The world is warming faster than ever, caused mainly by the ongoing burning of fossil fuels. Crude oil consumption has increased by 33% since 2000 (4000 metric tons of crude oil consumed worldwide in 2023). Without urgent action to reduce carbon emissions, we are on track to exceed the 1.5°C limit set in the Paris climate agreement, with temperatures estimated to rise by 3°C by the end of the century.1
'Switching to reusable cartridge insulin pens offers the potential for significant environmental as well as cost savings. Using reusable insulin pens would reduce plastic waste by 89% and the carbon footprint by 40%.'
Healthcare is one of the major contributors to the climate crisis and, in England, the NHS accounts for 4% of the country’s total carbon footprint. Some 33% of the NHS’s carbon footprint is associated with pharmaceuticals.
Despite this, no national guidelines currently provide advice on sustainable prescribing. If we are to have a meaningful impact on the current trajectory, we need to start reflecting on our prescribing habits, to make healthcare more sustainable.
DIABETES PRESCRIBING
Diabetes is a key area where action can be taken. An estimated 5.6 million people live with diabetes in the UK, many of whom require daily insulin injections. Insulin is commonly delivered via either disposable or reusable cartridge pens. Currently, disposable insulin pens are prescribed about 50% of the time, and contribute 60 tonnes of plastic waste and 1000 tonnes of CO2eq annually in England (equivalent to driving approximately 2.5 million miles by car).
WHY SWITCH TO REUSABLE INSULIN PENS?
Switching to reusable cartridge insulin pens offers the potential for significant environmental as well as cost savings. Using reusable insulin pens would reduce plastic waste by 89% and the carbon footprint by 40%. If all patients in England swapped a disposable pen for a reusable cartridge insulin pen, this would save 59 tonnes of plastic waste and 400 tonnes of CO2eq (equivalent to about 1 million miles by car) annually.
As well as contributing to a more sustainable healthcare system, reusable cartridge insulin pens also offer practical benefits to patients. These include the cartridges taking up less fridge space and the pens sometimes coming with features such as memory functions, which help patients keep track of their doses.
A further significant benefit is that cartridges are often cheaper (1–5%) than disposable pens,2 meaning that we can be more sustainable while saving the NHS money.
HOW DO I SWITCH?
Switching to a reusable insulin pen is simple – as easy as switching from a disposable ballpoint pen to a refillable fountain pen. Healthcare providers can either give patients a reusable pen or ask their GP to prescribe one. The key is to ensure that patients also receive the corresponding insulin cartridges.
We have developed local guidelines to help make the switch easy.
WHAT IF REUSABLE PENS AREN’T AN OPTION?
While most patients can switch to reusable pens without an issue, there may be exceptions, such as problems with dexterity or forgetfulness. It’s important to take advantage of the available recycling schemes for those unable or unwilling to make the switch.
Novo Nordisk PenCycle and Sanofi RePen are product-specific recycling schemes. Unfortunately, not all manufacturers have similar programmes: Lilly, for example, does not currently offer a recycling scheme for its insulin products (such as Humalog and Humulin I).
Remember, whatever you do, patients should be advised to dispose of their insulin responsibly. For insulin which is not recycled, cartridges and unused insulin should be disposed of in sharps bins for incineration. It should not be put in landfill or domestic recycling bins, as it can leach into water systems and soil.
HOW DO I SUPPORT SUSTAINABLE DIABETES CARE?
As healthcare professionals, we play a key role in shaping a more sustainable future. Here’s how you can make a difference:
1. Update local guidance to make reusable insulin pens the default option, reducing both plastic waste and carbon emissions.
2. Engage your colleagues in discussions about how to improve the environmental impact of diabetes care.
3. Seek further training, such as carbon footprint training provided by sustainable healthcare organisations, to better understand the environmental impacts of your care.
Only through small, sustainable changes can we start to change the way we practise medicine to be more environmentally friendly and reduce the wider impact of the care we provide.
VINCENT SIMPSON
ST6 Diabetes and Endocrinology, Royal Devon University Healthcare NHS Foundation Trust, and University of Exeter
ESME GIRDWOOD
IMT3 Diabetes and Endocrinology, Royal Devon University Healthcare NHS Foundation Trust, and University of Exeter
REFERENCES
1. Campbell-Lendrum D et al. 2023 Nature Medicine https://doi.org/10.1038/s41591-023-02438-w.
2. Simpson V & Jones A 2024 Diabetic Medicine https://doi.org/10.1111/dme.15409.
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