Amid reports of patients rationing insulin, doctors raise awareness of community resources

Dr. Susan Brian, an endocrinologist with Cotton O’Neil Diabetes and Endocrinology Center in Topeka, says insulin rationing is very real.
Published: Nov. 17, 2022 at 9:48 PM CST
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TOPEKA, Kan. (WIBW) - Many people with diabetes are taking less insulin than they need, or skipping doses all together.

Dr. Susan Brian, an endocrinologist with Cotton O’Neil Diabetes and Endocrinology Center in Topeka, says insulin rationing is very real.

“It is tragic in the hospital what we see,” she said. “It’s common for parents especially if they have to save money in some way, they’re going to affect their own health and skip their own medications so they can provide for their kids. There’s a lot of patients that take a second job to pay for their diabetes medication, that’s very common. People that don’t retire (or) can’t retire because they have to keep a certain amount of insurance or they have to get another job in retirement to pay for their medical costs.”

An analysis of data from the CDC’s 2021 National Health Interview survey suggests 16.5 percent of insulin users - correlating to 1.3 million people - either skipped doses, took less than needed, or delayed buying insulin over the past year. The rate was highest among people with without insurance, at 29.2 percent.

Dr. Brian says the consequences can be deadly.

“Insulin is the only way the cells will actually open up their doors to let glucose come from the blood stream into the cells. The door is locked, basically. Insulin opens the door,” she explained. “If you have someone that has insulin deficiency, their blood sugar will stay in the blood and cannot get into cells, which is what needs it. Acutely, that can lead to diabetic ketoacidosis, where you end up in the hospital in the ICU in a coma because you have to have enough glucose for your brain to function.”

In extreme emergencies, it can cause death. Long-term, uncontrolled diabetes can damage smaller blood vessels and the organs they supply.

“Those are what are really damaged by high blood sugars because they make the cells sticky as they go by, and that makes it difficult for blood to get to the kidneys, the eyes and the nerves,” Dr. Brian said.

Part of the issue: reports show manufacturers have raised insulin prices 200 to 600 percent over the past 20 years. Even with insurance, people with higher doses shell out higher co-pays.

Under the Inflation Reduction Act, starting next year, insulin co-pays for people on Medicare will be capped at $35 per month. For everyone else, Dr. Brian says talk to your provider to see what resources are available.

“We have two nurses (at Cotton O’Neil) whose whole job is to help us support the patients by finding programs that work for the patient, that they might fit into. Shawnee County actually has a lot of great programs, (such as) Health Access,” Dr. Brian said. “For people who have private insurance, there are often savings cards that you can find on the internet.”

In addition, Dr. Brian said Stormont Vail recently began fully covering diabetes medications for its employees.

Dr. Brian said the U.S. also has a safety net, where two older forms of insulin are sold over the counter at pharmacies. However, she cautioned it is meant for emergencies, such as when a person is traveling and may lose or run out of medication. She stresses a person must be familiar with their dosing and how to administer insulin.

No matter what, Dr. Brian says it’s important patients don’t go it alone.

“The best care is under the supervision of a physician, with a diabetes education system,” she said.

In Shawnee County, people without insurance can reach out to Shawnee Co. HealthAccess at https://scmsha.org/. Another resource is GraceMed, https://gracemed.org/.

With November being Diabetes Awareness Month, D. Brian is hosting this Saturday’s “Walk with a Doc” program. It starts at 9 a.m. Nov. 19 on the east side of Washburn University’s Lee Arena.

Find information about diabetes from the American Diabetes Association.