We read with interest the article by Berne et al. (1), which confirms our own observations on the effect of syringe dead space on the proportions of insulins delivered (2). Their values for annual insulin wastage when syringes with separate needles (64 ml) and fixed needles (8 ml) were used are much larger than ours (45 and 1.6 ml, respectively). This may simply reflect the type of syringe used, but the message is the same. The potential wastage is great. In Britain, patients are routinely advised to reuse "disposable" syringes as often as possible (a practice shown to be both safe and economical; 3,4), with the result that insulin retained in the dead space may be included in the next injection. Although this reduces wastage, it may have unpredictable effects on the proportions delivered.The authors quote work that suggests that elderly patients in particular may deliver very inaccurate total doses of insulin (5,6), which may in turn affect glycemic stability. We asked 100 patients to draw up their usual morning mixture of insulins on five occasions and assessed the accuracy and reproducibility of the total dose and proportions drawn up. Eighty of these patients were using syringes with separate needles. We found that 94 patients delivered their total dose within 10% of the intended dose (and 77 within 4%), whereas the median proportion of the second insulin delivered was 2% less than intended (95% confidence limits + 8 to -10%). The total dose was delivered with a C.V. of <5% by 87 patients and the proportions given were also highly reproducible. Whereas inaccuracy of total dose administered is more likely to be of clinical importance when another person takes over a patient's insulin administration, poor reproducibility might be expected to produce day-to-day variation in circulating insulin levels. However, when compared with a typical intraindividual C.V. of 25% for the half-time of insulin absorption (7,8), our results suggest that variation of administered insulin dosage or ratio is probably not an important cause of diabetic instability.