Diabetes evolutions: The insulin vial

It all began with Regular and NPH. One of them was clear. The other was cloudy. One of them was short-acting. The other was long-acting. That was the entire landscape of insolence when I was introduced to them as an eight-year-old.

I will give myself injections of the Regular insulin two times a day — in the morning, and in the afternoon. I would give myself injections of NPH in the evening and in the morning. That was just how it was. Meals, snacks, all food intake were arranged around the time of insulin administration.

And for the first four or five years, that’s all there was to it. My diet followed a simple protocol. I would have a small breakfast at 8 a.m. I would have a snack at 10:30 a.m. I would eat lunch at noon. I would have a snack at 2 p.m. I would have dinner at 5 p.m. I would finish up the day with a snack at 8 p.m.

All these years later, the schedule reels forth from my brain without the slightest hesitation.

That’s how ingrained in the schedule was. That’s how ingrained of the ways of the insulin were.

The biggest change came in middle school. I was finally put on an insulin plan based on when I ate rather than the time of day. It was only a short hop, skip and a jump from that to bolusing based on carbohydrates.

Over the next handful of weeks, I’m going to be digging through my memories of diabetic supplies and treatment, past and present. This week I’m talking about insulin, which has changed in ways both good and bad over the past few decade.

Given that we’re talking about insulin, I should note that Regular and NPH didn’t last forever. New insulin came into the mix, too. Humalog, Novolog, Lantus. And all of these cases the insulin action was quicker or more consistent or some combination of the two.

Especially when paired with an insulin pump, this new generation of insulin shined. The fluid inside the vials was all clear now, and it was still magical stuff.

Something else changed with insulin, though. It became more expensive. While glucose meters and test strips continually dropped in price (visit your local convenience store and check out the generics to find out how much), while pumps and continuous glucose meters have been covered by more and more insurance plans, the price for a vial of standard insulin has gone up and up and up.

And up, and up.

Briefly, while I was on a high-deductible insurance plan, I spent $250 for a single vial of Humalog insulin. Thankfully, myself and my family were not put in the position of having to decide between food or insulin. But it was a stark reminder of the fiscal price levied on the heads of the many Type 1 diabetics.

Because while some diabetes technology might be optional — while not everyone has to use a pump or a fancy meter — no Type 1 can go without insulin. It’s indispensable. And unless every diabetic has a ready supply of the very substance they need to live, none of the other advances are worth it.