Asked by Bethany, San Diego, California
My husband is a Type 2 diabetic who takes insulin three times a day. He often reuses the same syringe day after day or multiple times in one day. I am very concerned about this habit. It is unhealthy or dangerous?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
This is a common question and indeed a common problem.
Insulin syringes are expensive, and many patients want to reuse needles to save money. Many also reuse the lancets used to prick the skin and draw blood to measure blood sugar.
You are right that the reuse of insulin syringes and lancets is dangerous. It can even be deadly, as it can cause a number of skin infections. Some of these infections can progress beyond a localized problem and become an abscess or even systemic blood infection.
A person with Type 2 diabetes mellitus, which is also referred to as adult-onset diabetes mellitus, is at risk of developing a number of health problems. Most talked about is the risk of cardiovascular disease, which includes an increased risk of heart attack, stroke and peripheral vascular disease, as well as kidney disease and diabetic eye disease. Diabetic vascular disease is a leading cause of leg amputation.
Diabetic kidney disease is a leading cause of kidney failure and dialysis. Diabetic retinopathy is a leading cause of blindness. Important risks that we should perhaps talk more about include the risk of infection. Diabetes increases the risk of infections of the skin, lung (pneumonia), and other organs.
All of these risks can be reduced through good blood sugar control, good diet, exercise, and taking medications properly. Mild diabetes can be controlled through diet and exercise. Moderate disease often requires oral medications, and more severe Type 2 disease requires oral medicines and insulin injections.
These injections are sometimes administered two, three or four times a day and timed with meals. Every patient with diabetes should undergo diabetic teaching at diagnosis and get a refresher course every couple of years thereafter.
For those who are taking oral and injectable medications, this includes when the medications should be taken, as well as what foods should be eaten and when meals should be eaten. An important part of diabetic teaching is how to take injectable medicines and check blood sugars.
Sterile procedures should be used at all times. One should wash one's hands with soap and water before getting the syringe ready. The area to be injected, which is usually the leg, arm or abdomen, should also be cleaned. A piece of cotton or gauze soaked in rubbing alcohol should be used to cleanse the injection site and to clean the top of the insulin bottle prior to drawing the dose of insulin from the bottle into the syringe.
A used needle can have bacteria from the skin in and on it. Bacteria can contaminate the bottle of insulin when reinserted into the bottle. The bottled insulin is a growth medium that can allow the bacteria to reproduce. Insulin is stored in a refrigerator to prevent bacterial growth.
Certain types of bacteria when injected can be especially devastating and can even cause death. In the U.S., several thousand diabetic patients die each year due to bad sterile technique causing abscesses, skin infection and sepsis, which is generalized infection involving the blood.
In an effort to prevent reuse of needles, the physician can prescribe needles pre-filled with insulin. This is more expensive than buying bottles of insulin and filling syringes as needed. These pre-filled syringes are especially convenient for patients who have visual impairment.
There are some injection devices that are designed to be reused. Insulin for these devices comes in cartridges with a needle. A new cartridge and needle is used with each dose. The cartridge system is not very useful for the patients who have to mix immediate and long-acting insulins at a dose.
Another option that might be discussed with the health care provider is an insulin pump. A tube from this device is placed into the skin and it is designed to stay in place for a couple of days or so. The pump can be programmed to give a specific insulin dose at a prescribed time.
Please encourage your husband to get a refresher course in diabetic care. You might want to go with him.
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