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Vial: Once the vial is punctured, it is OPEN. Once you stick a needle in the vial, it is OPEN. OPEN vials can be stored in the fridge or at CONTROLLED room temperature. Regardless of where it is stored, OPEN insulin will only last 28 days before it must be thrown in the trash.
The manufacturer seemed to stress that patients not use a started bottle of this insulin for >28 days (2). Two patients of mine highlighted this point. L.K. is a 76-year-old woman with type 2 diabetes, diagnosed at 55 years of age, and treated with insulin since age 56.