- There are about 29 million Americans known to have one of the two types of diabetes. The 1.25 million people in the US who have Type 1 diabetes – an autoimmune disease – need to inject insulin to live.
- Insulin differs by type, depending on how quickly it gets absorbed, how long it lasts, and when it peaks, according to the American Diabetes Association.
- Insulin has gone through modifications over the years, but the newer analogue form, which has quicker onsets and can be more quickly absorbed, comes at a higher cost than the older, human insulin.
- Switching types of insulin can be dangerous if not done properly, and people should talk with a doctor about dosing before doing so.
- Visit INSIDER’s homepage for more stories.
The death of a man with Type 1 diabetes who had switched from a $US1,200-a-month prescription insulin to a $US25 per vial, over-the-counter insulin highlights a little-discussed aspect of the autoimmune disease: switching types of insulin can be dangerous if not done properly.
There are about 29 million Americans known to have one of the two types of diabetes. The 1.25 million people in the US who have Type 1 diabetes need to inject insulin to live.
Among them was Josh Wilkerson, a dog kennel supervisor who died in June after falling into a vegetative state. His family said he had multiple mini-strokes and fell into a diabetic coma after switching to an affordable $US25-per-vial insulin in order to save money for his wedding. In most states, the insulin, known as ReliOn, is available over the counter at places like Walmart. People with diabetes generally require one to six vials a month, and the option was far cheaper than the $US1,200-a-month insulin he had been prescribed.
A healthy body would normally produce insulin, but for those with Type 1 diabetes, the body kills the cells used for its production. Insulin differs by type, depending on how quickly it gets absorbed, how long it lasts, and when it peaks, according to the American Diabetes Association. Switching types has to be done with care to ensure it works for a patient.
Not all insulin is the same
Insulin has gone through several modifications over the years. The newer analogue form, which has quicker onsets and can be more quickly absorbed, comes at a higher cost, forcing many people to use an older, over-the-counter form of the drug, known as human insulin.
Human insulin (or synthetic insulin) mimics insulin in humans, and starts working about half an hour to four hours after injection. Human insulin takes more time to become effective than the prescribed “analogue” insulin. Analogue insulin is genetically altered to create more rapid-acting and uniform-acting insulin. It starts acting around 20 minutes after injection and lasts four hours.
While Walmart sells a Novolin insulin branded ReliOn for $US25, other types of human recombinant insulin are increasing. Humulin R was sold for $US40.65 per 10mL vial in 2009. It now goes for $US148.70, marking an 265% increase. With Novolin R, a 10mL vial sold for $US41.06 in 2009. It now sells for 137.70, marking an 235% increase.
Nes Mathioudakis, an endocrinologist and associate professor of medicine at Johns Hopkins School of Medicine, told INSIDER that human insulin is still used for patients unable to afford analogue insulin.
He said the key to safely switching from analogue to human insulin is to speak with a doctor.
“You have to have a clear conversation about how the medications differ,” he said. “How do you take the human meal-time insulin as opposed to what the patient was taking before.”
Getting the proper dose of insulin is crucial for people with diabetes
Unlike medicines like over-the-counter pain medication ibuprofen, taking one brand of insulin is completely different from another.
For people living with diabetes, getting the proper dose of insulin at the right time is crucial for glucose at the right level.
“We can’t make a uniform recommendation because every patient had a different blood-glucose profile, but the considerations are making sure you understand what the new type of insulin is replacing, how to convert the dose, and when to take it,” Mathioudakis told INSIDER.
According to the ADA, many factors can affect blood-glucose levels, including diet, exercise, illness, stress, and where and when insulin is injected.
“I was lucky during my run of high blood sugars and did not end up in diabetic ketoacidosis”
Mary Williams, a Texas-based diabetes advocate who was diagnosed with Type 1 in 1993, told INSIDER that she has had first-hand experience with insulin changes.
She first started using analogue insulin in 1996, but after a job change in 2009, she went back to human insulin because she didn’t have health insurance and she couldn’t afford the high price of analogue.
Nine months into using human insulin, she forgot to eat on a busy day. While taking a nap before work, she went into a severe hypoglycemic episode because her blood sugar had dropped so low her brain started haemorrhaging.
Six months later she was able to get back on health insurance and start using analogue insulin again.
But in 2015, she found herself in a similar situation during another job switch. Unable to afford an endocrinologist, she did the switch to human insulin on her own.
Two months later, she had another severe hypoglycemic episode. She had been waking up at 3 a.m. to check her blood-glucose levels nightly to ensure she wouldn’t crash while sleeping, but one night she turned off her alarm without checking her blood-glucose levels.
“It was our dachshund who woke my husband up by standing on his chest. He thought she needed to go outside, but when she wouldn’t get off the bed and leave my side he became concerned. He said he walked over to my side of the bed and felt my arm. I was starting to go into seizures. I was drenched in sweat and my body was extremely stiff,” she said.
Her husband called 911, and EMTs found her blood-glucose level was at 32 mg/dL. The US National Library of Medicine reports that anything below 70 is dangerous, and anything lower than 54 is cause for immediate action.
“I was lucky during my run of high blood sugars and did not end up in diabetic ketoacidosis (DKA),” she told INSIDER.
Ken Inchausti, a spokesman for Novo Nordisk, which sells human insulin at affordable, over-the-counter rates, told INSIDER that human insulin “is safe and effective and is used by millions of Americans who depend on it for the treatment of type 1 and type 2 diabetes.”
“This tragic story highlights the need for education concerning the appropriate use of human insulin. It also demonstrates that all insulins are not interchangeable without medical supervision and that any change in medication, including insulin, should be done under the supervision of a healthcare professional,” he said.
- Read more:
- Outrage over the cost of the life-saving drug insulin has drugmakers scrambling, but Congress and the public demand a price cut
- For people with diabetes struggling to buy lifesaving insulin, a major health company is now offering the drug for just $US25 a month
- 23andMe can now tell you your risk of developing diabetes, based on your DNA. Here’s what doctors want you to know.
- Many diabetics struggle to afford insulin and there’s little the US can do to regulate skyrocketing prescription drug prices