Making the Switch: When Your Patient Can't Afford Analogue Insulin

I'm going to talk about switching from analogue insulin to non-analogue insulin. This is often required because analogue insulin is very expensive, and particularly when our patients reach the doughnut hole or they lose their health insurance, they may need to switch from their analogue insulin to non-analogue insulin.

Non-analogue insulin is the old-fashioned NPH and regular. Many people have not really used much NPH and regular in their patients, particularly those who are younger and who trained after the advent of analogue insulin. I trained long ago, when we started everybody on NPH and regular.

First, to review, you have to be aware of the pharmacokinetic profile of NPH and regular. NPH is basically regular insulin mixed with protamine, and as a result, it's cloudy insulin.

When your patients go to pick up their NPH insulin, you need to warn them that it will be cloudy and that it doesn't mean it's contaminated—that's what is considered normal.

Gathering the Right Tools

Non-analogue insulin is often cheapest in a vial. Walmart has historically had very low-cost non-analogue insulin, maybe Costco. Patients need to figure out in their own neighborhood where the least expensive place is. Usually, vials are cheaper than pens of NPH, and they don't even have pens of regular insulin.