I've noticed that the re-use debate has flared up quite a bit recently in multiple threads, and I thought I would comment with a little bit of perspective (perhaps partially personal perspective, but I like to think it's a mostly objective/factual perspective)...
I'm an occasional re-user (e.g. if I'm injecting Novorapid (fast-acting) and Optisulin (long-acting) close together time-wise I will use the same needle on both pens, or if I am travelling overseas or unable to get a fresh supply I will re-use once or twice to make my limited stock last a little longer). Best practice is obviously to only use once, but this is general advice in the absence of considering your individual extenuating circumstances (e.g. difficulty changing needles for mobility/vision reasons) and it is also a personal decision what risks you are willing to accept for convenience or environmental considerations or any other motivation.
Personally, I think the infection risks of re-use are fairly minimal - think of how many times you have had a medically-significant infection or other noteworthy complication from getting a splinter or a rose thorn prick while gardening. This is when the skin of your hands is covered in dirt and compost/manure versus a fairly clean and dry patch of belly skin, being "injected" by a non-sterile and porous "needle" much blunter than a moderately-used steel medical needle, and usually having it under the skin for longer than a count of 10, and most likely leaving small portions of the material under the skin once it is removed. Everything involved in the situation is waaaaay worse than the worst insulin injection you've ever done and yet you nearly always have no significant negative outcomes from a splinter. In fact, clinical studies have found that even with well-re-used needles, microbial contamination is almost non-existent and reported infections of injection sites are startlingly low, while modelling and simulation studies show that it is highly unlikely that a needle will encounter and inject/collect skin microbes during use (see, for example,
https://onlinelibrary.wiley.com/doi/10.1111/apm.13230). In fact, the WHO found a while ago
that disinfection of perceptibly clean skin before subcutaneous injections is ineffective and unnecessary - I have even noticed that none of the medicos swabbed my skin before any of my COVID vaccinations (4 so far at 2 or 3 different practices). The two main risks seem to be: mechanical tissue damage due to bent/bluntened/barbed needle tips and loss of the smooth silicon coating of the needle which may cause pain and irritation and lumps/scars and maybe impact the absorption pattern of your insulin; and dosage inaccuracy due to clogging or micro-overdosing with residual crystallised insulin. With only low-numbers of re-uses, changing the needle well before I notice any side-effects like pain/bruising/swelling, flushing the needle with a unit or two of insulin before re-injecting, and not relying solely on my calculated dosage to know if I have the right insulin balance in my body, I feel personally satisfied that I have minimised these complications to a risk level I am personally willing to accept. And as a little more perspective, who will change a finger-prick lancet every single time they test their blood? There's not much difference between the risks of a blunt lancet and a blunt needle...
Different people will place different weightings on the perceived benefits (e.g. how inconvenient/difficult it is to restock your needles depending on your location and time commitments, how important the environmental concerns are to you, how much extra time, effort and personal resources you want to dedicate to yet another aspect of your daily diabetes management, etc). Different people will even have different weightings on the actual risks (e.g. if you are already prone to or living with diabetic complications, if you are immunocompromised, if your dexterity or skin quality make it difficult to avoid damaging the needle, your age, etc). As long as you consider all these factors, and are willing to accept the consequences of whatever happens, I'm not going to judge you for re-using a needle any more than I am going to judge you on how often you measure your BGL per day or how often you eat pizza. While there are best practices and everybody from your great-aunt's neighbour to your endocrinologist will offer extensive advice and personal experience, ultimately it is largely a matter of personal choice and what works best for you individually that dictates how you manage your diabetes. Within reason, I don't think anybody else should judge you either - they can offer knowledge and advice, and if you experience any symptoms from your needle use you should probably take that into consideration, but otherwise, I think there are many many way bigger issues for diabetics to spend their mental effort stressing over. I think the significance of the issue is not proportional to the thread length and professional effort put into discussing it. Probably not even proportional to the word count of my single post! ;)
In all of life, we ignore best practice routinely - how many people will carefully inspect every tyre, check the oil and test all lights before every single car journey, and who will just jump into the car and go when they just need to pop down to the local shops for milk? Do you put on sterile gloves and swab your stomach with chlorhexidine before every injection? Who has calibrated and serviced their reusable pens and glucometers recently? Have you familiarised yourself with changes in road legislation since you passed your driver's licence test? Nobody has the time and money to do all the things that someone somewhere tells you that you should always do, and nobody ever does exactly the best and most correct thing all the time. Diabetes is just another place where we fudge best practice and take shortcuts to get us through the day. Whatever works best for you, as long as it works best for you...
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Todd
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Original Message:
Sent: 02-11-2022 15:17
From: Diabetes Australia Community team
Subject: B &D and Novo 4mm needle supply
Hi members,
For those looking for recommendations on needle use etc. we have been provided with the attached from one of our health professionals.
Have a lovely day, Ange.
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Community Team
Natasha, Erin and Ange
community@diabetesaustralia.com.au
Original Message:
Sent: 29-10-2022 19:28
From: Michael
Subject: B &D and Novo 4mm needle supply
Hi Paul,
69 years a Type1 is amazing with I'm sure many trials and tribulations. Some , like yourself, can escape complications with reusing needles, however all major manufacturers of needles stringently state on their websites and packages, single use only. This is for health and safety reasons and backed up by their statistics and health professionals.
This Diabetes Australia website has a multitude of diabetics, both type one and two, many with severe long term problems where infections can lead to severe complications. Even those on pumps, which includes many younger Type1's, underrepresented on this site, should be educated and always encouraged to use the most sterile, hygienic procedures suggested by the manufacturers and medical professionals.
Some of us are very fortunate not to get complications from reusing needles or even after having high blood sugars that could lead to renal, vascular, heart etc etc problems, however this is certainly no excuse not to encourage a high standard of diabetic practice for all.
This is why after so much discussion on reusing needles it is in the interests of Diabetes Australia to make some acknowledgement on safe procedures using single use needles.
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Michael
Original Message:
Sent: 29-10-2022 00:24
From: Paul
Subject: B &D and Novo 4mm needle supply
Michael, I have never had an infection after 69 years of reusing needles & syringes [even boiling them for 5 minutes to resterilize the early ones in 1953. In all these years since 1953 I have NEVER had a needle break off. I currently use 5mm that has a 31 gauge which is thicker & far less likely to bend. Studies done years ago said there were no infections. [It could be possible if careless.] I have never had Lipos [lumps] as you won't IF you rotate the injection sites properly around the stomach. You do seem overly concerned but most reusers happen to go along without ANY problems.
Original Message:
Sent: 10/28/2022 3:11:00 AM
From: Michael
Subject: RE: B &D and Novo 4mm needle supply
Hi Anita,
The shortage of a specific type of needles is no doubt problematic for some diabetics. This of course should never override the safety concerns of reusing single use needles. As stated, there are staggering statistics that up to 60% of diabetics constantly reuse their needles and it seems by the members in these discussions, this also applies to Australia. Diabetes Australia must take a stance on needle reusing, shortage or no shortages, as part of its overall educational platform for diabetics.
I have had many complications of needle usage and most probably used every length and gauge of needle. Diabetic statistics most probably don't measure infections, lipos, miscalculation of dosages due to crystallised insulin, lumps caused by blunt needles, needle breakage under the skin etc etc. That is why the pharmaceutical companies, medical professionals and hopefully Diabetes's Australia will always promote single usage of needles. It's in all our interests, health and wellbeing.
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Michael
Original Message:
Sent: 28-10-2022 16:35
From: Anita
Subject: B &D and Novo 4mm needle supply
Hi Michael, I and I feel most of us understand the best way is to not re-use any needles, however with the short supply of them currently and some Pharmacies not being very cooperative, to temporary reusing, or perhaps change to any of the other sizes if they are available is a good solution. But to me, I would just for now reuse needles if we can't get them. The alternative of no insulin injections isn't a very promising or good alternative. So let's hope that this is only a short time we have to think like this. I have had experience with the local Pharmacy that they are not interested to help out at all. I tried to ask if they could try a different supplier, but their answer was, we only deal with one supplier.
So I thanked them for their effort and told them I remember them if I get into deep trouble, and will not hesitate to say why I'm in trouble.
Hopefully, this is only a short time of trouble.
Cheers
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Anita
Original Message:
Sent: 28-10-2022 15:40
From: Robin
Subject: B &D and Novo 4mm needle supply
Hello All,
It is most interesting reading about various experiences with MDI's and needle re-use. FYI if not aware, Insupen now have a 33G 4mm needle which is listed on the NDSS site. The 33G is finer than the 32 and even more comfortable to use than 32G. If Novo Fine Plus continue to have issues, these are well worth a try, and maybe Novo might realise that they may be losing a rather large market share.
It would be nice to hear about these shortages from DA when they occur or are expected to occur. A DA bulk email to its members as soon as letters such as the 29 August NDSS newsletter re Novo are received, I am sure would be appreciated by many members. I hope this may be possible and again say thanks for all your assistance.
Kind regards,
Rob.
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Rob
Original Message:
Sent: 26-10-2022 13:36
From: Michael
Subject: B &D and Novo 4mm needle supply
Hi Community Team,
It's concerning the lack of supply for the needles however the risks Type1's are will to take reusing their needles is alarming and requires further discussion. Maybe, there are further studies to that discuss this issue. Further, although it seems apparent most medical professionals would certainly not encourage reusing needles there are a number of members who seem to advocate reusing needles for various reasons.
I used to reuse my needles as a teenager and boiled my needles in water every morning before school to sterilise them. These needles were meant for reuse and there was no other available choices. They certainly became blunt and I remember sharpening them with a fine file which did not work and left massive lumps on my legs. Today, we certainly do not have to reuse our needles thanks to Diabetes Australia and hopefully I will never have to go through the ordeal again.
Below, highlighted, is a fairly current article about reusing needles by diabetes UK, written byAmar Singh on January 15, 2019 · Last reviewed on June 10, 2022
"Insulin pen needles are intended for single use only but it is known that a significant proportion of people with diabetes do re-use needles.
People with diabetes ultimately have the choice of whether they wish to re-use needles for injections This article reviews evidence from research studies to help you make an informed decision about re-use of pen needles
Whilst this guide refers to insulin pen needles, the same principles will also apply to pen needles for injections of incretin mimetics such as Byetta and Victoza.
What are the risks involved in reusing needles?
Reusing insulin pen needles could increase the following:
- Bacterial growth on the needle
- Likelihood of experiencing pain when injecting
- Risk of lipohypertrophy (lumpy skin) occurring
- Risk of the very fine tip of the needle breaking off
The risks of the above will grow with each re-use.
Re-use of needles and bacterial growth
A study carried out at the Moscow Regional Research Clinical Institute found that bacteria were present after injections had been completed and that bacterial growth on needles increased with further re-use.
Bacteria found on the needles was mainly bacteria found naturally on skin (staphylococcus epidermidis). Whilst this form of bacteria is usually harmless, re-use of needles could increase the risk of contamination of more harmful bacteria.
Re-using insulin needles and pain
The fine tip of needles can become slightly distorted with re-use and this can increase the chance of experience pain whilst putting the needle in or taking the needle out.
If you are experiencing pain when withdrawing the needle, this could well be caused by distortion to the tip of the needle.
The Moscow study referenced above showed that re-use of needles is associated with more pain.
The study divided patients into groups that re-used needles and those that didn't. Those that re-used needles in the study communicated higher levels of pain with their last injection"
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Michael
Original Message:
Sent: 26-10-2022 11:12
From: Diabetes Australia Community team
Subject: B &D and Novo 4mm needle supply
Hi members,
Thanks for your engaging conversations on the forum.
With regard to the 4mm needle supply, please follow this link to the NDSS website:https://www.ndss.com.au/news/supply-shortage-of-ndss-code-165-novofine-plus-32g-x-4mm-pen-needles/
Remember there is always the National NDSS helpline that you can call with regard to product supply: 1800 637 700
Hope where ever you are today you are keeping safe and dry.
Take care, Ange.
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Community Team
Natasha, Erin and Ange
community@diabetesaustralia.com.au
Original Message:
Sent: 17-10-2022 18:23
From: Delma
Subject: B &D and Novo 4mm needle supply
Hi all,
I have been unable to get 4mm needles for 2 weeks, Pharmacy advised absence of supplies from warehouse, Warehouse does not know when stocks will be received, Now using 5mm whichever brand I can get.
Del
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