Insulin – The Life or Death Drug With Costly Consequences
The diagnosis of type 1 diabetes (previously known as juvenile diabetes) used to be a death sentence. Literally. Prior to 1923, the onset of type 1 diabetes meant death anywhere within a few days to a few months as there was no cure and no treatment. One doctor discovered he could prolong the lives of children with the disease up to a year by putting them on a starvation diet. Yes, starving them. Wards of 50+ children lying in comas from diabetic ketoacidosis (DKA) were common. But the discovery of insulin in the ’20s, and then the refinement of it to its current standards in the 1980s (yes, you read that correctly – modern insulin was not available until the 1980s), has allowed countless millions to live long, fulfilling lives. Albeit with the inconvenience for most of finger pricks and needle sticks.
Maintaining Blood Glucose Levels
Typically, a type 1 pricks a finger between 7 and 9 times a day to test their Blood Glucose (BG) levels, and get a fast-acting insulin shot around 6 times a day in addition to their one or more long-acting insulin dose(s). If a type 1 doesn’t test their BG on a regular basis, they could go too high or too low. According to the Juvenile Diabetes Research Foundation, “Severely low blood-sugar levels can lead to hypoglycemic seizures, unconsciousness, coma, and death if left untreated. Regular high blood-sugar levels over time can lead to complications including blindness, heart disease, kidney failure, and amputation.
Breaking the Bank
The cost of insulin has gone up 200% in the past 4 years. Why? Unfortunately, nobody has a good answer to that. According to a report by the Health Care Cost Institute, the price of a 100 ml vial of insulin doubled between 2012 and 2016 and they continue to rise while pharmaceutical companies continue to show consistently huge profits. This drug has been around for almost 100 years, and the formula has changed very little in that time. There does not seem to be a good reason for the price other than “because they can.”
Imagine depending on this drug every single day of your life, but you don’t have insurance, or you have inadequate insurance. You now have to pay for insulin and all the necessary supplies that go with it out of pocket or with high deductibles because NOT having insulin is not an option. And while some manufacturers offer coupons and discounts to help people in financial hardship, these programs are often short-term.
“Insulin Belongs to the World…”
It should be noted the three original American insulin patents were sold to the University of Toronto for $1 each. The scientist who discovered insulin, a researcher at the University, wanted to be sure it would be affordable for everyone who relies on it. In 1923, when asked why he sold the patents so cheaply, Dr. Banting said, “Insulin belongs to the world, not to me.” It should be noted insulin is available over-the-counter in Canada, meaning you do not need a prescription for it. It is also significantly less expensive; for example, website PharmacyChecker.com noted in a blog post in 2017 that “The price in Canada for a three-month supply of Lantus Solostar (3 ml) is currently around $447.00 while the average retail price in the U.S. is a staggering $1,160.39.” Is it any wonder Americans are gassing up the car and driving north for their prescriptions?
It’s Not About Diet Choices
You may think a diabetic can simply change their eating habits to reduce their dependence on insulin. Stay away from sugar and carbohydrates. While this is may be true for many type 2 diabetics, type 1 is completely different. A person with type 1 has to have prescription insulin every day to stay alive. Their pancreas does not produce any insulin. None. Any glucose within the body is therefore not used properly by the cells to produce energy. This can lead to a condition known as Diabetic Ketoacidosis (DKA), which can lead to the kidneys shutting down, coma, and ultimately death.
Everyone Needs Insulin
So, let’s assume a type 1 goes on a starvation diet in an effort to help ration their insulin because it has become too costly. The liver believes the body is in starvation mode and therefore produces glucose. This actually happens for most people, and it’s called the “dawn effect” – you’ve been asleep for around 8 hours, not consuming any energy-producing foods, and your body needs a kick-start to get out of bed and begin the instinctual search for food, so hormones within the liver give you that little glucose boost. This happens in diabetics as well. However, they don’t have the insulin which helps cells convert that glucose into energy. So if they go for long periods of time without eating anything, their bodies are still producing sugars which are entering the bloodstream and damaging the kidneys which then have to work overtime to dilute the sugars.
Go to Bed Hoping to Wake Up
As you can imagine, the routine of these patients involves lots of other products besides just insulin. They have to purchase one-time-use items like syringes or insulin pen tips, blood testing supplies, and emergency glucose items. There have been reports of type 1s reusing syringes and pen tips. These are not items designed to be re-used and it is, therefore, dangerous to engage in this type of rationing. Many also do not follow their prescribed ratios, cutting back to dangerous levels in order to stretch a vial, or using expired insulin so none is “wasted”. A recent federal worker who had been furloughed during the recent government shutdown, and who is diabetic, told CNN’s Anderson Cooper ‘she resorted to rationing her insulin medication because “the thought of having more debt was scarier than the thought of dying” in her sleep.’
US Pharmaceutical companies need to provide a solid explanation for keeping this essential and life-saving medication priced out of reach for many of those struggling with a condition over which they had no choice. Type 1 diabetics have enough tough choices to make every day. Whether or not they pay for their medication or pay their other bills shouldn’t have to be one of them.
March 12, 2019 at 6:37 am, Nicki Hammond, RN said:
The cost of insulin and its availability, or should I say “non availability” at a reasonable cost or even FREE infuriates me!! But Narcan for drug addicts is FREE because addiction is a disease. Makes NO sense. Eli Lilly announced yesterday a multimillion dollar expansion of their insulin production and research area.
March 14, 2019 at 5:04 am, DEBORAH A BOUCHARD said:
I so agree. My mom lost her weight watches her diet and still is followed by her doctor but isn’t taking insulin anymore. She isn’t perfect but it does work if you are followed by your doctor. She couldn’t afford the prices of insulin. She paid over a 1,000 at one point on how they did her medical insurance. It was ridiculous. But Narcan is free. Something is wrong
March 12, 2019 at 6:43 am, tamara said:
This situation does not speak well for our pharmaceutical companies or this country. It states that greed that rules over compassion.
March 12, 2019 at 7:28 am, Joe said:
I would hope the FDA allows insulin OTC to bring the price on par with Canada, assuming the price north of the border is not subsidized (I suspect some hideous form of drug abuse is a concern down here). I would also hope the companies are re-investing their profits to find an improved insulin or an actual cure for type 1.
March 12, 2019 at 7:45 am, ZebBlanchard, AEMT said:
I volunteer in a local free clinic. It is not uncommon for our DM1 patients to run out of insulin for lack of funds to buy it. They have become so hyperglycemic that we can’t measure their BGL (off scale on the meter) and must be sent to the Emergency Room. This is very dangerous for the patient and yet another example of Big Phama passing on health care expenses to the general population.
March 12, 2019 at 9:43 am, Mary Kauffman said:
Type 1 Diabetes is a horrible dibilating disease. To see your child suffering with this and knowing that it can only get worse because of the greed with the pharmasudical companies is discusting. I pray for all who suffer this horrible condition. 🙁
March 12, 2019 at 10:28 am, shirley foucher said:
This is not only horrible but an embarrassment to the United States.
What can be done to change this? There must be something we can do collectively to expose the greed of big pharm.
March 12, 2019 at 11:04 am, KC Greuter LT. EMS (ret) said:
The FDA has to step in and help regulate the prices for all drugs!
Also our Senators and Representatives must stop taking MONEY from the Pharmaceutical Companies!!!
This is something that should be INVESTIGATED!!!
March 12, 2019 at 11:50 am, Carl said:
Very good article. I guess I will have to move to Canada if I want to live after retirement.If they Canada, will let me in considering the current US relationship with Canada.
Can’t believe that there is no help from our government with this situation.
March 20, 2019 at 10:54 am, Patricia Galloway said:
I am a type 1 diabetic, diagnosed in 1960. I almost lost my life because so little was known at that time about diabetes. I am now 65 years old and still can not afford Lantus, humalog, or any of the insulins that are available in the pens which are so much easier to use. I buy my insulin at Walmart, Novolin N and Novilin R for 25.00 a vial twice a month. There were times when I had to take half doses because my financial situation did not allow me to purchase my insulin. Even Medicare does not pay for your insulin, only your testing supplies. It is terrible that the United States has let this problem go on for so long. I am blessed to still be alive. I was told at the age of 9 that I would probably not live past 30. It is really a shame that this health problem is not taken care of with more care and awareness. I have seen many of my friends and their children die from DMI and it infuriates me. This is AMERICA!!