Happy Saturday, all! Welcome back to Ask D'Mine, our weekly advice column hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico, who happens to have experience as a clinical diabetes specialist. This week, Wil takes a look at the issue of whether needles used to inject insulin (or other meds) actually go bad at some point. As Wil phrases it, "everything but Scotch expires..."

Read on for more on that point (pun intended!).

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Joseph, type 1 from Rhode Island, asks: Do insulin syringes and pen needles expire?

Wil@Ask D’Mine answers: Yep! They sure do, just like beer and Cool Ranch Doritos, both syringes and pen needles expire. Well… more accurately put, like almost all diabetes supplies, they have expiration dates.

Granted, at first glance this seems ridiculous. After all, it’s just a sharp piece of metal, for crying out loud, right? How the eff’ can it expire? Many PWDs—genetically disposed to cynicism in the first place—cry foul thinking this is just another pharma trick to make us flush more of our hard-earned money down the diabetes toilet.

But not so fast. There’s more to the needle than meets the eye. Well, at least there’s more to the modern needle than meets the eye. For perspective, let’s visit the Needle Hall of Fame & Museum, at Point Bare in Nantucket. 

OK, I totally made up the Needle Hall of Fame.

But the humble needle probably deserves one, because if you use needles today, they sure ain't your father’s needles. Back in my clinical days I had an antique insulin syringe kit that I kept on my desk. It was a lovely machine-age polished aluminum pocket carrying case. Inside it held a glass barrel syringe and a huge bore needle big enough to slay a mountain lion with a single stab. (I kept it on hand to make modern syringes look like a damn good deal for folks who were nervous about starting shots.)

Our diabetes forefathers had to sterilize theses glass syringe barrels between uses by boiling them in a pot of water on the kitchen stove. Oh, and you know how they tell us to never use a needle more than once? Back in those days you only got one needle.

Ever.

You kept it sharp by grinding it on a whetstone. Like a kitchen knife. 

How times have changed. Today’s needles are apparently made by a distant branch of the Keebler Elf family. They are crazy small in diameter. The BD Nano sports a 32-gauge diameter. That’s 0.008th of an inch!

There’s not even room for one angel to dance on the tip of a needle anymore. 

But that’s not all. The smallest of the pen needles have their hollow steel tube noses carved down into five-sided pointed tips, and are coated with lubricants to make them slide through the skin more easily. Oh, and no more boiling. They come packaged in sterile containers, ready to go. 

OK, you say, that’s all good and pretty amazing. But it’s still just a hunk of metal, albeit more dainty and delicate than in the past. You really want us to believe it expires?

Now, at this point, I think we need to take a moment to differentiate between syringes and pen needles, as there are some different issues. I can see that the rubber parts of a syringe, sooner or later, are going to dry up, crack, and fall apart. Then your syringe will leak like hell or get stuck. Or both. So I could see where it has a life-limit. But what about the pen needle? There are no moving parts. It’s just a short piece of surgical steel in a plastic hub. To be honest, I thought the expiration issue with the pen needles might come down to the lubricant coatings; but to be sure I went straight to the top for answers.

The top, in this case, being Becton, Dickinson and Company, which, like Kentucky Fried Chicken whom adopted the more tweetable KFC, is now known simply as BD.

They hooked me up (not in that way) with Dr. Larry Hirsch, who has the weighty title of Worldwide VP, Medical Affairs, Diabetes Care. He got his medical degree at Harvard, and he also has a BA in Psychology from the University of Rochester. But he has another credential that matters even more.

He’s a type 1, and this November he’ll be celebrating his 61st dia-versary!

So he’s used more than his share of needles.

I had assumed that BD tested their pen needles and then based the expiration date on how long they stand up, but I was wrong. Hirsch says, “There’s no reason to test until the device fails.” Instead, he tells me that BD torture-tests their pen needles… well, he might have said they “rigorously test and document the performance” of their pen needles by subjecting them to varying temperatures, humidity, and so forth to ensure that they will still preform reliably “with a high degree of certainty” to their expiration date, which is five years.

I found this a bit backwards. Instead of testing pen needles to see how long they will last, BD has chosen a time period, and then just assured themselves that the needles will last that long.

So where the heck did the five-year window come from?

Interestingly, Hirsch doesn’t know, saying “I honestly can’t give you an answer for that.” He said he asked some of his production people, and they didn’t know either. He did confirm it isn’t an ISO standard, and said it could simply be a legacy number they’ve just stuck with.

Hmmmm… So 20 years ago someone just pulled this number out of their (err, rear end)? Needless to say, my mother raised me to well to put it to the good doctor in that way, so I let it drop.

But I was enough of a brat to ask him: if he had to choose, would he rather PWDs use an expired product once, or a fresh product numerous times? He didn’t take the bait, saying, “I’m going to demur on that question. We just want people to use the product in a safe and effective manner.”

Meanwhile, Hirsch was a tiny bit defensive about the five-year time window during our interview, saying he felt that five years is “a generous period of time,” that allows the needles to go from factory, to supplier, and ultimately ensure that “the consumer has an adequate amount of time to use the product.”

He also set me straight on the lubricant. Pen needles are coated with silicone, which apparently doesn’t evaporate, and won’t break down on the outside of the needle (although using a needle several times will rub it off). So now what’s left to break down on a pen needle? For one thing, he points out that the adhesive that holds the paper tab to the hub can’t last forever. If it were to break down, the needle would lose its sterility.

Again: Hmmmm… 

I guess to protect their tails, some sort of expiration date is needed. After all, if you got some horrible flesh-eating virus from a non-sterile decades-old pen needle that didn’t have a use-by date, BD could be liable. But is five years reasonable? Is it just a money-making choice? Or did some past research show that some element of the needles wouldn’t last much more than half a decade? 

Sorry, I don’t have an answer for that. But, hey, speaking of money, how much money is there in needles anyway? The answer is: A mind-boggling amount. The “needles market” reached 5.82 billion-with-a-B last year, and is forecast to reach 8.47 billion dollars in 2022. 

One year of needle revenue would support my diabetes in high style for the rest of my life.

Anyway, there you have it. Straight from the source of the Nile. The Needle Makers have chosen a date—perhaps by doing research, perhaps by letting the marketing department pick a date, or perhaps by putting it to the lawyers—and then have proved to themselves that their products will last that long. 

So naturally, we have to wonder: Could they, in theory, last longer? Perhaps much longer? I think that’s a fair bet, especially with pen needles, although I can see that syringes will truly “expire” more quickly.

So what do we do with all of this? Expired milk? Down the sink with it. Expired beer? I can’t tell the difference. Expired Doritos are kind of nasty, but they won’t kill you. But of course, back to diabetes, a stale blood glucose test strip might kill you. They function using enzymes that have a finite life time. Beyond a certain point, they start giving off funky readings. Likewise, liquid medications also falter over time, losing their punch. So nothing lasts forever, although you’ll never hear anyone say, “Ah heck, that bottle of Scotch is 100 years old. I guess I’d better throw it away.”

I doubt a pen needle will last 100 years, but I’d put money on it being good for more than five.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.