r/news Jan 14 '22 Wholesome 18 Evil Cackle 3 Silver 19 Gold 1 Helpful 19

Shkreli ordered to return $64M, is barred from drug industry

https://apnews.com/article/martin-shkreli-daraprim-profits-fb77aee9ed155f9a74204cfb13fc1130
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u/shieldoversword Jan 15 '22

Yeah, of course. Most of what I’m experienced in treating is T2DM. T1DM is relatively much more rare and I didn’t want to conflate the issue by going into differences, but yes t1DM needs tighter control and has no base insulin production so much more need for a constant pump, which uses exclusively short acting. My whole point was that it wasn’t as simple as “Walmart insulin bad” but I guess I did a poor job of making that case.

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u/thrilla-noise Jan 15 '22

Walmart insulin is not equivalent to Humalog. They are different medications and they work differently.

Humalog in Canada is about $20 OTC and hundreds of dollars in the US.

I’m sure you mean well, but it’s frustrating that every time the US cost for rapid acting, standard of care, modern insulin like Humalog/Novalog is brought up, a chorus of people chime in about a non-equivalent insulin that Walmart sells.

Walmart insulin is just not the same medication as Humalog. While Walmart insulin can be used to (poorly) manage T1D, there is no reason people should need to resort to it. Humalog should not cost what it does in the US.

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u/shieldoversword Jan 15 '22 edited Jan 15 '22

First of all, same team. Even the Walmart insulin is overpriced IMO, it’s just unfortunately the best value we have.

Humalog and novolog are not the same as Walmarts 70/30 insulin, and I never said it was. Like you said, the Walmart 70/30 is older, but it’s not as much about that as it is about the timing of how it works. Humalog and Novolog are the most rapid onset/offset drugs we have, they make it easier to control glucose spikes because they’ll treat it as soon as they’re given and won’t stick around for too long after to cause hypoglycemia. The walmart 70/30 uses a combination of long acting NPH insulin (not as long acting as lantus, but similar concept with twice daily dosing instead of once) and regular insulin (slower onset and longer acting than Humalog/Novolog are, but also similar concept).

You seem to be focused on type 1 DM. They aren’t producing any insulin on their own so precise dosing of rapid acting insulin is essential, otherwise you’re risking very high highs and low lows. Typically a pump is optimal for continuous glucose infusion with these patients, also preferably in conjunction with a continuous glucose monitor if possible. All of this stuff costs way too much in our current health care system and it’s a travesty. That said, you can still treat it with a standard basal bonus dosing regimen or the Walmart version of that, it’s just especially not ideal for type 1 diabetics because the longer onset/offset is going to make it a lot harder to get good control without risking hypoglycemic episodes.

For type 2 DM (90-95% of diabetics), things are a bit more forgiving in that they do produce their own insulin, the problem is that their body has just seen so much insulin signaling that it starts to tune it out, developing insulin resistance. But they’re still making insulin in most cases, so it’s more forgiving to treat than T1DM. In these patients, we still would rather treat them with a daily basal dose of insulin (Glargine/lantus) which will provide constant insulin coverage all day without peaks that will cause hypoglycemia, then if that’s not enough they also get boluses of shorter acting insulin (pref humalog/novolog or lispro/aspart) three times daily with meals to control spikes in glucose from meals (gold standard basal-bolus regimen) . The Walmart insulin is still not ideal here since the shorter acting NPH can cause unpredictable peaks (no peak effect from lantus) and the shorter acting insulin is also more likely to cause peaks and valleys in blood glucose around meal times , but it can mimic this coverage with appropriate modification of its dosing regimen. The ultimate goal with T2DM is to work on lifestyle modification and use other non-insulin meds to get and keep them off insulin entirely, so with a good PCP or endocrinologist they might not need to take insulin for all that long. However non-insulin diabetes meds can also be very expensive, with the newer (and better) ones like trulicity costing thousands of dollars out of pocket if insurance won’t pay.

In conclusion, I think Walmart insulin does an ok job meeting demand for insulin in diabetics who otherwise can’t afford it (more so for T2DM), and it’s unfortunately the best we can do for a lot of poor diabetics out there now, but we can do much much better at making diabetes meds more affordable and accessible in the US, we are by no means in a good place with DM treatment in this country.

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u/thrilla-noise Jan 15 '22

That said, you can still treat it with a standard basal bonus dosing regimen or the Walmart version of that, it’s just especially not ideal for type 1 diabetics because the longer onset/offset is going to make it a lot harder to get good control without risking hypoglycemic episodes.

They will die earlier. They can use it, but it will reduce their quality of life and and shave off a few years.

You can treat a bee sting allergy with Benedryl, you just have a lower survival rate than an epipen.

Wouldn’t you find it frustrating if every time anyone complained about epipen cost, someone chimed in about “cheap Benedryl at Walmart”?

In conclusion, I think Walmart insulin does an ok job meeting demand for insulin in diabetics who otherwise can’t afford it

Disagree.

it’s unfortunately the best we can do for a lot of poor diabetics out there now

It’s the best we choose to do. Obviously we can do better. Everyone else does better. (See: cheap OTC Humalog in Canada)