Temperature, my sweet enemy

_3 Second

One of the main challenges I will have to face during my journey as a type 1 diabetic is the logistics around the supply and conservation of insulin. Indeed, while insulin can be found 24/7 in nearly all pharmacies in the western world, finding insulin in Africa is another story.

In a few words, insulin, like many liquid medications or vaccines, needs to be kept at a controlled temperature in order to keep its efficacy. Subject the insulin to temperatures below 2°C or higher than 8°C and the molecules composing the active substance and/or the adjuvants may break down or associate and render the medicine ineffective or unreliable. As a result, I would get high blood sugar levels.

A complex logistics system is hence required to bring insulin from the production laboratory to the patient. This isn’t a problem in the western world as all the needed infrastructures are well in place. Try to do the same in less developed parts of the world, and you will certainly be confronted to important difficulties. Different organizations are trying to tackle the temperature problematic by developing new transportation procedures, systems and equipments, while others are doing research in the hope of, one day, making it possible to administer insulin and other medications in another way than through injections. Things are moving in the right direction on several fronts, yet a great deal of work still lays ahead.

So while the capitals and the big cities throughout Africa have infrastructures able to comply with high levels of requirement, the temperature controlled chain of supply will most probably be broken from that stage on. This is certainly true in remote parts of certain countries, or in areas where the electric power supply is subject to interruptions or simply broken or absent. And even if the power-grid is functioning, you need, as a patient, to have the financial resources to have a fridge at home to keep your insulin away from the heat. This, of course, is unthinkable for many people across the African continent. Those people are hence, in such conditions, excluded from a reliable treatment and find themselves in a very difficult situation !

The planning

Knowing I will have to face such a difficulty, I need to find out about the temperatures I will be confronted to, at which moment of the year and in which areas these will occur. To do so, I collected data about the maxima, minima and average temperatures per month in the main towns I am planning to cycle through. All in all, I ended up with about 1,000 entries that I translated into several graphics. It looked… colourful and artistic. Which was nice, but not very helpful.

graph-maxima-temperatures
Maxima °C temperatures per month and location

This is where my friend Ryan McKenna offered his help. Being a marine scientist who develops and creates maps and cartographies for his work and studies, Ryan kindly offered to help create the maps I desperately needed. I transferred him the data I had collected and he looked up other sources he was familiar with in his field of work. The result ? A set of maps especially created for Bike with Diabetes, compiled into a GIF : precipitations and average temperatures on the African continent.

Brilliant ! I now have a dynamic tool to project myself in space and time instead of loosing myself in confusing colourful lines.

_3 Second

The first and most important information that this map brings out is that whatever the route or the period I choose to start cycling, I will, somewhere, at some point, be confronted to high temperatures on my route. This means that I need to be equipped and be prepared to confront myself and my insulin to such conditions.

The second teaching is that I have a 3 months slot between late October and late January to cycle the circa 4,000 km that separate the warm lower fields of the Nile Delta and the cooler altitudes of the Ethiopian plateaus. Given that information, I have to make sure I will be in Alexandria by the end of October 2017 and in Gondar or further in Ethiopia by the end of January 2018.

Now that I know what I may be confronted to, I need to find out a way to make my journey possible, despite the climatic and meteorological conditions and despite the supply and conservation difficulties. In other words, I need to choose the right equipment to transport my insulin and make sure I will be able to get medical and insulin supplies on a regular basis, about every 4 to 6 weeks.

Feel welcome to point me in the right direction in the choosing of the appropriate gear on Twitter, Facebook or in the comments bellow the post.

Ryan McKenna holds a Bachelors degree in Marine Sciences from the University of Ulster in Northern Ireland and is a PhD candidate working between the Marine and Fresh Water Research Centre at GMIT and the Marine Institute in Galway, Ireland. His work consists of comparing the historical and current distribution of fish species to develop indicators of change to inform European marine policy (Marine Strategy Framework Directive). Ryan loves maps ! If you have specific mapping needs you may contact him for enquires. You can also follow his research on ResearchGate.

 


Température, ma douce ennemie

Le défi

L’une des contraintes principales à laquelle je suis confronté en tant que diabétique de type 1 pour l’organisation de mon périple relève de la logistique nécessaire pour l’approvisionnement et la conservation de l’insuline. En effet, alors que la disponibilité en insuline est garantie 24h/24 et 7j/7 partout en Occident, trouver de l’insuline en Afrique se révèle être plus compliqué !

En quelques mots, l’insuline, comme la plupart des médicaments et vaccins liquides, doit être maintenue à température contrôlée afin de maintenir son efficacité. Soumettez la à des températures inférieures à 2°C ou supérieures à 8°C et les molécules composant la substance active et/ou les adjuvants sont susceptibles de se briser ou de s’associer, rendant l’insuline peu fiable voir inopérante. Si cela se produit, je risque d’obtenir des glycémies élevées.

Un système logistique complexe est donc requis afin d’acheminer l’insuline du laboratoire pharmaceutique au patient. Cela ne constitue pas un problème particulier en Occident où toutes les infrastructures sont bien en place. Essayez d’en faire autant dans des contrées moins développées du globe et vous serez confrontés à d’importantes difficultés. Différentes organisations tentent d’apporter une réponse à cette problématique grâce à de nouveaux systèmes et équipements de transport alors que d’autres ont l’espoir de trouver un moyen d’administrer l’insuline et d’autres substances pharmaceutiques sous une autre forme que liquide. Ces avancées vont dans le bon sens, mais ne sont pas encore la panacée.

Ainsi, bien que les capitales et les grandes villes d’Afrique sont en mesure de répondre à un haut degré d’exigence en matière d’infrastructure et de respect de la chaîne d’approvisionnement à température contrôlée, cette dernière sera fort probablement brisée à partir de cette étappe. C’est certainement vrai pour les zones les plus reculées de certains pays, ou dans les zones où l’approvisionnement en électricité est susceptible d’être interrompu de manière régulière ou, pire, est carrément inexistant. Et quand bien même le réseau électrique serait fonctionnel, vous devez disposer, en tant que patient, d’un frigo vous permettant de conserver l’insuline à domicile. Ceci est bien entendu inconcevable pour bon nombre de personnes sur le continent africain. Ces personnes se retrouvent de facto dans l’impossibilité de bénéficier d’un traitement fiable et se retrouvent dans une situation très difficile.

La planification

Sachant que je serai confronté à cette difficulté, je dois commencer par poser un diagnostique sur les températures que je risque de rencontrer le long de mon itinéraire, à quel moment de l’année. Pour réaliser ce diagnostique, j’ai collecté les données par mois concernant les températures moyenne, maxima et minima des différentes villes par lesquelles je compte passer. Dans l’ensemble, je suis arrivé a près de 1.000 entrées que j’ai traduites en différents graphiques. Le résultat fut coloré et artistique, mais somme toute, assez peu lisible.

graph-maxima-temperatures
Températures °C maxima par mois et par ville

C’est là que mon ami Ryan McKenna m’a proposé son aide. Spécialisé en sciences marines, Ryan développe et crée des plans et cartes dans le cadre de ses études et de son travail. Il m’a donc proposé de créer les cartes nécessaires à mon diagnostique ! Je lui ai fait parvenir les données que j’avais collectées et il a fait appel à des sources avec lesquelles il a l’habitude de travailler dans son domaine d’activité. Le résultat ? Une série de cartes spécialement créées pour Bike with Diabetes compilées en un GIF : précipitations et températures moyenne !

Parfait ! Je suis maintenant en mesure de me projeter dans l’espace et dans le temps au lieu de me perdre dans ces lignes colorées.

_3 Second

Le premier enseignement qui ressort de cette cartographie est que quelque soit l’itinéraire ou la période choisie pour le voyage, je serai confronté, à un moment donné, à un endroit donné, à des températures élevées. Cela signifie que je dois m’équiper et me préparer à me confronter à de telles conditions.

Le second enseignement est que je dispose d’une fenêtre de 3 mois, étalée de la fin octobre à la fin janvier, pour couvrir les 4.000 km séparant les chaudes plaines du Delta du Nil des hauts plateaux d’Éthiopie, où les températures sont plus clémentes. Sachant cela, je dois m’assurer que je serai à Alexandrie d’ici la fin octobre et à Gondar ou plus loin sur mon parcours d’ici la fin janvier 2018.

Maintenant que je sais à quelles conditions climatiques et météorologiques je serai confronté, je dois trouver le matériel qui me permettra de réaliser mon voyage, malgré les difficultés énoncées, tenant compte du fait que je devrai me fournir en insuline et matériel médical toutes les 4 à 6 semaines.

N’hésitez pas à me contacter afin de m’orienter dans mes recherches via Twitter, Facebook ou en commentant l’article ci-dessous !

Ryan McKenna dispose d’un Baccalauréat en Sciences Marines de l’Université d’Ulster en Irlande du Nord. Son travail consiste à étudier et comparer la répartition actuelle et passée des différentes espèces de poissons afin de développer des indicateurs de changement permettant d’informer la Politique Marine Européenne (Directive-cadre “Stratégie pour le Milieu Marin”). Il est candidat pour un PhD et travaille entre le Marine and Fresh Water Research Centre du GMIT et le Marine Institute à Galway, en Irlande.

4 thoughts on “Temperature, my sweet enemy

  1. Last year I rode across the USA during the summer and into the fall (June 21 – October 23). I kept my insulin in a Large Frio Wallet – http://www.frioinsulincoolingcase.com/frio-large.html. This worked perfectly. The key is to make sure you don’t over soak the wallet as the crystals will swell to the point that you can’t get the insulin vials/pens in the wallet. Also the wallet should be in a place where air can flow over it, as opposed to trying to store it inside an enclosed dry bag or cooler.

    Cheers,
    Mike

    Liked by 1 person

  2. Thank your for sharing your experience Mike !
    Frio coolers indeed seem to be the most convenient system and are hence on my shopping list for in-use insulin, yet I will need to use a more “efficient” cooling system for my stored supplies and during at least two stages of my journey due to temperatures that will probably be higher than 38°C (between Khartoum in Sudan and Gondar in Ethiopia, as well as on the border area between Ethiopia and Kenya). This is because the Frio system will keep insulin between 18 and 26°C in air temperatures up to 38°C and maxima temperatures in the shadow in those 2 areas are estimated to be around 32-33°C when I’ll be cycling through them. So probably above 38°C while cycling in the sun.

    Where/how did you store your Frio packs on your bike while cycling in order to allow a constant evaporation ?
    I hope you have other cycling plans coming up this summer !

    I wish you all the best,

    Arthur

    Like

    1. Arthur,

      I carried my frio wallet in a mesh part of my handlebar bag. Sometimes I moved it to a mesh part of my side pannier. I did this to move the frio away from direct sunlight in the afternoon. Mostly though, I made sure it was wet each morning and then forgot about it.

      In some areas where it was quite hot, I was able to soak the frio in cold water. I think this kept the insulin at a cooler temperature, but I can’t guarantee that since I did not carry a thermometer to read the temperature inside the frio.

      How long do you think you will be in areas where the temps will be above 38C? My experience has been as long as it is not a prolonged period, most insulins are surprisingly more robust than their label would suggest. I lived on a sailboat for 5 years traveling in pretty warm tropical climates. During that time, I had my back-up insulin refrigerated on the boat, but was out with insulin in my pump for many hours. I really never experienced a problem (being careful at the same time though!).

      My last bike trip was 4 months and I did purchase two vials of insulin along the way from pharmacies that had proper refrigeration. This year we are going to ride from Vancouver Island, BC Canada and then down the US Pacific Coast to Los Angeles.

      Liked by 1 person

  3. Thanks for the info Mike !
    I was told by my doctor that I could keep my in-use insulin at 30°C for up to 2 to 3 weeks and that if that would be the case, I would have to pay extra attention to its efficacy. But my back-up insulin should always be kept at a much lower temperature.
    The amount of time I will be cycling in high temperatures is a bit difficult to predict now as this would depend on multiple factors : weather at the moment I will be cycling, chosen itinerary, state of the road, etc… This said, my estimate would be about 4 to 5 weeks in the Sudan-Ethiopia leg and about the same on the Ethiopia-Kenya border area (see red coloured area on the GIF).

    The Vancouver – Los Angeles route seems to be amazing! I have a friend who is cycling from Los Angeles to Seattle at the moment. Who knows, you might meet on the road ? Here is her blog, just in case : http://www.survivaltour.org/home

    Like

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