Syringes & Needles – Pharmacy Diabetes

Delivery Systems for Medicines for People with Diabetes

Insulin is hormone that is used as a medicine to treat elevated blood glucose levels in number of conditions including type 1 diabetes, type 2 diabetes, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycaemic state.
Since insulin is a protein, it must be given as an injection, usually subcutaneously, but occasionally can be injected into a vein or muscle. Insulin can be delivered via a syringe, insulin pen or insulin pump depending on the preference of the person with diabetes. If a person were to take it by mouth as a tablet or capsule the body’s digestive enzymes produced in the stomach would dissolve the protein and it would not have any impact on blood glucose levels!

National Diabetes Services Scheme (NDSS)

In Australia when an individual is diagnosed with diabetes, they are registered on the NDSS (National Diabetes Services Scheme). The NDSS aims to enhance the capacity of people with diabetes to understand and self-manage their life with diabetes and to access services, support, and subsidised diabetes products. Products include (but limited to) blood glucose monitoring strips to check what the level of glucose is in the blood and needles and syringes to deliver insulin to the body when it is not producing adequate amounts.

NDSS Registration for Syringes & Needles

When starting insulin with type 1 diabetes, registration should occur on the NDSS for access to both needles and syringes
(https://www.ndss.com.au/about-the-ndss/registration/ ).
If an individual has type 2 diabetes and needs insulin (or exenatide), the classification of the NDSS becomes insulin requiring type 2 (or injectable medicine requiring) and again needles or syringes can be given immediately and a form for further supply can be filled out as appropriate.
https://www.ndss.com.au/wp-content/uploads/forms/form-syringe-pen-needle-access.pdf
Please note this form DOES NOT need to be signed by a health care professional to upgrade the person to injectable medicine (this includes insulin and Byetta at the time of writing). A copy of the prescription accompanying the form is sufficient to change the NDSS status.

Insulin Syringes

Insulin syringes come as a 1ml (100 IU-international units), 0.5ml (50 IU) and 0.3 ml (30 IU). They are usually used when more than one insulin is mixed and injected at the same time (in the same syringe) often in children or when there is a third party giving the injection (a carer or nurse perhaps in a hospital setting). It should be noted however that only insulin that is 100IU per mL can be drawn into these syringes.
Which size syringe is chosen usually depends on how much insulin (volume) needs to be injected?
Syringes should only be used once.
Syringes should be discarded in a sharp container and disposed of appropriately.

Pen Needles

Pen needles are designed to be placed on the end of the pen device (Penfill, Flexpen, Innolet, FlexTouch, and some of the injectable medicines including exenatide {Byetta}, dulaglutide (Trulicity), semaglutide (Ozempic) and liraglutide (Victoza) to ensure the medicine is delivered accurately and precisely where it is intended.

Each needle should only be used once.

At the time of writing there were needle lengths ranging from 4mm up to 12mm on the NDSS. What determines which length needle is to be used by an individual is dependent upon several factors including (but not limited to) the type of medicine, the units of medicine injected, the amount of adiposity of an individual, the presence (or absence) of scar tissue at injection site, the injection site (abdomen vs. leg), type of diabetes, and length of diabetes.

Pen needles should only be used once.
Pen needles should be discarded in a sharp container and disposed of appropriately.

Lipohypertropy

Using blunt needles can cause scaring at the injection site and affect insulin absorption long term. This is known as lipohypertropy. Lipodystrophy may delay insulin absorption and cause unpredictability, compounding the possibility of erratic glucose levels.
Ensure that each person using insulin (or injectable medicine) understands a new needle or syringe must be used each time.