Supply shortages
Pharmacy out of your insulin or sensors on backorder. Why a reorder point beats a reorder date, who to ask in what order, and the one thing never to do.
Supply problems happen: a pharmacy without your insulin, a sensor on backorder, a pen type discontinued. It is stressful in a way most medication shortages are not, because insulin is not optional and there is no waiting it out. There is a route through it, and it starts earlier than most people start.
- Order early. A buffer of a couple of weeks turns a shortage from an emergency into an inconvenience.
- Your pharmacist is the first call, not the last. They know what is actually available and can often source it.
- An equivalent product may exist, but swapping insulin brand or type is a prescribing decision, never a substitution to make yourself.
- Never ration insulin to make a supply last. That leads to ketones, and there are better routes long before it comes to that.
- If you are genuinely close to running out, say so plainly to the pharmacy or your team. This is an urgent problem and they treat it as one.
- A switch to a different product can move glucose either way, up or down, so a hypo is possible at the time or shortly after, and again hours later including overnight. That is another reason the change is made with your team.
Why ordering early does most of the work
Almost every supply crisis is a timing problem rather than an availability problem. If you reorder when you open your last pen, a delay of a week becomes a genuine emergency. If you reorder with a fortnight in hand, the same delay is something you barely notice, and the pharmacy has time to order it in.
So the single most useful habit is a reorder point rather than a reorder date: a level of stock at which you request more, regardless of how long it has been. It survives holidays, bank holidays, forgotten weeks and a surgery that takes days to process a request, all of which are ordinary rather than exceptional.
The same applies to everything else, not just insulin. Sensors, test strips, pump sets and ketone strips all run out, and a sensor arriving late is a different problem but still one worth not having. Ketone strips are the most commonly forgotten, because you only need them when things are already going wrong.
Who to ask, in what order
Start with the pharmacist. They know what is in the wholesaler system, what is on shortage nationally, and what equivalent products exist, and they can often order something in for a day or two later or point you to a branch that has it. Ringing round yourself is slower and less informed than asking the person with access to the ordering system.
If the exact product is unavailable, an equivalent may exist, and in some national shortages there are formal arrangements that let pharmacists supply an alternative without a new prescription. What matters is that any change of insulin type or brand is a clinical decision: different insulins are not interchangeable unit for unit, and switching without your team involved is where this becomes dangerous rather than annoying.
Then your GP surgery for the prescription itself, and your diabetes team if a product change or a longer shortage is involved. Say clearly how much you have left, because “I am nearly out of insulin” is treated very differently from a routine request, and understating it does not help you.
The one thing not to do
The instinct when a supply is short is to make it last, and with insulin that instinct is dangerous. Taking less than you need lets glucose and ketones climb, and it leads toward DKA rather than toward buying time. Insulin is not a medication where a reduced amount is a reduced version of the same thing.
There are always steps before that point, and they are worth taking early rather than late: the pharmacist, an equivalent product, a different branch, an urgent prescription, and out of hours services if it is a weekend. Emergency supplies exist, and pharmacists can supply insulin in an emergency in some circumstances, which is exactly what those arrangements are for.
If you find yourself weighing up how to stretch what you have, that is the moment to tell someone rather than to work it out alone. That is not an overreaction, it is the situation the urgent routes are built for.
What makes shortages harder
Less common products are affected more often and take longer to source. Bank holidays compress everything, so a late-December request is a different proposition from a mid-March one. And a repeat prescription that has lapsed for review is a very common reason for a delay that feels like a shortage and is actually an administrative gap you can pre-empt.
How it plays out
Examples, not instructions or doses.
Your pen type is out of stock for a week. You have a fortnight in hand, the pharmacy orders it, and it is a phone call rather than a crisis.
The prescription needs a review before it can be reissued, so nothing is wrong with supply at all. Two days lost to an administrative step nobody flagged.
Three days of insulin left and the pharmacy cannot get it. That is a say-it-plainly moment: to the pharmacist, to the surgery, and to your team, because urgent routes exist for exactly this.
When it's urgent
Never take less insulin than you need to make a supply last. Reducing or skipping insulin lets glucose and ketones climb and leads toward DKA, which is a medical emergency. If you are close to running out, tell your pharmacist and your diabetes team plainly, and use out of hours services if it is a weekend. If you have high glucose with ketones, are being sick and cannot keep fluids down, or feel very unwell, contact your team or call NHS 111. If you are drowsy, confused or breathing very fast, call 999.