Short vs. Long
There is a common misconception that all insulin is the same. Unfortunately this is not true. The $25 bottle of insulin that someone bought for their diabetic pet at Walmart is not the same as what most people with type 1 diabetes use. My children with diabetes use two types of insulin. The first is a rapid acting or short acting insulin that is given every time they eat. This insulin begins to work about 15 minutes after injection, peaks after about an hour and continues to work for 2 to 4 hours (depending on which brand is used). The second type of insulin they use is a long acting insulin which has a “life” of approximately 24 hours. They receive this insulin once a day and it acts as a background/base (called basal insulin) in their body. The job of basal insulin is to keep blood glucose levels steady in between meals or during times of fasting (ie overnight). The only time my children do not need a basal insulin is if they are using an insulin pump. An insulin pump uses only short acting insulin and gives a constant drip (similar to an intravenous line) to keep glucose levels steady in between meals and overnight.
Each pharmaceutical company has their own “formula” for making insulin. Even though the formulas might be similar, every body is unique and can respond very differently. For example we have tried different long acting insulins all of which claim to last 24 hours. However, it is very obvious based on blood sugar readings that some wear off or peak sooner than others causing higher blood sugar after only 20-23 hours. The ph levels in insulin can be different as well, causing an injection to sting or hurt more. For a child receiving 6 to 8 injections a day this can be a big deal and add a lot of unnecessary stress and pain.
If It Ain’t Broke, Don’t Fix it
Our insurance company has denied BOTH insulins (along with other medical equipment) prescribed by our doctor for our 16 year old daughter. She has been using these insulins since her diagnosis (5 years ago) with good control. I say, if it ain’t broke, don’t fix it! When we appealed this decision we were told to either use an insulin pump or use the new “approved” insulin that insurance is willing to cover. The only explanation I was given for this change is her insurance has changed its formulary which is a fancy way of saying list of drugs they want to cover. They will not give any other explanation other than it is no longer on the list. Our daughter does not want to have a medical device attached to her body (that is totally within her right) and she does a great job managing her diabetes via injections only. Unfortunately the insulin that her insurance wants her to use is not as effective for her and makes it harder to manage her diabetes.
Three Is Better Than One
It can be hard to find the positive in having three children with type 1 diabetes. But in this case I am thankful we have other children that are also using insulin. Our two sons use the exact same insulin that has been prescribed for our daughter. (Our 12 year old even has the same insurance that for some reason has denied coverage for our daughter but approved it for him.) TOTALLY RIDICULOUS! This means we are stretching insulin that is meant for two people and making it work for three. This is also the reason that we chose to drive to Canada to buy insulin in March because our 7 year old was newly diagnosed and had not been approved for insulin coverage yet so we were stretching one prescription between three children.
The kids and I have been invited to ride a bus with other people in need of insulin to Canada in a couple weeks to purchase more insulin. I gladly accepted the invitation and opportunity to buy more insulin because if there is anything I have learned through all of this it is that insurance is fickle, unpredictable, and unconcerned about the health of their clients with diabetes. Money makes the world go round or in this case come to a screeching halt for those that rely on medication to stay alive. I am looking forward to meeting other people in similar circumstances and drawing more attention to the need for a change.
(If you made it this far, thanks for reading what I consider the most boring post I’ve ever written. I promise to be less like a medical textbook next time.) Your reward for reading this entire post is this photo of 4 week old puppies. One of these pups will be chosen by our trainer at the end of this month to become our diabetic alert dog! We will have more photos of him when she makes her final choice.