6 minute read
DIABETES NEWS
IS HUMAN INSULIN (WALMART INSULIN) SAFE FOR YOU?
By H. Kaan Akturk, MD and Viral N. Shah, MD
The discovery of insulin during the summer of 1921 by Banting, was one of the most influential discoveries in medical history. It has saved lives of millions of people living with diabetes around the world. In 1923, Banting, Collip, and Best sold the patent to the University of Toronto for $1 in a hope that insulin will be accessible and affordable to all who need it. Now, insulin is one of the costliest life-saving medications in the USA. Unfortunately, many deaths have been reported due to lack of availability or unaffordability of insulin around the world.
Currently, we are living in an unprecedented time where a novel coronavirus (SARS-CoV-2) had already infected 1.3 million people in the USA and resulted in more than 80,000 deaths at the time of writing. An unintended consequence of preventing the spread of this virus has resulted in more than 24 million people losing their job. This resulted in a great toll on people living with a chronic condition such as type 1 diabetes. Many questions have been raised on insulin affordability during this time and many people are wondering about the use of older insulins such as human insulin (e.g. Walmart ReliOn insulin) to reduce their insulin cost. In this review, we intend to provide details on different types of insulin preparation and how they are different and some common questions you may have around human insulin use.
WHAT ARE THE DIFFERENT TYPES OF INSULIN AVAILABLE IN THE MARKET?
After the initial discovery of insulin by Banting and Best, Insulin was purified from animal pancreas (cows and pigs), commonly known as Bovine or Porcine insulin. These insulins are no longer available in the market.
In early 1970, researchers made insulin from E.Coli (a type of bacteria) using recombinant DNA technology. These insulins are like human insulin. Examples of these types of insulin are Humulin-R (Regular insulin) and Humulin-N (N stands for NPH, intermediate-acting insulin), Novolin-R, and Novolin-N.
Human insulins were not perfect, and they have unpredictable absorption. Therefore, scientists have modified amino acid sequences to develop rapidacting and long-acting insulin called as insulin analogs. Examples of insulin analogs are Lantus, Levemir, Tresiba, Toujeo, and Basaglar.
DIABETES NEWS
Insulin analogs are different from human insulin in many ways such as they have different onset and duration (see the table below). Therefore, human insulin-R should be taken 30-40 minutes prior to meal (depending on blood glucose level) compared to analogs that you can take 15-20 minutes prior to meal. Also, the absorption is unpredictable with human insulin compared to insulin analogs, and therefore, human insulin is associated with increased risk for low blood sugar in type 1 diabetes.
HUMAN INSULIN
NPH (N) Regular (R) Premixed 70/30 N/R
ANALOG INSULINS
Detemir Glargine Degludec Lispro Aspart Glulisine Premixed 70/30 or 75/25
Onset
2-4 h 30-50 min 30-50 min
3-4 h 2-6 h 1-2 h 5-15 min 5-15 min 5-15 min 5-15 min
Peak
4-10 h 2-3 h 2-6 h
3-9 h none none 30-90 min 30-90 min 30-90 min 2-4 h
Duration
12-18 h 8-10 h 12-18 h
18-22 h 20-24 h 40-45 h 4-6 h 4-6 h 4-6 h 14-24 h
DIABETES NEWS
WHAT IS THE COST PER VIAL OF HUMAN INSULIN VS INSULIN ANALOG? As of May 2020, we searched the retail price of different insulin (U-100) on Good Rx website. Cost of various insulin per vial is provided in Table below. increased risk for low blood sugar in type 1 diabetes.
Brand name of insulin INSULIN ANALOGS
Humalog, Generic Humalog, Brand Novolog, Generic Novolog, Brand Admelog, Generic Apidra, Brand Afrezza, Brand Levemir, Brand Lantus, Brand Basaglar, Generic Toujeo, Brand Tresiba, Brand
HUMAN INSULIN
Humulin N Humulin R Humulin 70/30 Novolin N Novolin R Novolin 70/30 ReliOn insulin-R and N
Scientific name/ Company
Insulin Lispro, Eli Lilly Insulin Lispro, Eli Lilly Insulin Aspart, NovoNordisk Insulin Aspart, NovoNordisk Insulin Lispro, Sanofi Insulin Glulisine, Sanofi Technosphere inhaled insulin, Mannkind Insulin Detemir, NovoNordisk Insulin Glargine, Sanofi Insulin Glargine, Eli Lilly Insulin Glargine, Sanofi Insulin Degludec, NovoNordisk
Eli Lilly Eli Lilly Eli Lilly NovoNordisk NovoNordisk NovoNordisk They are manufactured by NovoNordisk and same as Novolin R and N.
Cost per vial #
$165 $324 $174 $310 $146 $378 $347 (90 cartridges of 4 units) $330 $315 $390 (5 pens)* $324 (3 pens)* $599 (5 pens)*
$179 $172 $173 $25 $25 $25 $25
# this is average retail price based on GoodRx. This cost may be different depending on geographical area, use of coupons, your insurance plan and formulary within your plan. Also, cost for insulin pen is different than vial. *These products are available as pen only.
IS THERE ANY SUPPORT FROM INDUSTRIES ON INSULIN ANALOGS?
Those who are on insulin pump and those who cannot change to human insulin due to various reasons can get some support from companies to lower the cost of insulin analogs. Companies have support programs and if you are eligible, you can apply either online or through paper application. After the COVID-19 financial crisis, insulin manufacturing companies initiated financial support programs too. We mentioned a few support programs below however it is better to check company website for recent updates. Regulations and rules of financial support programs are subject to change anytime. Programs available include free insulin for eligible patients, capping insulin prices at $99, and so on.
1.
2.
3.
NovoCare and patient assistant programs from Novo Nordisk: www.NovoCare.com
Eli Lilly Insulin Affordability programs:
Type 2 diabetes
www.InsulinAffordability.com
Sanofi Insulins Valyou Savings program:
IS HUMAN INSULIN RIGHT FOR YOU?
www.InsulinsValYOU.com
There is still some pancreas function so human insulin use may cause less problems compared to type 1 diabetes. There is more evidence that in higher HbA1c in patients with type 2 diabetes, human insulin may be safer. For lower HbA1c, evidence is lacking.
Type 1 diabetes
If you are on insulin pump: There is not enough data for human insulin to use in a pump effectively. There is literally no information to use in hybrid closed loop since all studies are done with rapid insulin analogs. We recommend not using human insulin through insulin pump unless suggested by your provider. If you are on injections: Human insulin has a different physiology than insulin analogs. Hypoglycemia risk is higher with human insulin compared to analogs in type 1 diabetes. Most individuals with type 1 diabetes, human insulin is not the best choice. We suggest you discuss with your diabetes provider if human insulin is right for you and how to use it safely and effectively.
DIABETES NEWS
CONCLUSION
Human insulin is a cheaper alternative to insulin analogs. Using human insulin seem less problematic in type 2 diabetes comparted to type 1 diabetes. But for patients that plan to use human insulin, best approach is to discuss with their providers and plan of transition. It is vital to know how each insulin is working and how to make changes in meal planning, exercise and administration frequency.
