sites need to be changed every 3 days with new insulin, but the same rules apply.
• If using a pen, keep refrigerated until you begin using it. After that, leave it at room temperature (up to 86F or 30C). Vials can be stored at room temperature or the refrigerator until they are finished.
• Be aware that refrigerator temperatures fluctuate. If you think your refrigerator may be too cold, check with a separate thermometer and take action as required.
• When picking up prescribed insulin, don’t accept expired or nearly expired insulin.  Ask for better dated insulin.  Also, make sure the insulin has been adequately stored, refrigerated. 

Listed below are the most used types of insulin (by manufacturer) and their lifespan once a person has started to use (aka, open vial or open pen):

Lilly insulin

Insulin Glargine (Basaglar®): Throw away pen/vials after 28 days, even if it still has insulin left.
Insulin Lispro (Humalog®): Throw away pen/vials after 28 days of use, even if there is still insulin left.
Humulin R: Throw away vials after 31 days of use. If pen, throw away after 28 days.
Humulin N: Throw away vials after 31 days of use. If pen, throw away after 14 days.
Humulin 70/30: Throw away vials after 31 days of use. If pen, throw away after 10 days, even if it still has insulin left in it.

Novo Nordisk insulin

Insulin aspart (Fiasp®, Novolog®, NovoRapid®): Pen and vial, throw away after 28 days.
Insulin degludec injection (Tresiba®): Pen and vial, throw away after 56 days.
Insulin detemir injection (Levemir®): Pen and vial, throw away after 42 days.
Isophane insulin human suspension (Novilin® N NPH): Vial – 42 days; pen – 28 days.
Insulin human injection (Novolin® R): Vial – 42 days; pen – 28 days.
70% human insulin isophane suspension and 30% human insulin injection (Novolin® 70/30): Vial – 42 days; pen – 28 days.

Novolin NPH and R also represent the ReliOn ® brand available at Wal-Mart.

Sanofi insulin

Insulin lispro injection (Admelog®): Pen and vial, throw away after 28 days
Insulin glulisine injection (Apidra®): 28 days
Insulin glargine injection (Lantus®): 28 days
Insulin glargine injection (Toujeo®): 28 days

For questions about a particular brand of insulin, problems, concerns about product stability, contact the manufacturer for help (links above), and in some cases, ask for a replacement.