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Uncontrolled blood sugar levels despite taking insulin. Could this be due to the improper storage of insulin?

Please help with your advice as my Wife is on Novomix 30 insulin flexipen with dosage of 20 units in the morning and 10 units in the evening but still her sugar levels are hovering around 14- 18 all the times . Please advise what to do as 1 local doctor told us that the way Novomix is to kept once we are using is in the refrigerator but on the usage manual in the box it says that only unused to be kept in refrigerator and once opened it should be kept under room temperature below 30 c for up to 4 weeks
We are very confused. Please if we can be helped
Asked On : Wed, 10 Apr 2013
Answers:  4 Views:  65
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Internal Medicine Specialist 's  Response
this is from UPTODATE
How do I store and/or throw out this drug?
• Store unopened containers in a refrigerator. Do not freeze.
• You may store opened vials at room temperature or in a refrigerator. If stored at room temperature, throw away any part not used after 4 or 6 weeks as you have been told.
• Store opened cartridges and pens at room temperature. Throw away any part not used as you have been told by your doctor.
• Protect opened containers from heat.
• Protect opened containers from light
Answered: Thu, 11 Apr 2013
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Internal Medicine Specialist Dr. Akhilesh Dubey's  Response
Welcome to HCM,
You are Diabetic and taking pre mixed insulin,please understand that just taking insulin will not control blood Glucose please take care of your diet, and exercise.
Insulin can be combined with other insulin sensitizers as there is possibility of resistance is there like Metformin or Pioglitazone.
Then you need to titrate the dose of insulin with monitoring of Fasting and pre lunch and pre dinner blood Glucose level.
This insulin is good as it is premixed please roll between palms to evenly mix it before taking it.
It can be kept at room temperature for 1 month after opening.
Please take help of of your Physician to titrate the dose and I am sure your blood sugar will be controlled in few weeks.
Please also monitor your diabetic control with HbA1c every 3 months.
Take care
Good Luck
Answered: Thu, 11 Apr 2013
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General & Family Physician Dr. Luchuo Engelbert Bain's  Response
Hi and thanks for the query,
I suggest that the doctor might be right. This is because the temperatures in the refrigerator must not necessarily be in the freezing zone, its below room temperature and also more stable. Kept elsewhere, there are many environmental fluctuations in temperature, and drug might not be very stable.
I do not honestly think the first thing to think of with respect to improper storage of insulin, although the quality of the insulin and storage conditions might count. Different patients are sensitive to insulin in different manners, and monitoring when patient is just put on treatment is very vital. It is during this period that he dosage are either increased if levels remain raised or reduced if tendencies of hypoglycemia are noticed.
I suggest your wife gets a review from her physician for a probably fasting blood sugar and Glycated Hemoglobin (HbA1c) measurements.
Thanks and best regards,
Luchuo, MD.
Answered: Wed, 10 Apr 2013
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General & Family Physician Dr. Pavan Kumar Gupta's  Response
In spite of treatment,it is sad that your wife is having uncontrolled diabetes.
Uncontrolled diabetes can have various future micro as well as macro vascular complications and all efforts should be made to bring the sugar levels in tight control.
You must consult a diabetologist in this regard and get the right prescription made.
Since there is no information regarding her medications or any thing else pertaining to her illness,it is very difficult for me to advise any medication to your wife.
As far as storage of insulin is concerned keep unopened cartridges of insulin in the refrigerator until needed. They may be used until the expiry date on the label. Never allow insulin to freeze. 
Insulin that is currently in use may be kept at room temperature for no more than 28 days and then discarded. Insulin must not be exposed to extremely hot temperatures or to sunlight. 
I hope it helps you.
Answered: Wed, 10 Apr 2013
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