Share and Share Alike? Keeping Insulin Pens and Needles to Themselves

A few months ago the FDA issued a formal statement about the issue of sharing insulin pens and cartridges. In short, they gave it a big NO all around. I heard about it through the news, but did not give it much thought until I was contacted by an acquaintance at TuDiabetes.com to find out my views on the matter.

Initially I thought this was essentially a non-issue—sharing insulin cartridges was not to be condoned because of threat of possible communicable diseases like hepatitis. And while out in the public it continued, sometimes out in the open and at other times under-cover, the formal opinion from the medical establishment of course had to be “no.”

The recent economic turn has made this issue, among others, more complicated. As we all know, insulin cartridges and pens are expensive. Several insurance companies/programs do not offer much coverage on many brand name insulins, much less the pen devices and needles that must be used. Frequently I have encountered my own patients sheepishly admitting that they used some insulin from their husband, wife, mother, aunt, etc because their own supply was not handy or had run out. The most common scenario I encounter is a husband—wife team sharing insulin and supplies. Given the painful economic tide, this does not surprise me at all. However my stance must remain the same because the threat is the same, sharing insulin cartridges and pens can promote the spread of communicable diseases. In the face of financial stress, I rather switch patients to a less expensive medication.

But the argument does extend out to other medications. I had one patient who was sharing EVERYTHING with his wife—half a lisinopril tab for me, half for you; 10 units of levemir for me, ten for you etc. They were an elderly couple living only off their social security, and had Medicare coverage. They both had multiple comorbid conditions and bills for medications alone were driving them to desperation. Thus in their cute married-for-fifty-years way, they started sharing medications, decreasing their doses slightly, but both getting daily doses. While I held my ground, I must admit that I had a very difficult time stressing the importance of not sharing insulin to this couple. They were both older than 70 years, had been married for almost 50 years, and were severely financial stressed while trying their best to keep up with their medical care. I of course recommended they speak with the financial services department of our hospital to see if they could secure some additional medication assistance. We provided them with any samples that we could from our supply. However beyond that all I could do was ask, not demand, that they stop sharing insulin, all the while feeling somewhat ridiculous as they stated that neither of them had a communicable disease to worry about. What could I say?

So even with some situations that may seem to be exceptions, I stand with the FDA on this one because I HAVE TO. I accept that in real life there may be some circumstances, especially with a foundation of financial stress, that push in the direction of sharing insulin. But in the world of medicine and the half-truths that abound in patient histories, I stand on the cautious island of recommending against sharing insulin pens and cartridges. It’s a lonely island at times, but I think it is the right place to be; if only just to be safe.