Comment by sgt101 | Hacker News Reader

Comment by sgt101 | Hacker News Reader

My daughter is insulin dependent.

We live in the UK - which has a fantastic free provision for diabetics, my daughter has a Diasend artificial pancreas (on her phone + a sensor on her arm and a pump for the insulin controlled by the app). This gives her very very high levels of control and flexibility.

However, when covid hit I was really scared because I thought that if things went really wrong (beyond loo paper being sold out) there would be no possibility of me protecting my daughter - I simply had no means to provide insulin for her that don't depend on a large scale modern pharma supply chain.

Any way that was viable for insulin to be made in a shed or a garage would be huge from my perspective because it would give me an option in the case of a SHTF situation - right now I haven't got one. If things go bad, my daughter dies - no if's no buts. I know (in my heart) that the reality is that if SHTF then I will die too, but the sheer hopelessness of my daughters position is really hard to take.

If SHTF, then we should think about old-school methods based on animal extraction. The process is involved, but still approachable.

My daughter did a project in her high school chemistry class on the entire process, describing the steps involved - I don't have that paper handy, but if a high school student can work it out it's probably available elsewhere. She later told me that this project was part of her post-apocalypse-family-survival-plan;)

FWIW: https://www.canada.ca/en/health-canada/services/drugs-health...

It doesn't even need to be a large-scale breakdown. Extreme weather is becoming more and more of an issue, which often leads to things like loss of power. When you use a refrigerator to keep your medication cold, a sudden "you're going to lose power until further notice" introduces significant logistical hurdles.

I share these sorts of worries with you. It's hard.

That seems obvious once you point it out, but yeah, I never really considered how tough it would be if a natural disaster knocked out the fridge for a few days for temperature-sensitive medicine.

Like in Texas earlier this year. (Though I suppose it was cold enough you could stash stuff outside…). I wonder if there any teeny little thermoelectric coolers that you could keep for an emergency and run off a bunch of batteries…

As it so happens, I live in Austin...

Yeah, in theory you can stash stuff outside, but that also isn't as simple as it sounds. While I take some issue with the milk analogy below, in this case, I think it fits. Imagine you have a gallon of milk. You lose power. You go stash it in the snow. Okay, it's kept "cold" for some value of cold. That "some value" matters, because with this gallon of milk, you can't smell it to see if it's spoiled, and if something goes horribly wrong, you die. It's not a binary thing as it sounds immediately. "Cold in the snow" is not the same as "kept at the same value I can control exactly in my fridge."

Ha, yes, I do suppose medical-grade peptides need a bit more rigorous temperature control than that frozen yogurt I buried in the snow during a brief power outage…

Yep. And this whole thing is a microcosm of the entire situation: the details really, really, really matter. It's quite easy from the outside to not realize how much they really, really matter.

(It is also true that it is not the case that if it is not continuously absolutely refrigerated, it immediately goes bad, which is one reason why the milk analogy gets strained. Milk expires far, far faster, and in a more binary way than insulin goes bad... but freezing it is extremely bad, so... analogies are hard.)

I live in the North and I've been thinking about building an ice box in the basement that stores cold from outside during the winter – mostly for energy-saving purposes, but it would be interesting to try making a system with precise temperature controls.

You can buy 'cold chain' stickers that indicate whether they have exceeded certain temperatures. Could be useful for prepper diabetics. (And for practicing and testing different ways to maintain cold chain in emergency-like conditions)

Though I suppose it was cold enough you could stash stuff outside…

That may work for some things, but freezing insulin destroys it.

That’s easier to protect against though. You can install a standby generator, or run a small portable generator to keep the fridge going (or any other medical equipment). Or install solar + battery system.

But if you can’t buy more insulin then that’s a real problem.

You mean something like this?

https://www.bestbuy.com/site/cooluli-classic-0-1-cu-ft-mini-...

Runs in 120v, 12v and even 5v (Eco) mode.

In a pinch I would say a 12v based battery setup should keep something like this running for a while. A few of my emergency power lithium battery packs had cigarette/car ports on them.

This is a real problem for people dependent on medicine.

My wife needs specific immuno-depressants to keep her alive (or at least not drastically decrease her health) and since we live in France it is not a problem.

When COVID hit I had real concerns about the manufacturing keeping up, but also about other mechanical devices she needs. These were at risk because they are manufactured in a normal factory (non-critical state infrastructure kind). Everything was fine but these are the moments you realize how reliant one is on technology, supply chain etc.

How cool would it be if you could keep something like a sourdough starter (maybe a shelf with a half dozen jars that need tending 1-2 times a week) that would continuously produce the medications people need to live in their own homes.

It would almost certainly be more of a hassle than getting it from a pharmacy, and purification is probably a tricky step, but I think we're just a decade or two from this potentially becoming a reality.

Would be incredibly egalitarian and empowering to individuals.

I had the same thought in 1989 following Fleischmann and Pons' "discovery" of cold fusion. I dreamed of football-size reactor everyone could have at home and be done with electricity dependence.

More than just electrical dependency. The output vs size/weight would be a very big revolution in engineering.

Could you just store more insulin as a stop gap?

You can store insulin but not in large quantitites and it is a hugely delicate process to synthethise it in the first place. You can "biohack" it to a certain degree (it is how it was first discovered and manufactured after all), but getting a good purity end product that aligns to nowadays' standards is quite difficult and you can't do it in a shed. And with insulin purity and consistency in the product are paramount seeing how small the necessary doses are.

I understand the issues that come with dependence on pharmaceutical companies, but this is what they do. In today's world we are highly dependent on supply chains and that includes both toilet paper and insulin.

We have two years of insulin in our fridge, I'm curious what you mean by you can't store large quantities?

Does that work? Over time insulin flocculates and becomes inactive. I suppose my info is ~10 years old from when I worked on insulin biophysics, it's possible contemporary formulations are more effective at maintaining stability.

(Not your parent)

Expiration dates vary wildly based on a number of factors, which you probably know, but for completeness: opened vs unopened, refrigerated vs non-refrigerated, brand to brand, etc.

It is true that it becomes inactive over time, but those rates vary. And people know that manufacturers put expiration dates based on liability. Yeah if it says that it expires after a year, that's because they know that 2 units is 2 units after that long, but it's variable enough that you're not going to just get rid of something so expensive and precious when it's likely to still work just as well, and even if it's not "just as well," still be reasonably effective. It's a slow, steady decline, not a "this goes from fully potent to useless at this moment in time" kind of thing. Yeah maybe you'll give yourself four units and it'll actually be effectively 3.5; that's still better than zero.

> It's a slow, steady decline, not a "this goes from fully potent to useless at this moment in time" kind of thing. Yeah maybe you'll give yourself four units and it'll actually be effectively 3.5; that's still better than zero.

The process of flocculation itself is autocatalytic and therefore ~exponential. Though the k factor might be low enough and minor deviations in the exact mechanism that are formulation-dependent might to make it look quasi-linear for quite a long time, followed by a precipitous drop.

I doubt you can stockpile. Pharmacies have checks in place, heck,even my local supermarket flagged when I tried to buy too many otc painkillers.

At least in the US, stockpiling is absolutely common to a degree. You are absolutely correct about checks, they make it even hard to get supplies when it's legitimate at times, but what ends up happening is people skimp in order to save some away, and build up a reserve over time.

You can but it goes bad like milk.

Most insulin has a very long shelf life unopened and refrigerated.

US here. I only managed to do it because of a loophole. My wife has the beetus, and with insurance we pay $40 a month, without insurance it is about $600 for a month, so stockpiling it is effectively impossible.

Luckily during her last pregnancy my wife was prescribed substantially more insulin than she'd previously need for a month because the pregnancy was messing up her blood sugar, it stopped once she had the baby, but we still have the same dosage right now, so we are accumulating a small amount. That being said, it was the only way we could figure out to do it.

Thanks for sharing your experience, it must be really hard as a parent in times like this

Reply on news.ycombinator.com