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Comment by rhinoceraptor | Hacker News Reader

Hugely reducing insulin dosing is still probably valuable, especially for Americans since it's so expensive.

It's expensive but not as bad as you'd think. I didn't have insurance for half a year, and I just called the manufacturer and got a huge discount ($200/bottle -> $35/bottle). One bottle lasts a month or so.

This was only due to not having insurance and wasn't need-based - I had earned FAANG income earlier that year and the year before.

Both those prices seem excessive.

The best part of economic freedom is that one is free to start a manufacturer delivering a cheaper whatever one is complaining is too expensive!

It's possible the price is too high, but the reason it has that price $35/bottle is the minimum required to sustainably produce it. It's well accepted in economics that price of manufacture is not necessarily the societally optimal price [0]. If this is the case, what needs to be done is government subsidization, and no individual person can just start a company and do it themselves.

Also, the idea that everyone is free to start manufacturing insulin ignores the billions of dollars of capital that is required to create a FDA-compliant insulin production plant, which almost no one on earth has access to.

[0]: https://www.investopedia.com/terms/e/externality.asp

"Not only are the big three insulin manufacturers financially opposed to biosimilars entering the market, they’ve actively taken legal steps to prevent it."

https://beyondtype1.org/how-much-does-it-cost-to-produce-ins...

Not with the way the FDA has a pile of rules and regulations that combined have the unintended effect of blocking the market. Drugs of all kinds are not in a market state of economic freedom. There are pros and cons of the situation, but at least please stop pretending that it's a free market.

These prices are not high. I went through a period when I had no health insurance, and I had to rely on generic insulin, the kind you can buy at Walmart for $25 a vial. I have insurance now and the insulin I take now costs me a co-pay of $100 a vial. Paying $35 a vial without insurance is not bad at all.

It's a hell of a lot higher than most developed nations. Here in Ireland, as far as I'm aware, it's free thanks to the long term illness scheme. (We have both public and private healthcare available)

Just because you never see the cost, doesn’t mean it costs “nothing”.

Sure, but to someone who's on unemployment benefits. It's free. To someone who's earning a little bit more than that, it's free. To someone who is earning enough to pay tax, they're paying a tiny amount. To someone who's earning more than 30K€, they're paying a few grand in taxes (which covers other public services also). To someone who's earning 60k€ they're paying even more.

But the important thing is that the person who's earning fuck-all can still afford it, because it costs nothing to them.

I am aware that insulin costs a lot less in other countries. I have read the stories of Americans going to Canada to buy insulin. I have also read the stories of diabetics in the United States who died because they tried to make their insulin last longer by rationing their dose.

If I didn't have insurance my insulin would cost me either $245 (fast-acting) or $700 (basal) a vial.

I was just pointing out that getting insulin for $35 a vial in the United States is a very good deal.

> I was just pointing out that getting insulin for $35 a vial in the United States is a very good deal.

That may very well be the case. But for someone paying 0% tax in Ireland, 0€ on insulin is an even better deal.

I agree, completely.

What's wrong with the cheap generic?

The cheap generic doesn't have the same effect profile. It's much harder to match an insulin bolus for the carbohydrates you're eating at a meal. The combination of fast acting and basal insulin can do a much better job of keeping your glucose readings in a good range.

That said, the same kinds of insulin cost a lot less in many foreign countries than they do in the United States.

The NHS (how much it pays not the patient) annual costs are about £400 so it doesn’t seem excessive

Just curious, which manufacturer did you call, Eli Lilly or Novo Nordisk? I think the details of how you were able to get a discount would be beneficial to others. I am a type 1 and I recently heard of another type 1 who recently died at age 40 because he lost his job+insurance and was rationing insulin.

I called Lilly, but both manufacturers have programs to help. These two are need-based. I didn't qualify but still got a sharp discount.

https://www.lillycares.com/aboutlillycares.aspx https://www.novocare.com/diabetes-overview/let-us-help/pap.h...

It’s not without tradeoffs. There’s a substantial overlap between T1 and CHD, and the impacts of keto on CHD in non-normal populations (hyper-responders, metabolic patients) are even more poorly understood than they are in the general population.

Lowering carbs is one thing; LCHF is an entirely different beast (and I say this both as a T1 and a T1 who tried LCHF for nearly a year).

It’s an option for some, but billing it as “remission” is going to make people think it’s a cure-all, when it’s far from that, and isn’t exactly “new” for the treatment of T1 - it’s both part of the general instruction set (“reduce carbs”) and even prior to insulin therapy, was the only treatment for T1, and it had a pretty poor success rate.

What does CHD stand for in this context?

Coronary heart disease. CVD (cardiovascular disease) may be more appropriate as it’s less specific but still covers the linkage between the two conditions.

http://journal.diabetes.org/diabetesspectrum/99v12n2/pg81.ht...

Thank you.

Yes, but any T1D is acutely aware of this fact. The whole treatment regimen is ratioing carbs to insulin.

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