We all know the benefits of the newer insulins, i.e., faster action times, less peak from the long actings, etc. But the cost, more often than we know, can lead to patients decreasing insulin doses, doing without until the next payday, or doing without it altogether, as we’ve read about. (See David Kliff’s recent article.)
What are the responsibilities of health care providers, including pharmacy staff, when a medicine as life/health saving as insulin is not being taken as needed?
As providers, do we ever ask our patients with high A1c’s, “How many times a week do you miss or take a lower insulin dose?” If they admit to taking less or even none, ask why. It could be they forgot, are trying to keep their weight down, or because they just cannot afford the insulin.
Since regular and NPH can be bought over the counter, are we not obligated to tell the patient about them? At about $25 a vial (per Walmart in CA) vs about $300 for the newer insulins, it is easy to see why some patients may not be able to pick up their Rx. Offer an alternative.
Know and teach the onset peak and action of the different insulins. The risk of lows is higher with NPH because of the peaks, but some of us lived with that insulin for many years. And the risk of highs are also higher when insulin is not matched with meal timing or able to correct as soon.
A healthy A1C for your patients is doable with regular and NPH. Some insulin, with proper education, is better than not enough or no insulin at all. It can prevent disasters and in some instances, prevent death.
What patients can do to lower costs:
- Use regular in pump (teach it may occlude more often)
- Use regular with either NPH or glargine; just remember and teach the onset, peak, and action times. Ask for coupons and/or apply for pharmaceutical assistance programs
- Reach out to Insulin For Life and other organizations that may be able to help
Remember: People with diabetes, especially type 1 diabetes, have to have some insulin! If you know and don’t share, would you consider that malpractice? Now you know! Now go out and let your patients and colleagues know!
Jeannie Hickey RN, CDE, CPT
Type 1 for 53 years
Assistant Medical Director Diabetes, Youth & Families, operators of Bearskin Meadow Camp
|Help! Tell Us How To Avoid Disasters Using CGM
Many of you have and have not had experience with the Continuous Glucose Monitors (CGMs) now available.
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Sometimes the best way to learn is from real life experience from each other.
Joy Pape, FNP-C, CDE
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