Boats to blame.
We’re down in the southern end of Thailand right now, and if I was having a hard time with the heat before, I am now realizing I had nothing to complain about up north. Thailand’s islands seem to be trying to cook me and my insulin alive every moment from sun up to sun down.
We took a ferry boat from Phuket to a smaller island called Ko Phi Phi. And I hesitate to even call this a ferry ride, as it was actually a gigantic cattle call of hundreds of people being packed on a giant boat with no seats and a seemingly endless supply of rude tourists swigging beers and smoking cigarettes. Ko Phi Phi is known as a party island, but Jacob and I had heard great things about the beaches and were curious about the hype, so we joined the fray to check it out. It’s safe to say it wasn’t exactly our type of party scene, but that’s ok. That’s what travel is all about.
When we first boarded the ferry, all we saw for luggage stowage was a huge heap of suitcases sitting in the blazing sun, and a deeply tanned Thai man lobbing each new passengers bag onto the pile. Jacob pointed to my bag and looked at him.
“No sun. Medication. No sun. Can we take with us?”
The man pointed to the entrance of the main cabin, and we followed his direction. The inside cabin had AC blasting, and a new pile of bags was quickly forming by the door. Perfect! Jacob and I left my suitcase with the others there but then went back outside so we could sit on the top level of the boat. Since I get seasick easily, being in the fresh air is usually my best bet on boats.
If only there was fresh air to breathe. There were no seats on top, people just popped down cross-legged wherever there was an open spot, or sat with their legs dangling off the side of the boat. Everywhere you looked there was another trashy tourist blowing cigarette smoke in you face while chugging a Chang beer. And there wasn’t a breeze to be found. Still docked with no momentum to create a little wind, Jacob and I found ourselves melting into the boat in the sweltering heat. I took comfort knowing that my reserve insulin was all downstairs in the AC, but I wasn’t sure the insulin in my Frio wallet in my purse would make it to Phi Phi. Finally the boat started moving and we both cooled down as wind whipped around us. My purse though, was still getting direct sun, and there was no escape.
We made it to Phi Phi in about an hour and half, and Jacob and I quickly bolted away from the tourist throng. My luggage had indeed stayed nice and cool in the cabin of boat, but we had to get inside quickly as the temps were scorching. We made our way through the maze of streets and found our hotel, and I checked on my insulin in my luggage: nice and cool. By then I pulled out the Frio wallet and it was warm to the touch. The pens inside also felt warm and I wasn’t sure if they’d survived or not. To find out, I used them that evening at dinner. I ran high pretty most of the night, but we had rice with dinner, beers afterwards, and even a late night slice of pizza as we made our way home from the bars. Hey, when you’re in a giant frat party that’s taken over an entire island you can’t beat ‘em. So we joined ‘em. And lemme tell ya, Ko Phi Phi knows how to party 
By the next morning through, my BGs hadn’t come down much, even though it had been eight hours since the pizza. I took some Humalog and ate breakfast, but it still wasn’t coming down. I couldn’t help but wonder if the insulin was indeed spoiled. I knew I wouldn’t relax until I fixed the problem, so I went back to the room and got two new pens out, just to be sure. I didn’t toss the other pens-they might be alright and I can use them for back ups if I really need them, but I brought enough insulin with me plus extra for this exact type of occasion. And peace of mind is priceless, especially when you’re already dealing with a lot of travel unknowns already.
A question I have is if there’s a way to tell by looking at insulin that it is spoiled from the heat-does it change color or anything like that? If anyone knows, I’d love to know a way to be sure! In the meantime, I will keep using my pens that I know are good to go. And also, I’m done with beers for a few days…of to the next (and quieter!) island!
The next mornin
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Comments
Hey Alexis,
Sounds like all is going well thus far. It’s funny this is happening to you, because I think I spoiled my novolog and levemir pens for the first time since I’ve been on them for over two years.
I was in Colorado instead of LA last weekend before coming back to Atlanta for work. My pens sat in ~30° for 4-5 hours (that’s another story all together). Anyways, like you felt unusually high the day after going out, I noticed this on the plane. My Dexcom showed me creeping into the 200s after a normal light carb breakfast that I eat and bolus for the same all the time before I fly. A finger prick confirmed the G4 rocking it within 5mg/dL. A few hours into it, I decided to correct with two unit whichs would normally be on the higher end, but I had my glucose. This ended up only bringing me down 50 over 4 hours, where normally it would be more around 100 down.
Long story short, these are my backup pens I keep in Atlanta, and had to use since my weekend was in Boulder instead of LA (where my apocolypse hoard is). If I didn’t have the CGM, I’d be in more of a situation. Over the last couple of days, I’ve figured out a scaling factor of ~1.4 times my normal units due to how my sugars have responded. Also upped my long term from 10/8 to 12/10.
3:12pm now my BG is 97 after a noon Thai red curry with chicken and brown rice I eat on a weekly basis. Peaked at 170 from 135 before eating. 8 units 15 minutes before my first bite instead of my normal 6 units right before my first bite.
Glad you have the backup stash! I’d say keep the less potent stuff for super backup stash, but moving on to the unspoiled stuff will surely get you back to your normal levels.
Happy travels
Connor
Rich thanks for looking that up, hey at least it’s something to look for. Nothing is worse than just blindly using the same pens and just being worried the whole time that they’re busted.
Connor thanks for your insight. You know something is wrong when you’re doing everything normally but surprises keep cropping up. I kept the suspect pens buried in my bag as last resort back ups, and feel better knowing the ones I have on my are working.
Found this online from an interview with an insulin manufacturer on how you can tell if heat has denatured the insulin: “So, can you recognize “bad” insulin? Most experts say “no,” and that the only way to know is in how it works. Spollett acknowledges that heat-affected insulin maintains its water-like color, but says that careful inspection can show a “frosty appearance.” She states “it’s not like a snow-globe, like old insulins, but you can see very fine particles” suspended in heat-affected insulin.”