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Comment by RHSeeger | Hacker News Reader

Is there any discussion as to why he didn't just switch to a cheaper (older) insulin? Last time I checked, it was still possible to get the older (R/N/L) insulins at around $25/bottle, over the counter.

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Patients refuse to switch for a variety of reasons: fear that a different insulin will harm them, mental illness, discomfort with disturbing their insurance arrangement. You will hear diabetics (I am one, too) say that only a particular insulin works for them, even if that means they end up using no insulin at all, and/or haven’t seriously tried the cheap options.

Patient education is a necessary step to decreasing prices and encouraging innovative medications at the same time. As is decreasing the inevitable fury at diabetics like myself who dare to look inward.

How is that a good answer? Certain death will scare you much more than some discomfort or insurance arrangement. Cheap insulin works fine.

This is a classic case when some ridiculous example, where it's clearly patient's fault, is presented as the fault of the system.

Cheap insulin works. For long-term outcomes, I'd certainly argue that it doesn't work "fine." But it's definitely better than death.

Outside of mental illness, I cannot fathom choosing death over trying a different type of insulin. I may be biased, because I've used so many different types over my life.

I think the "outside of mental illness" is a pretty important qualifier here. I've never hit the point personally where I'd prefer death to diabetes, but I've certainly been close, and were it not for a pretty fortunate life - good insurance, ability to afford a good doctor who is knowledgable in this field, ability to afford a CGM and never have to worry about paying for testing strips (another ridiculous expense - frankly far worse than insulin given how much larger of a population it impacts) - I could certainly see myself in their shoes.

The other comment said it well—I would additionally encourage you to help other diabetics to understand what flexibility they have, using your experience.

Would likely work if you had a CGM (continuous glucose monitor).

Blood glucose levels are really hard to get right with old insulin. Literally everything you do pushes your blood sugar demand up or down (sleep, stress, activity, macronutrient load/timing).

Modern insulin analogs tent to smooth out these variables.

It is more difficult, but its not completely horrible. It's certainly better than the death in the post I was replying to ("was found dead in his home because he couldn't afford $1,300 per month for insulin."). I get that the older insulins are not as good. I get that they're more difficult to use. They are, however, most definitely better than dying. Any story that says says the person died because they couldn't afford 1300/ month for insulin is being disingenuous.

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