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Comment by beached_whale | Hacker News Reader

Those pens allow for accurate dispensing.

Personally I'd say there is no difference; I've stuck out on syringes in the uk for ages just because I found them lightweight and convenient; but recently moved to pre-filled pens. The cost to the NHS for prefilled pens vs syringes is pretty negligible.

Syringes were fine for me, pens might be less embarrassing to use in public maybe?

are we talking the same thing, I am thinking of the pens I used to use that you would dial the dosage in and then push the plunger. In Canada, those pen fills costed about 70 vs 36 for the vials, but they also had 15mL of insulin vs 10mL. So about 1/3 more with the syringes and needles being about the same price.

The problem isn't their choice of insulin delivery, it is that there are no price controls and an incentive to increase prices without any significant loss in sales. This is an area that government need to be all over.

Who wouldn't choose to learn how to use a syringe well instead of paying a third of their income for auto pens?

Looking at what a good friend of mine has to put up with, I'd say someone with severe diabetes. You have periods when you cannot think very straight and it is easy to fuck up with standard syringes. Auto injectors should not cost a third of your income, they are not complex devices.

They shouldn't.

But you also have a tiny mass produced machine that is life and death for people. Insuring quality is expensive and the cost of mistakes is extreme.

If you want cheaper medicine you have to also have cheaper mistakes and there aren't many people arguing equally loud for both. (Just one issue of many)

The mistakes are not cheaper. The result of mistakes is a high risk of death in both circumstances. And measuring insulin into standard syringes while not being able to think straight is dangerous as hell.

By mistakes I was referring to manufacturing defects of medical devises and the levels of financial liability coming from them.

I'm referring to which course of action is least likely to result in the death of a friend.

So how much do you want to limit and punish the accidental death of a friend?

Higher numbers for the previous two will increase cost and death to people who can no longer afford the treatment.

"Least likely" means infinite quality control and is not possible. Failure rate is not zero, you have to pick finite regulatory requirements and financial consequences for failure.

You have to assign a dollar amount to a human life. It is uncomfortable for many people to think big picture thoughts but you're contently using things made by people who have to.

Not sure if this is the same issue, but apparently the cheaper insulin syringes are thicker and cause more pain and bruising. From my understanding, these are shots that need to be administered several times a day in perpetuity. The savvy consumer's options are chronic physical pain or poverty. With that in mind, would you still suggest that people go with the cheaper option?

Most importantly, the consumer should decide what is the best option here. If you are poor and the only available option to stay alive is injection multiple times through the day using thicker needles, perhaps it is still better then die? Or maybe not. I do not want to decide that for anyone.

Life sucks, diabetes sucks, and poverty sucks. More than people who don't experience it can understand.

But you do the best with what you have, and that means picking your pain.

Most diabetics, not pumping take two kinds of insulin. One that provides a basal dose that covers the glucose your body produces. One to two injections a day for that. In addition, there is the bolus dosages that are taken with any carbohydrates. So most people on average, eat 3 meals a day, plus any snacking. We are up to about 6 a day here.

The cheaper insulin in the US is garbage and should not be used. period. The problem is the companies are have no pressure to reduce prices. the customers are captive and must pay or die. They make money in other countries that have price controls on the same product.

I've seen a friend with Type 1 diabetes quietly and quickly go from someone who practices law competently to someone who can barely manage to stab herself when she realizes she's having a blood sugar issue. Dosage is hard when you're crashing.

If you’re crashing (low blood glucose) you don’t take insulin, you drink juice or call an ambulance (My partner has had to do this, unfortunately). If you’re so high that you’re having trouble using a syringe you need to be in a hospital.

Source: Type 1 diabetic.

To help people understand low blood sugar episodes, I think it's good to watch these three videos.

https://www.youtube.com/watch?v=pC_0CI9jV6A https://www.youtube.com/watch?v=Bv4HIci1Qtc

https://www.youtube.com/watch?v=TidRyyrTz4k

One thing I forgot was a Glucagon injection to revive someone who has passed out.

Yes, but generally you're not going to be injecting yourself with glucagon, as if you're lucid enough to do that, you're lucid enough to eat/drink some carbs.

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