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Mike Hoskins / DiabetesMine

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Remember that robot named Daisy that Apple created to take apart old iPhones and recycle them, to the tune of 200 per hour? Yep, it was a big deal in the consumer tech space.

Sadly, we don’t have anything like that yet for used diabetes supplies, even though they seem to pile up like there’s no tomorrow.

While our medical devices serve a critical role of helping keep us alive and healthy, that doesn’t mean we can’t also care about the environmental impact of their many disposable parts.

Still, it can be a chore to figure out what to do with used syringes and discarded test strips, old infusion sets, empty glass vials, or the large plastic bits that come with some continuous glucose monitor (CGM) and insulin pump devices.

These all leave behind a pile of waste that mostly ends up in the trash can or recycle bin, and eventually a landfill. Thankfully, the cardboard boxes and papers inside many packages are easy to recycle at a drop site or curbside pick up, along with all our Amazon boxes and used water bottles.

But what to do with the rest of it?

The major concern with recycling diabetes supplies is, of course, the needles. The FDA refers to these as “sharps.” That’s a medical term for supplies and devices with sharp points or edges that can puncture or cut your skin.

For people with diabetes (PWDs), “sharps” are often the lancets used to poke your fingers, the syringes or pen needle tips for injecting insulin, and the CGM sensors and pump infusion sets that have tiny built-in needles to puncture your skin.

One 2010 study showed that the public health risk associated with the concern of sharps disposal was well-documented. The information led to the FDA studying the concern of reclassifying lancets as “high-risk” items back in 2016. Nothing came from that rule proposal, but it signals how concerning this is for regulators and public health officials.

Interestingly, there isn’t much clinical data on how PWDs dispose of their used medical supplies at home. Hospitals and clinics have systematic processes in place, but the fate of sharp supplies and devices mostly goes off radar once those products are used in at-home settings and ready to be discarded.

In a 2018 study, researchers found that 59 percent of PWDs disposed of their used supplies correctly, but that individuals living with diabetes for 30 or more years had the lowest rate of correct disposal. The study concluded that education by healthcare professionals on this topic is often low, but it does have the potential to increase proper disposal of used medical supplies.

You can dispose of and sometimes recycle sharps in special sharps containers, according to state and local rules.

The FDA actually has a whole website section and a Be Smart With Sharps campaign focused on safe sharps disposal. Some basics of that campaign are as follows:

  • Used sharps should be immediately placed in a sharps disposal container.
  • FDA-cleared sharps containers are generally available through pharmacies, medical supply companies, healthcare professionals, and online. These containers are made of puncture-resistant plastic with leak-resistant sides and bottom. They also have a tight fitting, puncture-resistant lid.
  • Sharps containers come in many sizes, which can be important for certain supplies such as disposable insulin pens that are longer than some standard sharps containers can hold.
  • If an FDA-cleared container is not available, a heavy-duty plastic household container, such as a laundry detergent container, can be used as an alternative.
  • DON’T USE milk jugs, soda cans, glass containers, or water bottles because they can break or puncture easily.

A few national programs, such as the nonprofit Afya, accept donations of used medical supplies. Afya states they have “rescued over 11 million pounds of usable medical supplies and equipment that would have gone to U.S. landfills.”

It’s also worth researching local used medical supply collection programs, such as ReCares in the San Francisco Bay Area in California.

Each state and even local communities have different rules in place, so here’s a guide to sharps disposal in each state.

The leftover parts from insulin pump use include the infusion sets (the piece inserted under your skin with a needle to enable insulin delivery) and the cartridges or reservoirs that hold the insulin inside the pump.

You can include most of these pieces with sharps in those waste containers. Note that the 90-degree infusion sets (said to be more comfortable for people with smaller bodies) are compatible with all tubed pump brands. They come in plastic “pods” with the infusion needle built in. While you can also dispose those in sharps containers, they are a bit bulkier and take up more space.

All that said, some insulin pump brands create more waste than others.

Medtronic and some other older, discontinued tubed pump brands have a cylinder reservoir that holds the insulin, with the infusion needle housed in a small part on top. You can dispose them both with other medical waste, but it’s the needle part that’s a sharp.

Tandem’s t:slim X2 is the only tubed pump that doesn’t use a cylinder, but instead has a slim plastic cartridge with an insulin-containing bag inside. The t:slim supplies include a syringe and needle cap used to fill the bag, the plastic cartridge, and then a separate infusion set with tubing.

None of the insulin pump companies have official recycling programs specific to their products in the United States. Insulet had a recycling program for Omnipod, but it was discontinued in 2018.

Insulet, the makers of the tubeless Omnipod pump, had a recycling program in the United States since 2008, but closed that down in 2018 because it wasn’t being used enough to be efficient, the company says.

Insulet’s “eco-friendly disposal program” was once touted as a green initiative to keep biohazardous waste out of the environment. It separated any hazardous metals and materials and “pulverized the remainder” to make the materials more biodegradable.

Omnipod users in the United Kingdom and Canada can still use the programs operating in those countries. New Omnipod users in the United Kingdom receive information in their welcome letters about the disposal program. The program states that a partner company with a sustainability focus will make sure returned pods are “safely disposed of in line with applicable waste disposal regulations,” and that the heat from incineration generates steam that helps generate heat for other purposes.

Since waste disposal regulations and environmental guidelines vary by location, it makes sense that different countries would have different programs.

But it’s a shame to see that program close down in the United States due to underuse.

One of the questions we hear most often on the recycling front relates to the popular Dexcom G6 CGM. When it was first approved and launched in 2018, the company’s leadership said they were mulling a recycling or takeback program — specifically for the new Dexcom G6 single-button plastic inserter that’s quite a bit larger than the previous version. It’s considered mixed waste, having both non-recyclable metal and plastic parts inside.

On the company’s FAQ page, the question “Is Dexcom creating a recycling program for the sensor applicator?” is met with a clear answer: No.

“At this time, we can only recommend that the user dispose of the used applicator following local guidelines for blood contacting components,” the page states.

Dexcom’s senior public relations manager James McIntosh tells DiabetesMine that there was no decision on a potential takeback program for the Dexcom G6. But the upcoming Dexcom G7 model expected in 2022 will have a new fully-disposable form factor with a smaller sensor and transmitter, as well as a new auto-inserter.

That means it’ll reduce the volume of plastic and packaging by more than 25 percent compared to the Dexcom G6, he explains, adding: “In the long-term, Dexcom is committed to being good stewards of the environment while providing the best possible products for our customers.”

Meanwhile, lots of Dexcom users are concerned about recycling G6 parts as much as they possibly can, especially the bulky G6 insertion device.

In our first-ever Dexcom G6 review, DiabetesMine editor Amy Tenderich observed: “There’s a lot of ‘bot’ left to throw in the garbage… and given that it’s no longer clear plastic, it just feels very environmentally unfriendly.”

On various social media platforms, people in the diabetes community have shared their best ideas for disposing of and recycling the CGM:

  • They should definitely not go directly into the trash or recycling bin as-is, because of the used needle (sharp) inside. While it is self-contained, the plastic auto-inserter can still come apart and be dangerous to people picking up the recycling or coming into contact with it later on.
  • One option is collecting them over time, and then dropping them off in bulk at a local sharps container facility that can process them accordingly.
  • You can also take apart the G6 auto-inserter, using a screwdriver and pliers to separate the white and gray plastic parts and take out the sharp needle inside. You can put the sharper metal items into a sharps container, and recycle the rest of the plastic.

D-Mom Katie DiSimone from California disassembles each of her daughter’s used Dexcom G6 inserters. “I recycle as much as I can. It’s just overwhelming how much waste comes with those things and imagining it all over a lifetime makes me want to at least recycle where we can’t reduce or reuse,” she tells DiabetesMine.

Scott Paradis, a software developer who lives with type 1 diabetes (T1D) and has an industrial design background, broke open his own Dexcom G6 insertion device too. He was disappointed to learn that the design was not recycle-friendly. “Their choice of plastics, which appear to include nylon and polystyrene, are rarely recyclable in municipal programs,” he explains.

Despite the many brands of diabetes devices and supplies out there, the above-mentioned efforts by Insulet and Dexcom are the only industry-created concepts we identified.

Fellow PWDs have praised the design of Medtronic Mio infusion sets that seem almost made to be properly disposed of, compared to everything else out there.

Paradis says: “I give Medtronic credit with their Mio design. It functions as both packaging and the insertion device with a living spring built into the device made entirely of recyclable plastic. The waste is limited to a very small amount of cellophane and the infusion tubing itself which is discarded after use. Only a small insertion needle and the infusion site cannula would be biohazard waste. Almost the whole product is manufactured from polypropylene, which is a very widely recycled plastic.”

Paradis notes that the Mio sets actually have a recycling symbol stamped on them to indicate they are 95 percent recyclable, as long as the needle is removed.

Clearly there is a desire among PWDs to be environmentally conscious, and a willingness to get creative to do so.

“The sheer amount of waste generated is hard to ignore,” Paradis says. “While I have little choice in the types of supplies necessary to manage my condition, I can still be proactive in minimizing my waste footprint.”

In #WeAreNotWaiting diabetes DIY groups online, you can regularly find tales of people who’ve donated old transmitters and sensors to fellow experimenters to reuse for testing and building purposes.

Regarding sharps disposal, we’ve also seen pictures and heard stories from around the D-Community of crafting homemade disposal vessels, from thicker jugs to juice containers, many of which are of clear plastic with handwritten labels marking “sharp medical supplies” inside.

“Diabetes supply animals”

Some keep their old supplies for use in creative holiday decorations, to make festive holiday ornaments or light-strands to brighten the mood at certain times of year.

Others get crafty in using old insulin vials as an artsy way to mark diabetes anniversaries or other notable D-moments that they can display as part of their insulin affordability advocacy.

Of course, we can’t forget Diabetes Art Day, a fun online effort some years ago in which the community collectively used old diabetes supplies to create their artwork relating to life with diabetes. That was a great way to inspire folks to use old test strips and various supplies in a positive, expressive way.

In the end, we have to make due with the options at hand when it comes to disposing of these used supplies. Unless our resourceful diabetes DIY community comes up with a better way — like our Daisy recycling robot to do it for us?