A new approach for handling insulin could revolutionize diabetes treatment for millions of people

Mohamed Hussein Bule, 27, teaches science in a refugee camp in Kenya. Paul Odongo for MSF
For people with diabetes in developing countries, a lack of electricity can hinder access to insulin.
However, a project in Kenya has shown that insulin can be sustained in hot climates without refrigeration.
Researchers calling it a breakthrough are calling on the World Health Organization to change its guidelines.
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For people living with diabetes in developing countries, daily intake of life-sustaining insulin doses comes with access to electricity.
Once a vial is opened, manufacturers recommend keeping it in the refrigerator until it expires, usually after four weeks. But an estimated 470 million people around the world lack access to electricity and refrigerators for food and medicine, making it difficult to store insulin at home.
But now a new program could help revolutionize treatments around the world.
It started in the Dadaab refugee camp in northern Kenya, where temperatures can reach 99 degrees Fahrenheit and many have no access to refrigeration. As a result, patients' lives practically revolved around going to and from the hospital for insulin. Diabetes can mean a lack of school and work, especially as the camp's curfew limits the ability to make the hike.
When doctors working at the camp noticed an increasing number of patients were hospitalized with complications from their diabetes, they turned to researchers at the University of Geneva and decided to monitor insulin storage at home in the camp, where temperatures were much warmer than label recommendations.
In the laboratory, the researchers replicated the daily temperature of the camp, which was between 77 and 99 degrees Fahrenheit, and tested the effectiveness of the insulin. They also examined insulin residue from vials that patients had used after storage in their homes.
They discovered that insulin stored in the tropical temperatures of the warehouse could be used safely for four weeks without refrigeration - a discovery that could be life-changing for diabetes patients around the world.
After their examination, the team adapted the advice they gave patients, teaching them how to inject themselves, check their own blood sugar levels, and what hazard symptoms to look out for. Most excitingly, they showed the patients how to store the insulin at home using a plastic container with a damp towel.
What followed was a dramatic decrease in the number of diabetics hospitalized with acute complications. They could go to work and school and "not look for medical care all day to stay alive," said Philippa Boulle of Médecins Sans Frontières (Doctors Without Borders, also known as Doctors Without Borders).
Although insulin can be damaged if stored at high temperatures, the researchers found that cooler temperatures can keep the insulin safe overnight.
Somali refugees visit the market in the sprawling Dadaab refugee camp in northern Kenya. TONY KARUMBA / AFP via Getty Images
"Every protein is broken down when heated, but there are proteins that can go back when you cool them down again, and insulin seems to be one of them," said Leonardo Scapozza, professor at the School of Pharmaceutical Sciences at the University of Geneva. who worked with doctors at Dagahaley Camp, Insider told.
Right now, the instructions say that patients can store their insulin at an "ambient temperature", but Scapozza said "and hot settings" should be added for clarification. All you have to do is add three words: "and hot attitudes," says Scapozza.
He said the results could also be applied to high-income countries like the US, for example during natural disasters and storms that cut electricity.
The researchers have carried out further studies to test insulin in different climates and are helping refugees in their southern Sudanese community to take insulin home with them.
Now, MSF is calling on pharmaceutical companies to change the guidelines and the World Health Organization to confirm their findings.
While many studies have tested how stable insulin is at different temperatures, the oscillating temperature factor is a "new twist" in this study, Gojka Roglic, a doctor in charge of diabetes management activities at WHO, told Insider.
WHO won't make recommendations based on this study alone, but Roglic said they will be included in a review of all research later this year.
Ali Bishar, who is in charge of MSF's insulin management program at the Dadaab refugee camp in Kenya, said diabetes and insulin awareness was "of the utmost importance" to the program.
"After training, patients must pass a competency test. Then they are given their insulin and care is provided on and off the wards," said Bashar, adding that the program, which began in 2015, has grown from 35 to 45 patients in the past few six years.
However, insulin storage is only the beginning of the treatment of diabetes in resource-poor settings. Another major concern is how poor diet can contribute to patients' symptoms.
"You must have food when you inject insulin. In some situations, patients are afraid of the injection if they didn't have a meal that day," says Boulle.
Rahmo, who was in the first cohort of patients to start the MSF program in 2015, told Insider she was having trouble eating enough and eating well. But regardless of her diet, Rahmo said her health improved.
"Before that, I was confused about how to get on with my life and whether I would survive," she told Insider through an interpreter. "Today I am very happy to be able to control my diabetes at home."
Mohamed Hussein Bule, 27, a Somali refugee 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 has been back to around 143 pounds since joining the program.
"I was supposed to pick up insulin at the hospital early in the morning to take home and then go to work. I missed a lot of lessons. Now I take a vial in the morning, take my glucose, and continue with the program like mine Day goes on, "he said.
"I don't even feel like a patient with diabetes right now. I'm very happy to be on the program."
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