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Comment by srameshc | Hacker News Reader

I still don't understand why insulin is so regulated and expensive in US. I feel sorry for people with Type 1, Type 2 who many a times have to skip their insulin dose. I think it should be freely available over the counter and there should be some cheap availability for such a common drug.

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Walmart sells older forms over the counter.

http://www.npr.org/sections/health-shots/2015/12/14/45904732...

Pricing info isn't super apparent, I guess it probably isn't a whole lot more than the $25 a vial suggested in various articles and comments about it.

Yeah that's the old school NPH variety. While you can certainly manage with it, you'll not manage well.

Modern diabetes management includes either pumping or multiple daily injections (MDI). With MDI, you use a long acting insulin as a basal, or background, insulin. And then you'll use a rapid insulin to bolus for meals and to make corrections for unexpected spikes.

The pump is similar to MDI but you only use rapid insulin and the pump delivers a steady basal stream throughout the day, and you still bolus at meals and for unexpected spikes.

These two things allow diabetics to eat whatever they want.

We did the old school way for the first few weeks because that's the only way the doctors in Vietnam knew how to do it. It really sucked numbers wise.

It's not. I'm not diabetic, but there's some interesting research on intranasal insulin and cognition, so I thought I might try it out. At my local east coast Walmart, I bought on March 13th 2016 a 10ml vial of Novolin R insulin for $24.88. (No prescription required.)

> intranasal insulin and cognition

Please elaborate...

"Effect of intranasal insulin on cognitive function: a systematic review", Shemesh et al 2012 http://press.endocrine.org/doi/full/10.1210/jc.2011-1802 https://www.researchgate.net/profile/Assaf_Rudich/publicatio...

It seems relatively defendable - it is far, far more dangerous than many prescription only drugs (eg: birth control), and most people will not be able to work out how much they need without seeing a doctor first.

My understanding is that Dana Lewis developed the pre-cursors to OpenAPS because she had to perform dosage calculations several times a day. Often this was in the middle of the night. And getting it wrong could be fatal.

Going further, the calculations are rule of thumb and generic and each person has to make adjustments based on intuitions about their metabolism, what they ate, what they plan to eat, what activity they anticipate, and when they last dosed. It's every day, for the rest of their life.

[Source]

Scott Hanselman interviews OpenAPS hacker Dana Lewis:

http://www.hanselminutes.com/514/the-open-artificial-pancrea...

Yes, I have lived with relatives with diabetes and understand that it's quite complex. I don't think anyone with diabetes would suggest that it should be ok to just start taking insulin without a doctor involved, which is (to my understanding) the basic argument for whether a drug should require a prescription or not. You can make a separate argument about whether it should be a longer prescription, or about the failings of a system where seeing a doctor at all is prohibitive for some people, or the fact that the medication is outrageously expensive (which is not directly related to the need for a prescription at all).

Birth control is a bad example, because as far as I can find it's prescription only for sex-negative cultural reasons, not for medical reasons.

It is exceedingly easy to overdose on tylenol, and yet it's available without any controls.

Birth control pills are prescription because they can increase the risk of a woman getting a blood clot. In the case of women who smoke, it's a drastic increase.

Sex-negative has nothing to do with it. Plan B is non-prescription.

Until very recently plan B was prescription only, so that's not a strong counter example.

The question is, does something about visiting a doctor to get a prescription for birth control mitigate the risk of a blood clot? Something that there would be no way to replicate with say better women's health education or a nice info-graphic next to the birth control section?

Condoms aren't prescription only in many jurisdictions either.

After you've been a diabetic for a few months, you more or less know how to handle it, and you either will go to your doctor with your problems, or you won't. The fact that people with diabetes will be diabetic for the REST OF THEIR LIVES, taken with the fact that most major insurance companies require 4 or more specialist visits a year to continue covering their life support, just makes the prescription system seem like a racket.

Besides, insulin is available OTC anyway (in the US). It's just that prescriptions make it cheaper/free.

Thank you... Insulin is very expensive: more than my rent, just to stay alive, even with insurance :(

Maybe it's because the production process (protein separation, purification) has not been improved for a long time and the market is controlled by two big drug makers.

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