Guidelines for traveling with Byetta

The following guidelines were compiled by a reader, Mark Abbott.

They were updated in December, 2009, by adding the section "Cold Weather Travel."

 

On this page:

General Diabetes Travel Guidelines

• Take extras of everything (blood-glucose test meters, test strips, needles (syringes or pen-needles), prescription medications, etc. - this should include glucose tabs to manage hypoglycemia emergencies.
• Document all medications (names, quantities, prescribing doctor, doctor & pharmacy contact numbers, etc.) and carry copies of the list with your medications and on your person in case one list is lost.
• Carry ALL medical gear with you on planes - never check anything - if possible, split it up between you and another member of your party (spouse, etc.) so if one bag is stolen, you still have coverage. Same thing if traveling in multiple cars - split it up into two different vehicles in case a car is stolen or simply towed for illegal parking.
• Plan for delays and unforeseen weather (traffic jams, flat tires, plane delays on runways or when diverted to an unplanned location for a day or two; and with refrigerated meds you need to plan for hot weather when your A/C goes out, or even for an extended period of total loss of power in the event of a natural disaster (storms, flooding, etc.).
  • Always carry some food that will keep your blood glucose stable when you are stuck someplace - recommend individually wrapped items that a) do not need refrigeration and b) will not spoil when carried for an extended timeframe or in hot/cold temps. Best options are granola bars, Extend bars or something similar that will regulate your blood glucose level.
• When traveling for extended stays and especially when travelling in foreign countries, check in advance to find where medical support can be found - this includes hospital locations, medical response contact numbers and identify your emergency contact information for replacement of meds or medical supplies - Do NOT wait until you break your only bottle of insulin or the battery dies in your BG meter.
  • NOTE - Program contact numbers into your cell phone in advance of your trip so you have them if you need them, and be sure you carry your insurance card(s) with you.

Byetta Travel Goals

• Amylin/Lilly, the manufacturer of Byetta, recommends that new/unused Byetta pens be stored between 36 degrees to 46 degrees Fahrenheit (2-to-8 degrees Celsius).

   

• After first use your Byetta pen does not require refrigeration, but should not be exposed to temperatures that exceed 76 degrees Fahrenheit (e.g. - normal room temperature).

   

• Thus there are two levels of Byetta travel goals: active usage pens and unused pens.

Active Usage Pens

• Amylin/Lilly currently provides a free Travel Case to new Byetta users.
  • You can order the free Travel Case by registering at the Byetta website at: www.byetta.com/welcome
  • The travel case is useful for carrying a single Byetta pen and several needles.
  • While small enough to fit in a pocket, you should avoid carrying this case next to your body as the temperature may exceed the 76 degree room temp limit.
  • This case is great for an evening out to dinner or to visit friends where you know you can keep the pen at room temps, or you can readily get it to a room temp location.

   

• When carrying a pen that is actively in use, you need to make sure it will remain below the 76 degree temp limit at all times: when carrying the case, driving, waiting in lines, etc.
  • Plan for the unscheduled delays at common locations: airports (delayed flights, sitting in a plane waiting to depart or diverted to a temporary location), traffic jams (travel to/from home and destination) and even vehicle problems (an accident, a flat tire, or simply your car towed for a parking violation).
  • Be prepared to keep your Byetta pen below the 76 degrees limit even if you are not!
• When you know there is a chance you may be exposed to temps exceeding 76 degrees:
  • Carry a container that can be used to cool a pen without the risk of freezing the Byetta.
    • A small “six-pack” cooler or a small thermos bottle can work well.
  • Always carry a quart Ziploc storage bag as an emergency backup - you can drop your pen in the Ziploc bag, seal the bag and then cool it with water or (carefully) with ice.
  • Do not place the Byetta pen in water; moisture can get into the pen mechanism (not the sealed Byetta chamber). Water in the mechanism can be a potential source of contamination.
  • Do not place the Byetta pen in direct contact with ice - it may freeze the Byetta.
  • The best emergency cooling back-up is to carry a Frio pen wallet, available at: www.frious.com
    • The Frio pen wallet is very thin and weighs almost nothing, very easy to carry.
    • The Frio wallet cools the pen by controlled water evaporation.
    • The Frio wallet can be carried “dry” and then activated with cool water when you need to cool your Byetta pen.
    • The Frio wallet will maintain below 76 degrees for extended periods depending on the ambient temp (up to several days).
  • Hotels
    • Note: Hotels should provide a room refrigerator if it is requested for medical support (this is considered a “reasonable accommodation” under ADA guidelines). However, some hotels may not be able to provide one.
    • Hotel “Honor Bars” are refrigerators, but may not be adjustable to the appropriate or required Byetta temperature range.
    • It helps to take a small “stick-type” refrigerator thermometer with you so you can check out cooling sources before you commit your pen.
      • Recommended: Buy an armored “stick” thermometer for monitoring the Byetta temperature and checking hotel room refrigerators. An armored “Stream Thermometer” can be purchased from several sources including Bass-Pro for less than $12 (at www.basspro.com);Bass-Pro catalog item #38-489-400-00).
      • Digital thermometers with a “spike probe” work well for testing refrigerators; however travelers may not be allowed to carry spike thermometers onto airplanes since the spike’s probe resembles an ice-pick.
    • When traveling to a warm location for an extended period of time you may want to take your own cooling/refrigeration equipment with you.
    • The Frio Wallet listed above is also a very effective as the primary way to carry an active pen. The Frio Wallet works on the process of evaporation to cool the pen, you soak the Frio wallet in cool water and then insert the pen (note - follow the directions and do NOT over-soak the wallet - this does not increase the cooling time or temp). The pen must be carried where evaporation can occur, in an outside pocket of a bag or jacket; not in an inside pocket or in a closed purse or bag.
      • It is recommended that you buy the "Duo-Pen" (2-pen) wallet, this will allow for easy access and removal of the pen and allows you to also carry an armored stick thermometer in the wallet to monitor the pen temp.

New/Unused Pens

• New/Unused pens must be stored between 36 degrees and 46 degrees Fahrenheit (2-to-8 degrees Celsius).
• You may choose to travel with a new/unused pen for several reasons:
  • Your current active pen is not finished
  • You will be gone for more than a month
  • You want a backup pen in case your active pen becomes defective/contaminated
• The goals for traveling with a new/unused Byetta pen is to maintain the Byetta pen at the 36-46 temp range for the longest duration in a form that allows for easy extended travel.
• The proper temp for unused Byetta pens is much colder and is a narrower range than what is required for insulin. You should not use a travel cooler designed for insulin carry as it may not maintain the proper temp for Byetta. For example: the Frio pen wallet will not maintain the proper temp for a new/unused Byetta pen.
  • It is better to have the new pen get a little above the 46 degree temp for a short period, than it is to risk freezing the pen - which will quickly kill the Byetta.
• When traveling with a new/unused pen you may want to take your own refrigeration equipment with you.
• The Medi-Fridge Micro-Refrigerator at: www.medi-fridge.com
  • The Medi-Fridge Micro-Refrigerator is the best small pen cooling unit available, and is good for new/unused or active Byetta pens. This unit will cool down to 45F degrees below ambient temperature, but has a safety shutoff that will not allow it to cool below 40F degrees. The Micro-Fridge will hold two Byetta pens or a pen and several bottles of insulin. Cost is about $70.
  • The Medi-Fridge Micro-Refrigerator comes with an AC outlet plug and a DC plug for your vehicle. This unit will only continue to cool at the acceptable new/unused pen level when plugged-in and running, so make sure your vehicle’s plug outlet has power after you turn off the engine.
  • The Medi-Fridge Micro-Refrigerator will hold a steady temperature better than full-size refrigerators, since most household refrigerators are “frost-free” and will cycle the temperature of the freezer compartment up and down to eliminate frost. Cycling the freezer temp usually results in the fresh food compartment cycling up and down.
• The Medi-Fridge Mini-Fridge is similar to the Micro-Fridge, just larger in size and capacity. This unit also cools to 45F degrees below ambient temp with a similar 36F degree safety cutoff feature. Cost is about $100 and it can be ordered with a lock and key if desired.
• There are many other small refrigeration units available on today’s market, including the Unisar Portable MiniFridge, the BeBeSounds MiniFridge, ThermoKool and others.
  • These units may not provide as much cooling ability as the Medi-Fridge units.
  • Some mini-refrigerator units will maintain the new/unused Byetta pen temp only when used indoors, and other will get too cold when used in high humidity.
  • These units are only recommended for use at/near room temps and should not be used in areas with high humidity.
  • You must test any mini-refrigerator unit prior to use to assure that they will maintain the 36-46 degree temp range without damaging the Byetta pen due to low/high temps.
• When using any electrical refrigeration unit for extended vehicle travel or for camping trips, it is recommended you take the components for an alternate cooling method as a backup. Remember - any electrical device can fail, and if it does it will be at the worst possible time.

Short-to-Medium Travel

• There are several options for short-to-medium term cooling of either an active Byetta pen or a new/unused Byetta pen while traveling outdoors.
• The most common option is to use the 1/2-liter stainless steel "Briefcase" thermos - this method is described in detail in the Extended Travel section below; it is excellent for all travel activities.
• There are many refrigeration units called “Auto-Travel Coolers” sold in all discount stores.
  • These units will cool to 35F to 40F degrees “below ambient temperature”
  • However, if the ambient temp reaches 90 degrees, these units will only cool to 50 degrees, well above the maximum new/unused pen temp limit of 46 degrees.
  • These units are acceptable for short-term and local travel of an active pen but are not suitable for extended storage of a new/unused pen
• Cooler Options
  • Almost any cooler with ice can be used for short-term travel with an active Byetta pen. Listed below are a three specialty coolers that will also handle new/unused pens.
• Medi-Fridge Micro-Cooler at: www.medi-fridge.com.
  • The Medi-Fridge Micro-Cooler is a small case that contains a hard-shell freezer pack, and has room for two injectible pens. The Micro-Cooler is made of 800 denier Cordura (strong/durable stuff) and also has room for an armored stick thermometer. Cost is approximately $20 plus shipping. The Micro-Cooler will keep a pen within the new/unused temp range (36F-46F) for eight to ten hours, and will keep it within the active pen temp range (below 76F room temp) for up to 20 hours.
  • The Micro-Cooler comes with two freezer packs so you can freeze one while using the other. Make sure to follow the manufacturer's directions to warm the freezer pack before using it in the Micro-Cooler case - allow the freezer pack to sit at room temp for 10 minutes before use, or heat the freezer pack in a microwave for 1 minute before use.
• MediCool ProtectAll Waist-Pack at: www.medicool.com.
  • The MediCool ProtectAll Waist-Pack is a rectangular case covered in Cordura that looks like an oversized fanny-pack. You need to get the pack designed for Byetta (requires a specific cold-pack). Cost is approximately $45 plus shipping. MediCool says the ProtectAll will hold the proper new/unused Byetta pen temp for 8 hours with the special blue-cooler pack required for Byetta.
  • Make sure to follow the manufacturer’s instructions to freeze the insert and then let it sit out of the freezer for 10 minutes prior to inserting into the MediCool Pack and inserting the Byetta pen.
• The PolarBear MedCooler at: www.medcooler.com
  • The PolarBear MedCooler is basically a slightly enlarged and very well insulated soft-sided 6-pack cooler. The MedCooler is made of 1000 denier Cordura (strong/durable stuff) and closed cell foam. Cost is approximately $45 plus shipping. Combined with 2 of the PolarBear “Techni-Ice” packs, the manufacturer claims it will hold the 36-46 degree temp range for 14 hours in 100 degree heat, with no leaks or sweating.
  • One Byetta traveler has reported when using the MedCooler with the Techni-Ice that it was fairly easy to get the pen too cold, as much as 10 degrees below freezing. Caution is recommended - test before committing a “live” Byetta pen.
  • The PolarBear MedCooler appears to be a good solution for daily travel when you need to take your Byetta with you for more than 8 hours. However, regular monitoring with a thermometer is recommended to avoid getting too cold.
• Products like the Frio pen wallet, the Medi-Fridge Micro-Refrigerator and others can also be found at many online vendors.

Extended Travel

• When it is necessary to carry a new/unused pen for an extended trip, or sometimes carrying an active pen on an extended trip in temps above 76 degrees, you may want a secure carry option.
• Byetta travelers have found that a small 1/2-liter stainless steel "Briefcase" thermos with a few ice cubes works very well for extended travel (recommend the 1/2-liter ThermoCafe by Thermos). A 1/2-liter Briefcase thermos is 10 inches tall and less than 3 inches in diameter, small enough to fit into any small carry-on bag, backpack or even a large purse. Made of double-wall stainless steel, it is very durable and can be packed/carried in any manner that is comfortable. A 1/2-liter ThermoCafe Briefcase thermos can be purchased for $12-$15 at many stores (Wal-Mart, Walgreens, etc.) and websites . This is currently the most compact and effective solution for extended travel with a Byetta pen with a relatively simple loading process:
• Loading the “Briefcase Thermos” for traveling:
  1. Using quart Ziploc bags, drop 3-4 regular-ice cubes in one bag, roll the bag from bottom to top and seal the bag - put a rubber band around the bag to help hold it rolled, and to keep the ice cubes from slipping down into the lower part of the thermos as they melt.
     1. Crescent shaped ice cubes from an automatic ice-maker fit best, alternatives: you can break large cubes / use crushed ice.
     2. Insert that bag into the thermos "standing up" on the rolled end.
  2. Roll the pen in a small 6" square piece of bubble-wrap, drop that into a 2nd Ziploc and roll that bag from bottom to top and seal the bag - put a rubber band around the bag to help hold it rolled, (the Bubble-wrap is to keep the Byetta pen from touching the ice).
     1. Slide the 2nd rolled bag with the pen into the thermos alongside the ice cube bag "standing up" on the rolled end.
     2. Important: The pen should be inserted into the thermos with the blue cap end pointed up at the top of the thermos. The bottom of the thermos can get too cold for the Byetta.
  3. Final setup: Both bags are standing on end, side-by-side in the thermos.
  4. Make sure the stopper is tightly screwed into the top of the thermos. Failure to screw the stopper tight will result in a faster loss of cooling; reducing the time the Byetta temperature range can be maintained.
  5. Recommended: Buy an armored “stick” thermometer for monitoring the temperature in the thermos (and checking hotel room refrigerators). An armored “Stream Thermometer” will fit inside the thermos and can be purchased from several sources including Bass-Pro for less than $10, (www.basspro.com) Bass-Pro catalog item# 38-489-400-00).
  6. Slide the stick thermometer into one of the rolled "wraps" around the pen bag away from the ice - you want to monitor the pen temp and not the ice.
  7. Again, Digital thermometers with a “spike probe” will work well for spot-checking the thermos temperature. However, the “spike” thermometer may not fit inside the thermos, and travelers may not be allowed to carry spike thermometers onto airplanes since the spike’s probe resembles an ice-pick.
  8. Alternative ice method: You can put ice cubes into a snack-size Ziploc bag, place the bag in the bottom of the thermos and place the pen on top of the ice cubes. This method has not shown the same cooling qualities (range and elapsed time) as the first method explained above.
• Loaded in the recommended manner the Briefcase thermos has been tested to:
  1. Maintain the proper new/unused Byetta pen temperature range for periods exceeding 24 hours when the thermos is stored at nominal room temperature up to 80F degrees.
  2. Maintain the proper new/unused Byetta pen temp range for approximately 20 hours when the thermos is stored in a closed vehicle (with thermos stored out of the direct sunlight) when outside temperatures peak at 85-90F degrees (vehicle temp over 100F degrees).
  3. Maintain the proper new/unused Byetta pen temp range for approximately 16 hours when the thermos is stored in a closed vehicle (with thermos stored out of the direct sunlight) when outside temperatures peak at 90-95F degrees (vehicle temp up to 115-120F degrees).
• Some Byetta travelers have successfully used a larger stainless steel thermos with artificial ice for new/unused pen travel. The larger thermos will work with a specific and careful setup. Caution is recommended when using a thermos larger than the 1/2-liter briefcase thermos. It is easy to chill the larger thermos below the recommended new/unused Byetta pen temperature range. The use of artificial ice in the larger thermos can result in temperatures below freezing. We recommend you thoroughly test a large thermos setup before you store a “live” Byetta pen.

Thermos Extended Travel Notes:

1. Ice: Regular ice (not artificial ice or “blue” ice) is recommended for extended travel. You can always find a source for ice to refresh the thermos (airline, hotel, cruise ship, fast food restaurant, or convenience store). Artificial ice requires re-freezing on at least a daily basis, and some hotels do not have room refrigerators, or have room refrigerators with no freezers to re-freeze artificial ice packs. Airlines will NOT allow you to place anything (including Byetta pens) in their refrigerators, but will provide ice on request. If you have ready access to a freezer and can alternate freezer packs as required, then artificial ice or “blue” ice can be an easy and less-messy alternative to regular ice cubes.
   • NOTE: Both regular ice and artificial "blue" ice will freeze at 32F degrees, but very efficient freezers can get the temperature of regular ice down to the 10F degree range and artificial ice can get much colder, down into the -10F to 0F degree range. When ice is this cold you MUST use less ice in the thermos or you risk getting the Byetta pen too cold and killing the medication. This is another reason to use regular ice as the risk of getting ice that is "too cold" is less than when using artificial "blue" ice.
2. It is highly recommended that the pen and ice be placed in a separate sealed Ziploc bags. If the Byetta pen is exposed to water, moisture can get into the pen mechanism (not the sealed Byetta chamber), which can be a potential source of contamination.
3. Plastic Bags for the Thermos solution: Ziploc brand quart-size freezer storage bags are recommended for sealing the pen and the ice for use in a thermos. While regular storage bags will work, the Ziploc quart freezer bags are more durable and fit the thermos very tightly. New “double seal” Ziploc quart bags provide extra insurance against leakage.
   • Quart-size Ziploc bags are a tight fit, and will be slightly compressed when the thermos stopper is screwed into the top of the thermos. Make sure the thermos stopper is fully inserted to maintain the longest cooling time.
   • If you use regular “thin” sandwich bags, it is recommended that you “double-bag” both ice and Byetta pen to prevent leakage (in or out).
4. Accessing Thermos Ziploc Bags: With Ziploc bags inserted side-by-side you can remove the single bag you want to use: Byetta bag for a shot, or the ice bag to refresh ice.
5. The traveling position of the Briefcase Thermos travel position does not matter. The Thermos will maintain the temperature within the proper range for Byetta regardless if the thermos is upright or lying on the side.
6. Thermos temperature testing was accomplished using “Hobo” brand remote temperature sensors (data loggers) from Onset Computers. Each test run was executed a minimum of three times and included sensors located inside the thermos in the top and the bottom of the thermos, with the thermos in multiple positions and tested under nominal household and vehicle temperatures. All test ice cubes were crescent-shaped cubes from a standard household refrigerator automatic icemaker.

Cold Weather Travel

• Traveling with a Byetta Pen during cold weather can be easy or hard depending on how cold the outside ambient air will be, and how much time you will be exposed to actual cold weather.
• If you will be traveling from one enclosed location to another (e.g. from home to work) and you will be traveling in a heated vehicle, then you do not need to make any changes from most of the travel methods described above. Since your time outside being exposed to actual cold weather will be limited, you can pack your Micro-Cooler or 1/2 Liter Thermos as normal and your Byetta pen will be protected.
• If you will be spending a moderate amount of time outside, but the air temp is only slightly cold (e.g. above freezing), then all you need to do is to slightly reduce the number of ice cubes or re-usable ice packs.
  • In the 1/2 Liter Thermos, reduce the number of ice cubes from 4 down to 3, or if it is near freezing, reduce down to 2 ice cubes. Remember to use a "stick" thermometer inside the thermos to monitor the temp, even when using a reduced number of ice cubes or freezer packs.
  • With the Micro-Fridge Micro-Cooler, you can increase the amount of time you allow the freezer pack to thaw before using the Micro-Cooler. This can also be accomplished by increasing the time you heat the frozen pack in the microwave. o If you will still be using ice cubes or frozen freezer packs during cold weather, make sure they are not "hard frozen" at very cold temps (e.g. -20F to -40F). Instead use components that have been frozen between 0F and 30F (often called "wet" ice).
• If you will be spending significant time outside in cold weather and the outside temperatures will be below freezing (32F), then you will need to modify your travel procedures to avoid damaging your Byetta.
  • Reminder - when Byetta gets colder than 36 degrees Fahrenheit, the Byetta will be damaged and the colder the Byetta gets, or the longer it is exposed to temps below 36F, the Byetta will quickly cease working at all. Unfortunately there is no visible way to determine if your Byetta is "dead" from being too cold - you will notice the effect when your BG readings start rising since the Byetta is no longer working.
• To travel safely in extended cold weather, you need to keep the Byetta warmer than the outside air, basically the opposite of what you have to do during warm weather. This does not mean you should heat your carrying device, but you want to use "un-frozen" re-usable freezer packs. These "un-frozen freezer packs" act as a heat sink and provide some warmth to counterbalance the freezing temperatures outside.
  • In the 1/2 Liter Thermos, use 3 or 4 "un-frozen" re-usable freezer packs. Again, remember to keep a "stick" thermometer in the thermos so you can monitor the temperature.
  • With the Micro-Fridge Micro-Cooler, you can use the freezer pack at a refrigerated temp to start (e.g. - not frozen).
  • Basically, you want to provide an "un-frozen" heat source (not actually heated, just not frozen) to offset the freezing outside temperature. Always monitor the temp and be prepared to re-thaw your cooling packs when required.
• There is no simple formula for keeping a Byetta Pen in the right temp range when you will be spending a lot of time outside in freezing temperatures - success depends on how cold the outside air will be and how long you will be outside. You will have to find out what works best for you, and monitor the carry device temp on a regular basis!

Product Disclosure Statement

• The author has no agreement (financial or otherwise) with any of the vendors or with the products discussed in this document.
• All vendor/product comments are based on personal experience or the experience of other Byetta users as provided by them at no cost.
• All products tested were purchased through commercial online vendors that are available for your access.