Insulin and Hotel Refrigerators   (October 21, 2012)

Last week, my insulin pump and my CGM and I traveled to Chicago for a 3-day business meeting. Upon arrival at the hotel, I took my insulin vial out of the clear plastic baggie that the TSA recommends, and put it into the hotel room’s mini-refrigerator. I keep my travel vial of insulin in the baggie, wrapped in an old but clean white washcloth of indeterminate vintage, together with a business card with my name/address/phone, and the cardboard box the vial came in. I put the baggie and the cardboard in a dresser drawer with my other travel clothing and “stuff” and the insulin and the surrounding cloth in the fridge. BTW, if it’s hot outdoors, I add a cold pack to the baggie; and in emergency, I’ve even asked for free ice at airport fast-food joints and thrown it into the baggie (and removed the cardboard stuff).

I had just changed the pump’s reservoir before flying to Chicago, so I knew I had just about enough insulin for the three days I’d be out of town. Sure enough, the evening before leaving, my pump warned me that I was running low, so I mentally added “change reservoir and tubing” to my to-do list for the next morning, as well as packing everything, checking out of the hotel, getting my boarding pass printed on the hotel’s computers, and all the other fun things before flying.

But I didn’t go into the refrigerator the evening before leaving, as I knew I’d have a chance to pull the insulin from the fridge when a call of nature inevitably came in the middle of the night. Sure enough, nature called, and I checked my CGM reading, verified that the pump still had enough basal insulin to last until morning (although not enough to bolus for breakfast), and opened the fridge to get my insulin out.

But the insulin wasn’t there…

Was I dreaming? No, not that easy. Had I really put the insulin in the fridge several days before? I could clearly recall separating the insulin vial and its surrounding washcloth from the baggie, putting the baggie into a dresser drawer, and choosing the upper shelf of the minifrig to leave my cleverly disguised insulin for the duration of the trip.

Nope, it wasn’t in the fridge, it wasn’t in the dresser drawer, it wasn’t anywhere. Panic time. Called the hotel operator at almost four in the morning, had her send the security guy to my room, had him verify my story, and started thinking about where to get insulin before breakfast. Fortunately, the security guy knew that my pharmacy chain (CVS) had stores in the Chicagoland area although he didn't know exactly where, and I knew that many CVS pharmacies are open 24-hours. Went on-line, Googled CVS, found their website and store locator, found the nearest 24-hour CVS (the security guy agreed it was closest, about seven miles away), and called them. They looked up my prescription in their national database, found it, and had my insulin ready for me to pick up in a few minutes, well before I threw on some presentable clothing, grabbed the car keys and my wallet, and headed out onto the dark, rainy streets before the morning rush hour began. The pharmacist even threw in a cold pack. And as the computer said I had refills still authorized for the insulin prescription, he didn’t have to contact a physician to authorize the refill.

In the morning, the hotel apologetically called my room, and told me they had found the insulin vial, and that it was now in a fridge at the lost and found area at the front desk. Seems a hotel employee had found the vial in with the dirty linens, and turned it in. Why it was in the linens couldn’t or wouldn’t be explained: they obviously didn’t want to admit that a hotel employee had lifted it from my minifrig, but I don’t see any other realistic possibility.

Anyway, some lessons learned and suggestions for anyone traveling with medications, especially insulin:

1)      Don’t wrap insulin vials in plain white towels or washcloths, unless they are always within a baggie with identification. Separating the baggie from the vial/washcloth combo was my huge mistake.

2)      Don’t leave medications in a hotel fridge without taping a huge sign on the fridge’s door, saying “Medication in refrigerator. Property of XXXXX. Call XXXX if found.” This sign is mainly to remind you to grab the insulin before departing the hotel, but if you leave without it, at least the hotel staff will know how to contact you. And if you are in a non-English-speaking country, get someone to help write the sign in the local language.

3)      Find out from your pharmacy how to manage emergency refills of your medications if you will be out of town. It’s a lot easier to have a pharmacy with a 24-hour policy, and a national database, rather than having to find a local physician at four in the morning to write a script for a visiting patient. At least in the US. Not sure how I would have handled this if I’d had been overseas.

Another thought, if you are flying, is to read the latest version of the TSA’s webpage on Passengers with Diabetes. Their current policy (“the passenger’s insulin pump is subject to additional screening. Under most circumstances, this will include the passenger conducting a self patdown of the insulin pump followed by an explosive trace detection sampling of the hands.”) is still ridiculous, but it’s less invasive than the full-body patdown I got a while back. BTW, you can do what I do: disconnect from the pump, put it in your carryon bag, don’t declare that you have a pump, and thus never get the pump screened. That’s part of the idiocy of their policy: why anyone would think that people would use a $5000 prescription medical device to harm people is beyond me – the TSA never checks cell phones and other gadgets that could easily be just as dangerous. But that's another story.