Doctors are sounding the alarm over a predicted stock-out of insulin pen devices used by people living with diabetes. 

This comes after the pharmaceutical company Novo Nordisk, the previous supplier in South Africa, and other manufacturers failed to meet the demand to supply insulin pen devices. Instead, these manufacturers offer insulin in vials. Novo Nordisk has supplied over 14 million human insulin pens to South Africa over the last three years.

The difference between insulin pen sets and the vials is that the pens are already filled with the right dosage of insulin and they are easy to use. On the other hand with the vials, one has to measure the insulin dosage themselves. This increases the risk of an overdose. 

The medical non-profit organisation Doctors Without Borders (MSF) warns that transitioning from insulin pen devices to vials and syringes can have major consequences for patients. 

“People with diabetes who require insulin must calculate their food intake, check their sugar levels and predict how these will interact with the amount of insulin they administer, sometimes multiple times daily. The dosing mechanism on insulin pens provides a more straightforward way of measuring the correct dose, making it easier to inject outside the home,” MSF explains in a statement.  

Novo Nordisk has been the primary supplier of human insulin pens in previous tenders to the NDoH and has supplied over 14 million human insulin pens to South Africa over the last three years.

Diabetes is a noncommunicable disease that occurs when the pancreas does not produce enough insulin, or the body cannot effectively use the insulin it produces. About 4.2 million people in South Africa have the condition, and it’s the second leading cause of death. 

The doctors say changing medication could lead to serious complications such as extremely low blood glucose levels and loss of consciousness, and in some cases, even death.

Alarming circular 

Several weeks back, the National Department of Health issued a circular instructing healthcare workers to prioritise the available supply of insulin pen sets to the elderly, visually impaired individuals and young children. 

In the circular the department says a tender was awarded to Novo Nordisk in January this year aimed at securing a comprehensive range of insulin formulations. 

The department says bids were only received for specific insulin presentations which are vials of isophane insulin, soluble insulin, biphasic insulin and analogue insulin pen sets. 

“To address the shortfall of human insulin pen sets, a supplementary tender was advertised in March. The bid evaluation process of the supplementary tender is currently underway. In the meantime the department is obtaining quotations to address any supply constraints,” reads the circular. 

The department adds that there is a global shortage of human insulin pens as manufacturers are prioritising the products that are more profitable.

Dr Patrick Ngassa Piotie is a senior programme manager at the University of Pretoria’s Diabetes Research Centre and chairperson of the Diabetes Alliance. He warns that switching from pens to vials and syringes on short notice will impact patients with diabetes as well as the health department.  

“This is a devastating experience for people living with diabetes as it might bring complications to their lives. It will bring psychological problems for them as others will struggle to get the right dose when they are using the vials. This will also impact the way the health department will manage diabetes in the country. The government needs to get this under control,” he says.

He says the change of medication will also bring about psychological issues to patients as they will be stressing about when to take the next injection, something they are not used to.

“This will expose patients who have been used to human insulin pen devices since at least 2014  to complications as they might miss their dosage,” Piotie explains.   

Intricacies of diabetes treatment

Piote, who runs the Tshwane Insulin Project says it’s important to consider who benefits most from insulin pens. 

“They are mostly given to elderly patients and also kids so as to limit the number of injections they have to use to treat diabetes.”

According to MSF, people with diabetes may need to inject insulin up to four times a day. 

“Using insulin pens can simplify how insulin is administered, making dosing easier and reducing stigma when injections need to be given outside the home. Despite the advantages of the human insulin pen device over other injection methods, it remains inaccessible for most people with diabetes in low- and middle-income countries because it is expensive,” reads the statement.

MFS’s access campaign advocacy advisor, Candice Sehoma says South Africa is one of the countries that took the steps to make sure the human insulin pen devices are available in the public sector. 

“However, these pens are a bit more expensive. The low- and middle-income countries prefer to buy the most cost effective medication,” Sehoma says. 

MSF has called on Novo Nordisk and other manufacturers to acknowledge their responsibility and take immediate action to ensure a continuous supply of insulin pens to South Africa. A media enquiry was sent to Novo Nordisk last week and will be added as soon as received. – Health-e News