We hear from experts the foreseen problems if public sector patients living with diabetes have to use syringes and vials to inject insulin due to the alleged insulin pen shortage.
In June, an article published in The New York Times raised concern over an expected shortage of insulin pens in SA, specifically in the public healthcare sector. This is due to a pharmaceutical company, the sole provider, not opting to tender again for The Department of Health’s business.
It was also reported that the reason was that this pharmaceutical company wanted to rather focus on manufacturing new weight loss drug pens that are more profitable.
Since then two South African articles have also circulated, one article from News24 and another article from IOL shedding more light on the situation. Thankfully, it has been reported that another pharmaceutical company is willing to assist in solving what could be a serious problem for South Africans living with diabetes.
We requested comment from The National Department of Health and received the following comment from Foster Mohale, Director: Media Relations at National Department of Health:
“The National Department of Health (NDoH) is committed to ensuring equitable access to quality healthcare for diabetic patients through ensuring the availability of safe, effective, and cost-effective medicines, in the appropriate dosage form at the appropriate level of care.
Over the last few months, concerns have been raised about the availability of insulin pen sets in general, including premixed insulin pen sets in the public sector, amid fears of a shift towards an exclusive insulin vial use strategy.
The National Contract, which includes the supply of small volume parenterals (injections), including insulin, to the NDoH, was awarded in January 2024 and took effect from May 1, 2024.
The bid advertised included a comprehensive list of insulins required by the public sector in line with the Standard Treatment Guidelines and the Essential Medicines List. The insulin specifications advertised included both pen sets and vials.
Responsive bids were only received for the vials of isophane insulin, soluble insulin, and biphasic insulin, as well as for analogue insulin pen sets (ultrafast-acting and long-acting).
- Novo Nordisk (Pty) Ltd was awarded contracts for both short and long-acting human insulin vials.
- Sanofi-Aventis (Pty) Ltd was awarded the contract for short and long-acting analogue insulin pen sets.
- No responsive bids were received for isophane, soluble, and biphasic human insulin pen sets.
- No responsive bids were received for analogue insulin vials.
A supplementary tender is currently in progress to address items with no responsive bids, undergoing evaluation. In the interim, efforts are underway to obtain quotations to support the supply of pen sets, to bridge the supply gap and ensure patients have access to insulin formulations that best meet their needs.
It is important to highlight the global shortage of insulin pen sets, likely due to in an increased demand of more profitable products and manufacturers prioritising their production over insulin pen sets.”
Image supplied by NDoH
Other comments
Margot Mc Cumisky, National Manager Diabetes South Africa and Vice President of Southern Africa Region of International Diabetes Federation, comments, “Diabetes South Africa and NCD Alliance will bring this matter up with the International Diabetes Federation as it will not only affect patients in South Africa, but patients in countries all over Africa.”
Dr Louise Johnson, a specialist physician, comments, “It was with shock that we heard about the terminating of insulin pens at a diabetes congress. Insulin pens are easy to use with accurate dosing of small units such as 2 or 3. In cases where patients are insulin sensitive, such as with kidney failure, very lean patients and children, small amounts of insulin are used. One extra unit more or less can be very detrimental causing hypoglycaemia or hyperglycaemia.”
Dr Johnson continues, “Pens are also very comfortable for use in people with poor eyesight or arthritis; clicks can be counted to get to the correct dosage. It’s a very sad day when a weight lost drug is considered more important than insulin. Insulin has been a life-saving drug in Type 1 diabetes since 1914. The impact of changing to old-fashioned syringes and needles is a huge step backwards for diabetes treatment. The cost will be high in human lifespan due to unnecessary complications that could be prevented.”
The people who it affects
We asked on the Diabetes Facebook page if anyone has been affected by the shortage. A Facebook user, commented, “Being using vials intermittently when pens are not available but still get the required amount of insulin.”
Cain Tibbs, DSA Western Cape Branch Manager, has Type 1 diabetes and gets his insulin from Groote Schuur Hospital. He told us that he still has been getting insulin pens, just not as many as he normally would get.
He adds, “There is a certain social stigma when a person with diabetes uses a vial and syringe in public places…in that they get looked at in an unaccepting way as if they are using some type of illegal drug. I have experienced this as originally I started out using vials when first diagnosed some 40 years ago. It can be very awkward for a person with diabetes to inject in a public place. Hence, the pens are much more discreet or inconspicuous to use.
Why are insulin pens so important?
Margot Mc Cumisky explains below why insulin pens are needed in South Africa.
A person with Type 1 Diabetes (usually under 30 years) depends on insulin injections to live. Without daily and sometimes multiple daily injections of insulin, they will die.
A person with Type 2 Diabetes is often prescribed insulin injections to manage their diabetes and avoid serious diabetes complications (blindness, amputations, heart attacks, strokes and kidney failure), which can also lead to premature death.
Over the last 30 years with the new technology, people living with diabetes were prescribed insulin pens which are much easier to use, as you dial up your dosage with a number of clicks for each increase in dose. The needles used with the pens are short, so not invasive.
Going back in years before insulin pens were available, patients had to use syringes (up to twice as long as pen needles) and glass vials of insulin (which were fragile). This involved drawing up your dosage and injecting with a long syringe. These were also awkward to carry around with you. The pens are much easier to carry around as you can put it in your pocket, like a normal pen, with no danger of injecting yourself accidentally.
The foreseeable problems that could arise if vials and syringes are used:
Dosage errors
- Drawing up can easily happen which could be fatal.
- Poor eyesight – affecting older patients as syringes have tiny lines indicating the dosage.
- Load shedding and poor light leading to incorrect dosages.
- More chance of double dosing when drawing with a syringe, which could be fatal.
Other foreseen problems
- Needle phobia (syringes are much longer than pen needles).
- Syringes are more likely to get damaged and blunt, whereas with pens, the needles come in a sealed pod and have a cap to protect them.
- Mistaking the long-acting and short-acting when drawing up (pens are different colours for long- and short-acting which help to alleviate mistakes).
- With a syringe, you can accidently draw up too much and can be more prone to insulin spillages.
- A syringe to young children is threatening and scary, and it would take longer for the child to do their own injections.
- Syringes are longer and therefore more painful and cause bruising.
MEET THE EDITOR
Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on [email protected]
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