Did you know that Walmart sells Regular (R) insulin and NPH insulin for approximately $25 per vial? In most states, you don’t even need a prescription. They’re available over the counter from the pharmacy.
These insulins are comparatively inexpensive because they are older formulations. They are more difficult to use than today’s best insulins and are considered obsolete by most clinicians and patients.
Despite their shortcomings, these insulins can still keep your blood sugar in control. Many people with diabetes thrived for years on these insulins. If you’re struggling to pay for your insulin and have been forced to ration, these old-school insulins might keep you out of the hospital.
If You Need Insulin Now
Let’s be clear: Diabetes Daily does not believe that anyone that uses insulin should be forced to use these older obsolete insulins.
If you’re struggling to pay for your insulin, there are other options available:
How to Find Inexpensive or Free Insulin in the United States
But the unfortunate fact is some countries, including the United States, do not provide inexpensive insulin to all of their residents. As a result, there are far too many people that simply cannot afford the insulin they need to live. Rationing insulin is a common practice, despite how dangerous it is. Taking too little insulin will eventually lead to diabetic ketoacidosis (DKA) and possibly early death.
It’s a sad state of affairs that Americans sometimes need to opt for these older, outdated insulin formulations. But if you have no access to some of the emergency options described in the link above, “Walmart insulin” can keep you alive.
Two Old-School Insulins
Millions of people with insulin-treated diabetes relied on these older insulins during the 1980s and 1990s, before a new generation of medicine came along.
Regular (R) insulin was replaced by new rapid-acting insulins such as Humalog and Novolog. NPH was replaced by newer long-acting basal insulins such as Levemir and Lantus. All of these insulins, new and old, have a powerful ability to lower your blood sugar. The difference is in how quickly and consistently they act.
Today’s rapid insulins have a fast peak of glucose-lowering action, which matches the fast glucose-raising effect that carbohydrates have on blood sugar. Regular (R) insulin, on the other hand, takes much longer to peak, which makes it much more difficult to match and counteract the blood sugar effect of most foods.
Today’s long-acting basal insulins offer a relatively steady glucose-lowering effect for about 24 hours. But NPH insulin works for less than 24 hours, and has a distinct peak of action; dosing is considerably more complicated, and the risk of hypoglycemia is higher.
To put it simply, using these old-school insulins introduces a higher level of difficulty. Patients using R and NPH may encounter more blood sugar peaks and valleys throughout the day. Back in the day, people with insulin-treated diabetes were generally advised to eat the same number of carbohydrates with every meal, to eat meals at the same times every day, and to regularly eat snacks between meals and before bedtime to ward off hypoglycemia. Methodical habits were beneficial to get the most out of these awkward and inconvenient older insulins.
Regular (R) Insulin
Regular (R) insulin is sold under the brand names Humulin R (Eli Lilly) and Novolin R (Novo Nordisk).
R insulin usually takes at least 30-40 minutes to start working, reaches peak activity between 2 and 4 hours, and may affect blood glucose levels for up to 6 hours (these parameters may vary depending on many factors, such as exercise). In contrast, many of the newer insulin analogs start working in as little as 15-20 minutes, reach peak activity between 1-2 hours, and are no longer active after 4 hours post-injection.
Because R insulin takes longer to use, patients may need to pre-bolus much earlier in order to use the insulin most effectively. Patients are usually instructed to take this insulin at least 30 minutes before they eat their meal. (Life with R insulin means more planning ahead.)
As an aside, R insulin has also become trendy among people that adhere to low-carbohydrate diets, especially as advocated by Dr. Richard Bernstein. The slower activity curve of R insulin can closely match the protein-induced rise in blood glucose levels. That means R insulin may actually be superior for meals with plenty of protein and very few carbohydrates.
Although broadly classified as long-acting insulin, it may be more accurate to say that NPH is an intermediate-acting insulin. The medication begins to take effect between one and four hours after injection. Its peak effect occurs four to 12 hours after injection and keeps working for 12 to 18 hours after injection.
People using NPH often have to plan their snacks or meals around the peak of action, so as to avoid hypoglycemia. NPH may also require a more complicated personalized dosing schedule because its typical 12-18 hour cycle doesn’t lend itself quite as naturally to daily or twice-daily injections.
Many people that use NPH find success with consistent meal/snack patterns, to account for the predictable blood sugar highs and lows that come with using less consistent basal insulin.
Another quirk to NPH: this insulin should be gently mixed before injection by rolling the vial gently between your fingers for as long as two minutes. This insulin should look cloudy after mixing.
Be Safe: Older Insulins Can Still Cause Severe Hypoglycemia
These insulins are no less powerful than today’s versions: R and NPH can still cause severe hypoglycemia. It is extremely important to fully understand the action of each insulin before you attempt to use it. It is dangerous to switch to a new insulin formulation without understanding how it will work differently in your body.
If you’re new to R and NPH, we strongly advise you to talk to a healthcare provider for help with dosing. Be prepared to test your blood sugar more than you’re used to, as you get used to a new manner of intensive insulin therapy.
Walmart sells two older formulations of insulin over the counter for the relatively affordable price of about $25 per vial. These old-school insulins are tricky to use and require knowledge or training. While they are suboptimal in comparison to today’s best insulins, they can be literally life-saving for people that don’t have access to modern insulin.