Living with diabetes blog

Insulin: Weighing the costs of technology

By Nancy Klobassa Davidson, R.N. and Peggy Moreland, R.N., C.D.E. July 31, 2013

I recently met with a group of professionals representing a variety of health care companies and organizations that are looking at innovations to develop new models of care for people with diabetes. At this gathering, I was asked my opinion about the use of regular (short-acting) and NPH (intermediate-acting) insulin. My response was that I recommend the use of regular and NPH insulins for people for whom the cost of using analog rapid-acting and long-acting insulins is too high.

Let's face it, diabetes is an expensive disease, but the key to diabetes management is controlling your blood sugar level to prevent long-term complications. Because of the expense, I've seen people with diabetes ration their insulin or go without it to make an insulin vial last longer, thus negatively affecting their blood glucose control and, ultimately, their overall health and survival.

A vial of a brand name rapid-acting insulin analog (NovoLog, Humalog, Apidra) can cost up to five-times as much as a vial of short-acting regular insulin, which can be used instead. I recently met with an uninsured individual who uses an insulin pump. She was spending 1,000 dollars a month out-of- pocket for rapid-acting insulin for her pump and was able to save approximately 800 dollars a month by switching to regular, short-acting insulin. Similarly, a cheaper alternative to a long-acting insulin analog is an intermediate-acting insulin (NPH insulin).

Rapid-acting and long-acting analog insulins do have advantages over regular and NPH insulins. Rapid-acting insulin analogs give better coverage for meals; whereas regular insulin (originally named "fast") has a slower action that doesn't match the post-meal response as well as the rapid-acting insulin.

Long-acting insulin analogs (Lantus and Levemir) are very efficient at providing a slow, even release of basal or background insulin. NPH intermediate-acting insulin can be substituted for a long-acting insulin but is shorter acting, has a significant peak, and probably needs to be given in two daily doses.

The bottom line is that although the rapid-acting and long-acting analog insulins offer advantages, if their cost makes them out of reach, you can work with your doctor to adapt a number of specific insulin programs using regular and NPH insulin, instead. These programs will require you to be more regimented with your meal times, and eat meals 4 hours to 5 hours apart.

Some insulin companies may also have financial assistance programs with specific qualifiers.

Have a great week and regards,

July 31, 2013