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For people living in the developing world with diabetes, a lack of electricity can hinder access to insulin.
- But a project in Kenya has shown that insulin can be maintained in a hot climate without cooling.
- Researchers, calling it a breakthrough, are calling on the World Health Organization to change its guidelines.
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For people living in the developing world with diabetes, daily life-sustaining doses of insulin have been accompanied by access to electricity.
After opening a vial, the manufacturer recommends storing it in a refrigerator until it expires, which is usually after four weeks. It is estimated that approximately 470 million people around the world do not have access to electricity and refrigerators for food and medicine, making it difficult to store insulin at home.
But now a new program could help revolutionize treatments around the world.
It started at the Dadaab refugee camp in northern Kenya, where temperatures can reach up to 99 degrees Fahrenheit and many have no access to refrigeration. As a result, the patients’ lives practically turned to go to and from the hospital to receive insulin. If you have diabetes, you may miss school, work, especially because the camp time is limited if it is possible to undertake the trek.
When doctors working in the camp saw more and more patients coming to the hospital with complications due to their diabetes, they reached out to researchers at the University of Geneva and decided to monitor home insulin storage in the camp, which experiences much warmer temperatures than recommendations for labels.
Researchers repeated the camp’s daily temperature, ranging from 77 to 99 degrees Fahrenheit, in the laboratory and tested the effectiveness of the insulin. They also studied residual insulin from vials that patients used after storing it in their homes.
They discovered that even without refrigeration, insulin kept at the tropical temperature of the camp was safe to use for four weeks – a revelation that could be life-changing for diabetic patients around the world.
After their investigation, the team adapted the advice they gave their patients and learned how to inject themselves, check their own blood sugar and what danger symptoms to look out for. Most exciting of all is that they showed patients how to store the insulin at home with a plastic container with a wet towel around it.
What followed was a dramatic decrease in the number of diabetic patients coming to the hospital with acute complications. They could go to work and go to school and ‘not seek health care all day long to stay alive’, said Philippa Boulle, of the Doctors Without Borders (MSF, also known as Doctors Without Borders).
Although insulin can be damaged if stored at high temperatures, the researchers found that cooler temperatures can keep the insulin safe overnight.
Somali refugees attend the market in the sprawling Dadaab refugee camp in northern Kenya.
TONY KARUMBA / AFP via Getty Images
“Every protein is broken down when it’s heated, but there are proteins that can go back when you cool it down again, and insulin seems to be one of them,” said Leonardo Scapozza, a professor at the University of Geneva, School of Pharmaceuticals. Sciences and one of the researchers who worked with doctors in the Dagahaley camp told Insider.
At the moment, the guidance says patients can store their insulin at an “ambient temperature”, but Scapozza said “and warm settings” should be added for clarification. All you have to do is add three words: ‘and hot settings’, says Scapozza.
He said the findings could also be applied to high-income countries such as the US, when natural disasters and storms cut off power sources.
The researchers conducted further studies to test insulin in different climates and they help refugees in their South Sudan area also take insulin home.
MSF is now calling on pharmaceutical companies to change guidelines and for the World Health Organization to endorse their findings.
Although there are many studies that have tested how stable insulin is at different temperatures, the oscillating temperature factor in this study is a ‘new twist’, says Gojka Roglic, a medical officer at the WHO responsible for diabetes management activities. told Insider.
WHO will not make any recommendations based on this study, but Roglic said it will be included in a review of all research later this year.
Ali Bishar, who heads MSF’s insulin management program at the Dadaab refugee camp in Kenya, said training on diabetes and insulin was ‘of paramount importance’ to make the program work.
“After being trained, the patients have to pass a competency test. Then they get their insulin and take care of it inside and outside the ward,” Bashar said, adding that the program, which began in 2015, has grown from 35 to 45 patients in the last six years.
However, insulin storage is only the beginning of dealing with diabetes in low-resource settings. Another major problem is how a poor diet can contribute to the symptoms of patients.
“You have to have food when you inject insulin. In some circumstances, the patient is afraid of the injection if they did not eat that day,” says Boulle.
Rahmo, who was in the first group of patients to start the MSF program in 2015, told Insider that she has challenges in getting enough food and a good diet. But regardless of her diet, Rahmo said that improved her health.
“Before that, I was confused about how I could continue my life and whether I would survive,” she told Insider through an interpreter. “Today I am very happy to be able to control my diabetes at home.”
Mohamed Hussein Bule, 27, a Somali refugee who works as a teacher at a primary school in Dagahaley, enrolled in the 2015 MSF program.
He was diagnosed with diabetes in 2014 after dropping his weight from 150 to 82 pounds, but since joining the program, it has been around 143 pounds again.
“I was supposed to take insulin into the hospital early in the morning to take home, then go to work. I missed a lot of classes. Now I take a vial in the morning and record my glucose and continue with the program as my day goes on, ”he said.
“I don’t even feel like a patient with diabetes right now. I’m very glad I’m on the program.”