3 Stories of Insulin Fails

A certified diabetes educator reminds us that even those well-versed in their diabetes care can make errors in insulin storage or injecting technique.



Using insulin at first seems like a pretty straightforward endeavor, but the amount of information you receive with a diabetes diagnosis can be overwhelming. If we were all perfect, we’d remember forever every detail of the “rules” of using insulin, but we’re human instead.

I’m a certified diabetes educator who helps people with diabetes troubleshoot problems with their insulin therapy. I’ve found that even “veterans” of diabetes self-care can make some mistakes. Here are three common errors we’ve seen at my clinic in recent weeks:

Pen Oops
In our clinic, I recently met with a gentleman who had been using insulin for some time. He was referred for help with uncontrolled diabetes; several increases to his regimen were not solving the problem.

It turns out the problem was his technique. He was using an insulin pen, and he only removed the outer cover, not the needle cover before injecting. We at the clinic resolved to review proper insulin injection technique with all patients, even those who we expect know the proper technique.

Mind the Thermometer
A patient recently discharged from her hospital stay came to us wondering why she was not getting the same kind of blood glucose control from her new basal insulin plan as she had during her hospital stay. Through some detective work, we discovered that her family had procured her insulin at the pharmacy prior and safely packed it away with her luggage, which was placed in the outside back of the family truck. Then they took a wintery two-hour drive home.

The patient was experiencing the effect of denatured and ineffective insulin. It’s not just cold that’s the problem. insulin exposed to hot temperatures above 86 degrees, such as a vial left in a car on even a warm summer day, could also be rendered ineffective.

Believe the Expiration Date
For some patients, seeing the words “keep refrigerated” on the package of their insulin bottle seems to imply a protection that will allow them to use their insulin even long after the expiration date has passed. Another common problem is using insulin for more days than the manufacturer recommends after opening the bottle or pen. It’s important to remember that the manufacturer specifies and prints on the insulin packaging the recommended date to discard insulin after opening, and that date should be considered non-negotiable. Using insulin past its prime will not get you the results you need to maintain good blood glucose control.

Diabetes is complicated, and diabetes self-care has a lot of moving parts. There are no stupid questions to ask yourself if you find yourself suddenly having trouble with your blood sugar levels. It’s always possible you’ve made a mistake with your insulin storage, or even your injection technique. If you can’t find the answer after a basic review of your actions, don’t be shy about seeking help from a certified diabetes educator.

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Kristine Kilen RD, CDE has been privileged to work and learn with patients and their diabetes for over 20 years. She lives in Eastern Montana along the Yellowstone River with her husband and three teenage boys, enjoying river boating, mountain biking, and exploring the state.