Letters
1991 and HbAlc 1990 (r = 0.410, P = 0.014; Fig. 1). These data indicate that, in Japanese diabetic children, the plasma LP(a) level is determined by hereditary, and poor glycemic control affects its concentration.
FROM THE FIRST DEPARTMENT OF MEDICINE, OSAKA UNIVERSITY MEDICAL SCHOOL, OSAKA, JAPAN. ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO YOSHIMITSU YAMASAKI, MD, FIRST DEPARTMENT OF MEDICINE, OSAKA UNIVERSITY MEDICAL SCHOOL, 1-1-50 FUKUSHIMA, FUKUSHIMA-KU, OSAKA 553, JAPAN. LP(A), UPOPROTEIN(A).
References 1. Levitsky LL, Scanu AM, Gould SH: Lipoprotein(a) levels in black and white children and adolescents with IDDM. Diabetes Care 14:283-87, 1991 2. Utermann G: The mysteries of lipoprotein(a). Science 246:90410, 1989 3. Haffner SM, Tuttle KR, Rainwater DL: Decrease of Lipoprotein(a) with improved glycemic control in IDDM subjects. Diabetes Care 14:302-307, 1991 4. Kapelrud H, Bangstad H-J, Dahl-Jorgensen K, Berg K, Hanssem KF: Serum Lp(a) lipoprotein concentrations in insulindependent diabetic patients with microalbuminuria. Br Med J 303:675-78, 1991 5. Joven J, Vilella E: Serum levels of lipoprotein (a) in patients with well-controlled non-insulin-dependent diabetes mellitus. JAMA 265:1113-14, 1991
sterility, bioavailability, and economic issues, insulin should generally be refrigerated and injected without warming. High-performance liquid chromatography analysis versus older radioimmunoassay methods indicate that a vial of insulin stored at room temperature can lose as much as 1.5% potency/mo (3). Manufacturers recommend that, whenever possible, insulin should be stored at 2-8°C in a refrigerator. Refrigerator storage omits sunlight exposure and minimizes insulin transformation products (4). Additionally, the pharmacokinetics and pharmacodynamics of lente and regular insulin mixtures are profoundly influenced by insulin vial temperature (5). Undocumented information concerning the storage and administration of insulin is an issue of major concern. Collected education material advising that "insulin at room temperature is absorbed more evenly" (6), "room temperature will decrease the stinging sensation and the possibility of localized allergic reaction" (7), and "insulin is more comfortable to give if it is not used straight from the fridge" (8) is poorly referenced. Injecting refrigerated insulin has not been a problem in our clinical practice. Insulin storage issues are important for diabetic control and patient education. We believe that insulin should generally be stored and injected at a refrigerated temperature, and documentation is necessary in diabetic education materials.
FROM JOSEPH J. FALLON, JR., MD, PA, ENDOCRINOLOGY, DIABETES AND LIPID DISORDERS, VOORHEES, NEW JERSEY. ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO DR. JOSEPH FALLON, JR., 2301 EVESHAM ROAD, SUITE 210, VOORHEES, NJ 08043.
Insulin Storage and Injection Recommendation ROSALIE ALBERGO, RPH JIM BUNTING, RPH MARTIN K. BELSKY, DO JOSEPH J. FALLON, J R . , MD
T
he United States Pharmacopeia (1) and the American Diabetes Association (2) recommend that insulin "may be kept" at room temperature for 1 mo with the exception of Novolin Penfills Type N and 70/30, for which 14 days is allowed. After that time, unused portions should be "thrown away" (1). We believe that due to physical stability,
DIABETES CARE, VOLUME 15, NUMBER 8, AUGUST 1992
References 1. USP Pharmaceutical Convention: USP DL Rockville, MD, U.S. Pharmacopeia, 1991, p. 673 2. American Diabetes Association: Position statement: insulin administration. Diabetes Care 14 (Suppl. 2):31, 1991 3. Anderson JH, Campbell RK Pharmacy update: mixing insulins in 1990. Diabetes Educ 16:380-87, 1990 4. Gregory R, Edwards S, Yateman NA: Demonstration of insulin transformation products in insulin vials by high-performance liquid chromatography. Diabetes Care 14:42-48, 1991 5. Perriello G, Turlone E, Di Santo S, Fanelli C, De Feo P, Santevsanio F, Bronelli P, Bolli GB: Effect of storage temperature of insulin on pharmacokinetics and pharmacodynamics of insulin mixtures injected subcutaneously in subjects with type I (insulin-dependent) diabetes mellitus. Diabetologia 31:811-15, 1988 6. Wentworth S (Ed.): In Balance In Control. Diabetes Medication as Directed Professional Guide, pt. 3. Indianapolis, IN, Boehringer Mannheim, 1987, p. 15
1113
Letters
7. Garber AJ (Ed.): Lifestyle Lessons: A Guide to Diabetes Care. New York, Pfizer, 1990, p. 79 8. Sonksen PH, Fox C, Judd S: Diabetic Reference Book. London, UK, Harper and Row, 1985, p. 63
Study in Tanzania oflGT
Table 1—Result of retesting according to value of 1st 2HBG in subjects with initial value
1991 and HbAlc 1990 (r = 0.410, P = 0.014; Fig. 1). These data indicate that, in Japanese diabetic children, the plasma LP(a) level is determined by hereditary, and poor glycemic control affects its concentration.
FROM THE FIRST DEPARTMENT OF MEDICINE, OSAKA UNIVERSITY MEDICAL SCHOOL, OSAKA, JAPAN. ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO YOSHIMITSU YAMASAKI, MD, FIRST DEPARTMENT OF MEDICINE, OSAKA UNIVERSITY MEDICAL SCHOOL, 1-1-50 FUKUSHIMA, FUKUSHIMA-KU, OSAKA 553, JAPAN. LP(A), UPOPROTEIN(A).
References 1. Levitsky LL, Scanu AM, Gould SH: Lipoprotein(a) levels in black and white children and adolescents with IDDM. Diabetes Care 14:283-87, 1991 2. Utermann G: The mysteries of lipoprotein(a). Science 246:90410, 1989 3. Haffner SM, Tuttle KR, Rainwater DL: Decrease of Lipoprotein(a) with improved glycemic control in IDDM subjects. Diabetes Care 14:302-307, 1991 4. Kapelrud H, Bangstad H-J, Dahl-Jorgensen K, Berg K, Hanssem KF: Serum Lp(a) lipoprotein concentrations in insulindependent diabetic patients with microalbuminuria. Br Med J 303:675-78, 1991 5. Joven J, Vilella E: Serum levels of lipoprotein (a) in patients with well-controlled non-insulin-dependent diabetes mellitus. JAMA 265:1113-14, 1991
sterility, bioavailability, and economic issues, insulin should generally be refrigerated and injected without warming. High-performance liquid chromatography analysis versus older radioimmunoassay methods indicate that a vial of insulin stored at room temperature can lose as much as 1.5% potency/mo (3). Manufacturers recommend that, whenever possible, insulin should be stored at 2-8°C in a refrigerator. Refrigerator storage omits sunlight exposure and minimizes insulin transformation products (4). Additionally, the pharmacokinetics and pharmacodynamics of lente and regular insulin mixtures are profoundly influenced by insulin vial temperature (5). Undocumented information concerning the storage and administration of insulin is an issue of major concern. Collected education material advising that "insulin at room temperature is absorbed more evenly" (6), "room temperature will decrease the stinging sensation and the possibility of localized allergic reaction" (7), and "insulin is more comfortable to give if it is not used straight from the fridge" (8) is poorly referenced. Injecting refrigerated insulin has not been a problem in our clinical practice. Insulin storage issues are important for diabetic control and patient education. We believe that insulin should generally be stored and injected at a refrigerated temperature, and documentation is necessary in diabetic education materials.
FROM JOSEPH J. FALLON, JR., MD, PA, ENDOCRINOLOGY, DIABETES AND LIPID DISORDERS, VOORHEES, NEW JERSEY. ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO DR. JOSEPH FALLON, JR., 2301 EVESHAM ROAD, SUITE 210, VOORHEES, NJ 08043.
Insulin Storage and Injection Recommendation ROSALIE ALBERGO, RPH JIM BUNTING, RPH MARTIN K. BELSKY, DO JOSEPH J. FALLON, J R . , MD
T
he United States Pharmacopeia (1) and the American Diabetes Association (2) recommend that insulin "may be kept" at room temperature for 1 mo with the exception of Novolin Penfills Type N and 70/30, for which 14 days is allowed. After that time, unused portions should be "thrown away" (1). We believe that due to physical stability,
DIABETES CARE, VOLUME 15, NUMBER 8, AUGUST 1992
References 1. USP Pharmaceutical Convention: USP DL Rockville, MD, U.S. Pharmacopeia, 1991, p. 673 2. American Diabetes Association: Position statement: insulin administration. Diabetes Care 14 (Suppl. 2):31, 1991 3. Anderson JH, Campbell RK Pharmacy update: mixing insulins in 1990. Diabetes Educ 16:380-87, 1990 4. Gregory R, Edwards S, Yateman NA: Demonstration of insulin transformation products in insulin vials by high-performance liquid chromatography. Diabetes Care 14:42-48, 1991 5. Perriello G, Turlone E, Di Santo S, Fanelli C, De Feo P, Santevsanio F, Bronelli P, Bolli GB: Effect of storage temperature of insulin on pharmacokinetics and pharmacodynamics of insulin mixtures injected subcutaneously in subjects with type I (insulin-dependent) diabetes mellitus. Diabetologia 31:811-15, 1988 6. Wentworth S (Ed.): In Balance In Control. Diabetes Medication as Directed Professional Guide, pt. 3. Indianapolis, IN, Boehringer Mannheim, 1987, p. 15
1113
Letters
7. Garber AJ (Ed.): Lifestyle Lessons: A Guide to Diabetes Care. New York, Pfizer, 1990, p. 79 8. Sonksen PH, Fox C, Judd S: Diabetic Reference Book. London, UK, Harper and Row, 1985, p. 63
Study in Tanzania oflGT
Table 1—Result of retesting according to value of 1st 2HBG in subjects with initial value
