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For people living with diabetes in the developing world, a lack of electricity can make access to insulin difficult.
- But a project in Kenya showed that insulin can be kept in warm climates without refrigeration.
- The researchers, calling it a breakthrough, are asking the World Health Organization to change its guidelines.
- Visit the Business section of the Insider for more stories.
For people living with diabetes in the developing world, taking insulin doses that support daily life is associated with access to electricity.
After a bottle is opened, manufacturers recommend storing it in the refrigerator until expiration, which usually occurs after four weeks. But an estimated 470 million people worldwide lack access to electricity and refrigerators for food and medicine, making insulin storage at home difficult.
But now, a new program can help revolutionize treatments worldwide.
It all started in the Dadaab refugee camp in northern Kenya, where temperatures can reach 99 degrees Fahrenheit and many do not have access to refrigeration. As a consequence, patients’ lives practically revolved around going to and from the hospital to receive insulin. Having diabetes can mean missing school, work, especially since the camp curfew restricts when walking is possible.
When doctors working in the field noticed more and more patients arriving at the hospital with complications from their diabetes, they went to researchers at the University of Geneva and decided to monitor insulin storage at home in the field, which was experiencing much warmer temperatures than recommendations from the label.
The researchers replicated the camp’s daily temperature, which ranged from 77 to 99 degrees Fahrenheit, in the laboratory, and tested the effectiveness of insulin. They also studied leftover insulin from vials that patients used after storing them in their homes.
They found that even without refrigeration, the insulin kept in the camp’s tropical temperatures was safe for use for four weeks – a revelation that could change the lives of diabetes patients around the world.
After the investigation, the team adjusted the advice it gave patients, teaching them how to self-inject, check their blood sugar level and what danger symptoms to watch out for. Most exciting of all, they showed patients how to store insulin at home using a plastic container with a wet towel around it.
What followed was a dramatic drop in the number of diabetic patients who come to the hospital with acute complications. They were able to go to work and school and “not spend all day looking for medical care to survive,” said Philippa Boulle, of the organization Médecins Sans Frontières (MSF, also known as Doctors Without Borders).
Even though insulin can be damaged when stored at high temperatures, the researchers found that cooler temperatures at night can keep insulin safe.
Somali refugees participate in the market in the extensive Dadaab refugee camp in northern Kenya.
TONY KARUMBA / AFP via Getty Images
“All proteins degrade when they are heated, but there are proteins that can come back when you cool them down again, and insulin appears to be one of them,” said Leonardo Scapozza, a professor at the School of Pharmaceutical Sciences at the University of Geneva and one of the researchers who worked with doctors in the Dagahaley field, he told Insider.
At the moment, the guidance says that patients can store their insulin at “” room temperature “”, but Scapozza said “and warm settings” should be added for clarification. There just need to be three words added to it: ‘and hot settings’, says Scapozza.
He said the findings could also be applied to high-income countries, such as the United States, for example, when natural disasters and storms cut off energy supplies.
The researchers have done more studies to test insulin in different climates and are helping refugees in South Sudan to take insulin home as well.
Now, MSF is asking pharmaceutical companies to change the guidelines and for the World Health Organization to endorse its findings.
Although there have been many studies testing how stable insulin is at different temperatures, the temperature fluctuation factor in this study is a “new twist,” said Gojka Roglic, a WHO doctor in charge of diabetes control activities, told Insider.
The WHO will not make any recommendations based on this study alone, but Roglic said it will be included in a review of all research later this year.
Ali Bishar, responsible for MSF’s insulin control program in Kenya’s Dadaab refugee camp, said diabetes and insulin education is “key” to the program’s functioning.
“After being trained, patients need to pass a competency test. Then they receive insulin and care is provided inside and outside the wards,” said Bashar, adding that the program, which started in 2015, grew from 35 to 45 patients in the last six years.
However, insulin storage is only the beginning of diabetes management in low-resource settings. Another major concern is how a poor diet can contribute to patients’ symptoms.
“You need to eat when you inject insulin. In some settings, patients are afraid of the injection if they don’t 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 having a good diet. But regardless of his diet, Rahmo said his health had improved.
“Before that, I was confused about how to continue my life and whether I would survive,” she told Insider through an interpreter. “Today, I am very happy to control my diabetes at home.”
Mohamed Hussein Bule, 27, a refugee from Somalia who works as a teacher at a primary school in Dagahaley, enrolled in the MSF program in 2015.
He was diagnosed with diabetes in 2014 after his weight dropped from 150 pounds to 82 pounds, but since joining the program his weight has gone up to about 143 pounds.
“I should get insulin from the hospital early in the morning to take it home, then go to work. I was missing a lot of classes. Now, I take a bottle in the morning and record my glucose, and continue with the program as my day goes on,” he said. he.
“I don’t even feel like a patient with diabetes right now. I’m really happy to be on the program.”