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Comment by glenk | Hacker News Reader

I've been type 1 for over 30 years since I was a toddler. I could stand to lose a few pounds these days, but I am not fat, nor obese. Adjusting my diet would do very little to change the increasingly high amount I spend on insulin.

The cost of insulin over the last few years and as recently as the last few months has skyrocketed. Not just the fancy fast acting insulin, but even the regular stuff that you can buy over the counter without a prescription(R and NPH) has nearly quadrupled in the last 12 years. It's not an increase in manufacturing costs. It's price fixing by the two major players(Lilly and Novo).

You'd think that with Lilly significantly raising their prices a few months ago, that Novo Nordisk could make a killing, but no, they both did it at the same time. Funny how that worked out.

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Type 1 for about 15 years now. A1C has always been fine (typically 6.2 - 6.4).

Recently I decided to get "back in shape". I'm 5-foot-8, and this meant going from ~170lbs to ~140lbs. I actually dropped it rather easily (just walking and calorie counting), and I've maintained that weight since (6 months so far).

The kicker? I cut my insulin usage by 40%. However that wasn't just because I was no longer eating excess calories, but tracked my macros to see what I was eating. General guidelines are 50/30/20 for calories from carbs/fat/protein. Before I tracked it, I was apparently 60/25/15 which was VERY surprising to me, as I didn't think I was eating that many carbs. Now I'm 45/30/25, and slowly edging towards 43/30/27.

Granted, high protein diets aren't cheap, so the costs largely balance out. However tracking what you eat may reveal that you're getting far more of your calories from carbohydrates than you think.

I eat semi-low carb. I've done better than I am right now, but during the spring/summer I was playing basketball/volleyball about 3-4 times a week. Some nights for 2+ hours straight with minimal breaks. Eating low carb and trying to maintain a good blood sugar was pretty tricky for me. You have to eat quickly eat/drink something when you check the blood sugar between games and it goes low, and then you end up having to correct that later with more insulin. I've found low-carb to be fine and maintainable when I'm just working and sitting at my desk all day, but have struggled when trying to combine it with any type of higher intensity activity.

It seriously baffles me why anyone would get 50% of the calories from carbohydrates, let alone someone with diabetes. You don't need to eat high protein do you? Just eat fat...

If you have a Walmart nearby they carry Novolin R for ~$24/10ml. It's still expensive, but better than the $120 or more for Humulin I was spending at Costco (and still better that the $300 charged at some places).

I hadn't realized there was such a difference between cash price and prescription price.

Through work currently we can use a web site to help find your cheapest place for prescriptions. One bottle of Novolin R like you said about is about $25 from Walmart for cash price. One bottle of the same prescription with a discount coupon is $138 dollars.

That's still cheaper than Novolog/Humalog, but how in the world is it more expensive to buy insulin with a prescription and insurance than without? When I pay a 20% co-pay am I essentially paying my insurance company the extra money?

I think it's because of the pharmacy benefit managers mentioned in the article. You use your card, you pay the negotiated rate that they have with the insurance company. You pay cash, you pay the rate Walmart is willing to sell it at.

Of course it makes no sense that the fiddly details of how you buy medicine matter to the tune of 5x. I guess part of the problem is that an awful lot of people are insulated from the costs of their medical care.

As I understand it, there's no way around type 1 diabetes, you just can't produce insulin, or at least can't produce enough, and therefore need to supplement it.

But if you eat no carbohydrates, would you really need much insulin?

I don't understand what the fuss is about type 2. The resistance is developed because there is too much insulin in the blood all the time, and the solution is to take even more insulin?! It seems a no brainer that the solution should be to cut sugar out of the blood stream at all costs and reverse the insulin resistance...

That's not how type 2 works. The resistance is developed for unknown reasons and it continues to build over time. For a while, your body can compensate by producing more insulin to overcome the insulin resistance of your cells. You don't become symptomatic until your cells are almost completely insulin resistant. Your pancreas will continue to make insulin at crazy high rates, but eventually the cells that make insulin will die off (presumably from hyperactivity). This is the point at which type 2 diabetics need insulin.

As far as cutting sugar out of your blood - you can't. Your body tries to maintain 80-110 mg/dL of sugar in your blood. You NEED sugar. It's energy. In fact, sugar is the ONLY energy source your brain can use. The problem is when you're a diabetic, your body's cells can't take that sugar out of the blood to use it for energy. That's when you try to minimize your sugar intake, because if you don't, you can do irreversible damage to your nerves and vasculature.

Not so, you certainly don't need to eat sugar, too much sugar is poisonous and if usage is prolonged, causes insulin resistance and Type 2 diabeties. Starches are not much better, since they are so easily converted to sugars.

Most high energy usage organs inc the brain are quite happy burning ketone bodies - made from fat, in fact the heart prefers them. A few brain and organ functions do require some glucose, but these can be made from protein, better though to eat some healthy carbs such as spinach, for this. Most Type 2 diabetes sufferers can be cured by a strict low carb high fat diet. Healthiest fats are saturated grass fed cow's butter and lard, coconut oil or mono saturated olive oil - contrary to most people's belief. Unsaturated vegetable oils are very dangerous they are unstable and easily become poisonous, margarine is evil.

I have a relative that is type 1. A couple of years ago he went on a no carb diet and at xmas he was telling me that he now uses a lot less insulin and generally feels a lot better. He also lost some weight (he wasn't obese, either, but he now looks very trim).

Have you tried something like that?

I know you mean well, but managing this sort of thing is something that's extremely different from person to person, very hard to get right, and often a source of great personal pain for people trying and failing. Please refrain or be extremely cautious about enthusiastically telling everyone what worked for your relative.

While I agree it's worth being cautious about how you phrase any "advice", I think the parent post was perfectly reasonable. There was something that worked well for someone he knew, and he mentioned it in case it might help.

For context, I've been a Type 1 diabetic since around '85 and, as I get older, I'm becoming more insulin resistant (Type 2) also. While I've been able to keep my blood sugar mostly under control, I test my blood 4-10 times a day and sometimes need to take insulin 5+ times in a single day (sometimes it just doesn't "work" and I need to take more in smaller amounts to bring my blood sugar down. I can't just retake the original amount in case the first shot suddenly "kicks in").

Insulin goes bad about 30 days after first use. Pretty much all diabetics need to buy a vial or two every month, no matter if you've used it all or not.

Think of it like keeping milk stocked in your fridge. Even if you spread it out to last more than a month, the remaining half will go bad before you got to it.

So although changing diet and increasing physical activity may reduce insulin requirements in both type 2 and type 1 (as several people have anecdotally shared here), you can see how it doesn't avoid buying insulin every month.

I have T1 diabetes. Your post would create the impression that it's possible to do without insulin just by changing diet. The reality is that going without insulin is lethal in just a few days, and dietary changes can only reduce usage by a little.

I didn't mean to imply my relative went insulin free. He definitely did not. Based on the replies, I realize I probably shouldn't have posted what I did. I was trying to be helpful, but I'm no expert in this, so I should have stayed out of it.

Type I diabetes is a complex condition where restricting carbohydrates may not necessarily reduce hyperglycemia (high blood glucose) events. There is a dangerous downside counterbalancing the negligible benefits. The dieter significantly increases their risk of hypoglycemia (low blood glucose). Serious symptoms of hypoglycemia include heart palpitations, dizziness and coma.

I'm guessing a no carb diet could also imply high protein, to replace the carbohydrate calories. Too much protein (>20% of calories) is bad for Type I diabetics leading to a state known as microalbuminuria. In layman's terms: increased stress on your kidneys. More on this at: http://journal.diabetes.org/diabetesspectrum/00v13n3/pg132.h...

In summary, almost every (if not every) diabetes publication & specialist advises heavily against low/no carb diets, instead recommending a balanced diet.

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