In Australia, the majority of people give their insulin using disposable pens, which, once empty, contributes a significant amount of rubbish to landfill. Is it time the diabetes community improves its environmental report card by getting more people with diabetes to switch to a more environmentally friendly insulin delivery device?The three insulin companies, Lily, Novo Nordisk and sanofi-aventis, all have reusable cartridge pens available for Australians to use as well as their disposable counterparts. They use pre-filled cartridges, containing 300 units of insulin, and are available for most insulin options. The Pharmaceutical Benefits Scheme (PBS) provides the equivalent amount of insulin when dispensed as disposable pens or re-usable cartridges.Unfortunately many doctors only prescribe disposable pens and don’t give people with diabetes the option of the re-usable cartridge pen.  I have people with diabetes asking me about the environmental impact of their disposable pens and are surprised when I tell them there is another, more environmentally friendly option they could use to give their insulin.Is it time to take a more environmentally responsible, person centred approach to insulin prescribing?Yes … and the first step is to give people the opportunity to choose the insulin delivery device they want to use by actively involving them in the process of choosing the pen they want to use. A review of a person’s:

• • Ability to self inject using the device
  • Thoughts about a devices environmental impact
  • Type of insulin
  • Feel of the device
  • Available fridge space
  • Special features of the device
  • Travel requirements.

Time poor general practitioners (GPs) usually don’t have time to give people a choice of insulin pen type; they may not even be aware there is a choice. Referring people to a Credentialled Diabetes Educator (CDE) before writing the first insulin prescription lets the person work out the pen best suited to their needs. At times the brand of insulin may need to be decided by the pen device the person can safely and accurately use. For example, people with low hand strength may need the Novo Pen 4 because its insulin delivery button clicks into place when depressed, taking away the need to continue to press firmly on the button for a further 10 seconds as the insulin dose continues to delivered. They can release the pressure and count to 10 before taking the needle out of their injection site.CDEs have longer appointments and are trained to take people through the options in insulin delivery devices. They also counsel, educate and prepare people for their insulin commencement, providing the correct insulin pen delivery equipment, a signed NDSS form, equipment for travelling with insulin and discuss how to identify, treat and prevent hypoglycaemia. It is also important at this time to discuss how a device is disposed of, and their impact on the environment as many people with diabetes are uncomfortable throwing all of the the disposal pens to landfill.We all have a responsibility to be environmentally responsible. In the diabetes world, greater consideration can be given to actively involve people with diabetes with a CDE to discuss their choice of insulin delivery device. More people are likely to choose the environmentally friendlier insulin cartridge pens when given the choice and they will be better prepared to start insulin with confidence because of their time with the CDE.To find out more about the re-usable insulin pens click on the following links: Lily Australia – HumaPen Novo Nordisk – Novo Pen 4. Video Sanofi-adentis – AllStar PRO penIf you think a reusable insulin pen is something you want to explore, contact Jayne Lehmann or your Credentialled Diabetes Educator for an appointment.