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I still don't understand why insulin is so regulated and expensive in US. I feel sorry for people with Type 1, Type 2 who many a times have to skip their insuli

I still don't understand why insulin is so regulated and expensive in US. I feel sorry for people with Type 1, Type 2 who many a times have to skip their insulin dose. I think it should be freely available over the counter and there should be some cheap availability for such a common drug.

maxerickson 10y ago
Walmart sells older forms over the counter. http://www.npr.org/sections/health-shots/2015/12/14/459047328/you-can-buy-insulin-without-a-prescription-but-should-you http://www.npr.org/sections/health-shots/2015/12/14/45904732... Pricing info isn't super apparent, I guess it probably isn't a whole lot more than the $25 a vial suggested in various articles and comments about it.
- aab0 10y ago
  It's not. I'm not diabetic, but there's some interesting research on intranasal insulin and cognition, so I thought I might try it out. At my local east coast Walmart, I bought on March 13th 2016 a 10ml vial of Novolin R insulin for $24.88. (No prescription required.)
  - monkmartinez 10y ago
    > intranasal insulin and cognition Please elaborate...
    - aab0 10y ago
      "Effect of intranasal insulin on cognitive function: a systematic review", Shemesh et al 2012 http://press.endocrine.org/doi/full/10.1210/jc.2011-1802 http://press.endocrine.org/doi/full/10.1210/jc.2011-1802 https://www.researchgate.net/profile/Assaf_Rudich/publication/51871998_Effect_of_Intranasal_Insulin_on_Cognitive_Function_A_Systematic_Review/links/53d20c620cf2a7fbb2e96305.pdf https://www.researchgate.net/profile/Assaf_Rudich/publicatio...
- jawngee 10y ago
  Yeah that's the old school NPH variety. While you can certainly manage with it, you'll not manage well. Modern diabetes management includes either pumping or multiple daily injections (MDI). With MDI, you use a long acting insulin as a basal, or background, insulin. And then you'll use a rapid insulin to bolus for meals and to make corrections for unexpected spikes. The pump is similar to MDI but you only use rapid insulin and the pump delivers a steady basal stream throughout the day, and you still bolus at meals and for unexpected spikes. These two things allow diabetics to eat whatever they want. We did the old school way for the first few weeks because that's the only way the doctors in Vietnam knew how to do it. It really sucked numbers wise.
jacalata 10y ago
It seems relatively defendable - it is far, far more dangerous than many prescription only drugs (eg: birth control), and most people will not be able to work out how much they need without seeing a doctor first.
- brudgers 10y ago
  My understanding is that Dana Lewis developed the pre-cursors to OpenAPS because she had to perform dosage calculations several times a day. Often this was in the middle of the night. And getting it wrong could be fatal. Going further, the calculations are rule of thumb and generic and each person has to make adjustments based on intuitions about their metabolism, what they ate, what they plan to eat, what activity they anticipate, and when they last dosed. It's every day, for the rest of their life. [Source] Scott Hanselman interviews OpenAPS hacker Dana Lewis: http://www.hanselminutes.com/514/the-open-artificial-pancreas-system-openaps-project-with-dana-m-lewis http://www.hanselminutes.com/514/the-open-artificial-pancrea...
  - jacalata 10y ago
    Yes, I have lived with relatives with diabetes and understand that it's quite complex. I don't think anyone with diabetes would suggest that it should be ok to just start taking insulin without a doctor involved, which is (to my understanding) the basic argument for whether a drug should require a prescription or not. You can make a separate argument about whether it should be a longer prescription, or about the failings of a system where seeing a doctor at all is prohibitive for some people, or the fact that the medication is outrageously expensive (which is not directly related to the need for a prescription at all).
  - deleted 10y ago
    [deleted]
- kennywinker 10y ago
  Birth control is a bad example, because as far as I can find it's prescription only for sex-negative cultural reasons, not for medical reasons. It is exceedingly easy to overdose on tylenol, and yet it's available without any controls.
tdeschamps 10y ago
Maybe it's because the production process (protein separation, purification) has not been improved for a long time and the market is controlled by two big drug makers.
robobro 10y ago
Thank you... Insulin is very expensive: more than my rent, just to stay alive, even with insurance :(

maxerickson 10y ago

Walmart sells older forms over the counter. http://www.npr.org/sections/health-shots/2015/12/14/459047328/you-can-buy-insulin-without-a-prescription-but-should-you http://www.npr.org/sections/health-shots/2015/12/14/45904732... Pricing info isn't super apparent, I guess it probably isn't a whole lot more than the $25 a vial suggested in various articles and comments about it.

aab0 10y ago
It's not. I'm not diabetic, but there's some interesting research on intranasal insulin and cognition, so I thought I might try it out. At my local east coast Walmart, I bought on March 13th 2016 a 10ml vial of Novolin R insulin for $24.88. (No prescription required.)
- monkmartinez 10y ago
  > intranasal insulin and cognition Please elaborate...
  - aab0 10y ago
    "Effect of intranasal insulin on cognitive function: a systematic review", Shemesh et al 2012 http://press.endocrine.org/doi/full/10.1210/jc.2011-1802 http://press.endocrine.org/doi/full/10.1210/jc.2011-1802 https://www.researchgate.net/profile/Assaf_Rudich/publication/51871998_Effect_of_Intranasal_Insulin_on_Cognitive_Function_A_Systematic_Review/links/53d20c620cf2a7fbb2e96305.pdf https://www.researchgate.net/profile/Assaf_Rudich/publicatio...
jawngee 10y ago
Yeah that's the old school NPH variety. While you can certainly manage with it, you'll not manage well. Modern diabetes management includes either pumping or multiple daily injections (MDI). With MDI, you use a long acting insulin as a basal, or background, insulin. And then you'll use a rapid insulin to bolus for meals and to make corrections for unexpected spikes. The pump is similar to MDI but you only use rapid insulin and the pump delivers a steady basal stream throughout the day, and you still bolus at meals and for unexpected spikes. These two things allow diabetics to eat whatever they want. We did the old school way for the first few weeks because that's the only way the doctors in Vietnam knew how to do it. It really sucked numbers wise.

jacalata 10y ago

It seems relatively defendable - it is far, far more dangerous than many prescription only drugs (eg: birth control), and most people will not be able to work out how much they need without seeing a doctor first.

brudgers 10y ago
My understanding is that Dana Lewis developed the pre-cursors to OpenAPS because she had to perform dosage calculations several times a day. Often this was in the middle of the night. And getting it wrong could be fatal. Going further, the calculations are rule of thumb and generic and each person has to make adjustments based on intuitions about their metabolism, what they ate, what they plan to eat, what activity they anticipate, and when they last dosed. It's every day, for the rest of their life. [Source] Scott Hanselman interviews OpenAPS hacker Dana Lewis: http://www.hanselminutes.com/514/the-open-artificial-pancreas-system-openaps-project-with-dana-m-lewis http://www.hanselminutes.com/514/the-open-artificial-pancrea...
- jacalata 10y ago
  Yes, I have lived with relatives with diabetes and understand that it's quite complex. I don't think anyone with diabetes would suggest that it should be ok to just start taking insulin without a doctor involved, which is (to my understanding) the basic argument for whether a drug should require a prescription or not. You can make a separate argument about whether it should be a longer prescription, or about the failings of a system where seeing a doctor at all is prohibitive for some people, or the fact that the medication is outrageously expensive (which is not directly related to the need for a prescription at all).
- deleted 10y ago
  [deleted]
kennywinker 10y ago
Birth control is a bad example, because as far as I can find it's prescription only for sex-negative cultural reasons, not for medical reasons. It is exceedingly easy to overdose on tylenol, and yet it's available without any controls.

tdeschamps 10y ago

Maybe it's because the production process (protein separation, purification) has not been improved for a long time and the market is controlled by two big drug makers.

robobro 10y ago

Thank you... Insulin is very expensive: more than my rent, just to stay alive, even with insurance :(