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The 2024 Insulin Shortage and What You Need to Know

On March 25, drugmaker Eli Lily warned of an insulin shortage for 10mL vials of Humalog and insulin lispro injection. The two lifesaving insulin brands could be out of stock in April 2024. The company hopes the shortage will be brief and claims the problem is due to a manufacturing interruption.

The 2024 Insulin Shortage and What You Need to Know

The Biggest Epidemic of the 21st Century

The Centers for Disease Control and Prevention (CDC) declared diabetes an epidemic 30 years ago. According to the American Diabetes Association (ADA), 11.6% of the population has diabetes, rendering it a nationwide endemic, with over 1.2 million new cases each year. Also, an estimated 97.6 million Americans have prediabetes. Only 1.45 million Americans have T1D, but that number is expected to double worldwide by 2040.

With this prior knowledge, the question remains: how and why are manufacturers running out of insulin?

What is Insulin?

Insulin is the lifesaving hormone produced by beta cells in the pancreas. It regulates glucose levels by helping blood sugar enter the body’s cells to be used for energy.

In type 1 diabetes (T1D), the body’s immune system attacks the insulin-producing cells, leaving individuals insulin-dependent to stay alive. Insulin treatment can be via multiple daily injections (MDI), insulin pens, insulin pumps or inhaled insulin.  

Without insulin, glucose builds up in the bloodstream, resulting in hyperglycemia or high blood sugar, which can lead to serious complications like neuropathy (nerve damage), retinopathy (eye damage), and heart and kidney disease.

Ketones also build up in the bloodstream and urine, becoming acidic, causing diabetic ketoacidosis (DKA). DKA can lead to dehydration, shock, and exhaustion. In severe instances, a patient may slip into a coma or even death.

Important Fact: Lily advises patients who need immediate access to insulin and can’t receive alternative treatment options to seek emergency care. If a person with T1D is in dire need of insulin, they should go to the emergency room. The Emergency Medical Treatment and Active Labor Act protects individuals without insurance from being turned away.

Insulin and Type 2 Diabetes

Type 2 diabetes occurs when the body’s cells become resistant to insulin. Treatment includes diet, exercise, and a possible combination of oral medication, insulin, or GLP-1 semaglutide drugs, which are also in high demand this year.

Insulin is Pricy

Contrary to the fundamental economic principle that the price of a product drops over time due to supply and demand, insulin’s cost has risen exponentially. The ADA reported a 24% increase from 2017 to 2022. And, even accounting for inflation, the price has increased by 26% since 2017. One in four patients has had to ration insulin due to drug companies' inflated costs.

Insulin rationing is not an option. According to the Right Care Alliance, rationing insulin can be deadly as it can lead to DKA and other dangerous complications. The unfortunate reason for manufacturers’ price gouging is that insulin is a lifesaving drug that people can’t afford to skip, unlike home electronics or other consumer commodities.

Why the Shortage Now?

 In 2023, the federal government and patient advocates forced manufacturers to lower the price of insulin, leaving many worried about the prospect of shortages. Starting in January 2024, the Inflation Reduction Act capped insulin cost-sharing at $35 per month. Eli Lilly, Sanofi, and Novo Nordisk all capped their insulin co-pays at $35, reducing the list price of the drugs by 70%.

Eli Lilly spokesperson Tarsis Lopez told CNN, “The dynamic nature of insulin supply and demand, coupled with a brief delay in manufacturing, led to the temporary supply constraint.”

This news leaves individuals with diabetes scrambling to find insulin, with one man in Salt Lake City, Utah searching over seven pharmacies. We know from COVID-19 that fear can lead to stockpiling, which only exacerbates the problem.

Besides the depletion of Eli Lily’s two insulin vials, Humalog and insulin lispro injection (Humalog is the brand name of insulin lispro injection), patients should be aware of possible shortages with the following:

  • Novo Nordisk’s Novolin R Flexpens are also on backorder, and the Fiasp FlexTouch 100 units/ml pre-filled pens are expected to be out of stock from April 2024 until January 2025.
  • GLP-1 RA medications (Ozempic, Trulicity, Victoza, Saxenda, Byetta and Bydureon) could have supply shortages into 2025.

What You Can Do

Keep Your Prescriptions Up to Date

As equally important as watching for expiration dates with prescriptions and over-the-counter supplements, T1Ds should keep prescriptions for insulin, test strips, insulin pumps and continuous glucose monitor (CGM) supplies up to date. And order as soon as your insurance allows. This helps ensure you are covered for an emergency.

Check other Pharmacies

In addition to having your prescription up to date, it’s essential to know the brand, dosage, and frequency of use in case you need to switch pharmacies. Contact your insurance company for other pharmacies in your network.

Alternative Insulin Brands

Talk to your healthcare team about using an alternative brand of insulin in case of emergency. Different fast-acting insulin include:

  • Novolog
  • Admelog
  • Fiasp
  • Lyumjev

Also, discuss options with your insurance company to see if your coverage reaches other brands.

Keeping these steps aligned with your healthcare provider is crucial because sometimes patients may have side effects with particular brands, leaving them with rashes and other issues.

Pre-Filled Insulin Pens

Contact your healthcare team to discuss switching to the same insulin in a pre-filled pen or one of the other options listed. Lilly said the 10-milliliter vials of Humalog and insulin lispro injection would be in short supply at wholesalers, and some pharmacies, but the pre-filled pen versions of those medicines are available in the U.S. They will ship the 10-milliliter vials as soon as possible.

Though inconvenient for insulin pump users, the pens can be used in a pinch. Patients may also use a syringe to pull insulin from the pens and transfer it to their pump. Switching to pens or MDI while the shortage lasts can be a temporary fix.

Let Your Voice Be Heard

Eli Lilly said in a recent statement, they understand that the need for insulin amongst its users is vital and that it takes its responsibility to supply these medicines seriously. Lilly also said, “Any supply challenge may cause a disruption in people’s treatment regimens, and we are moving urgently to address it.”

Switching insulin brands or delivery methods is not conducive to many T1D lives. This hardship will affect households worldwide.

Reach out to your elected representatives and manufacturers and let them know this is more than a minor inconvenience – lives are at stake. You can contact legislators by email or phone. If you are unsure of your congressional district or need help finding your representative, go to house.gov.

Let’s hope this problem is addressed as swiftly as promised. Meanwhile, watch the news, keep up with your prescriptions, stay vigilant with your insulin therapy, speak with your healthcare team for alternative insulin treatment in an emergency, and let your voice be heard.

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