by Sarah Jane Tribble
When Carmen Smith was uninsured, she knew she needed insulin to control her diabetes.
But she couldn't afford to go to a doctor for a prescription.
So, she just went to a nearby pharmacy.
"I's not like we go in our trench coat and a top hat, saying, uh, I need the insulin. We go, I need to purchase a bottle of R insulin or the Novolin, N insulin, and they'll be like how many vials? …. The clerks usually don't know it's a big secret, they'll just go, 'do we sell over the counter insulin?' and the pharmacist will go 'hmm-mm."' laugh. And then they'll go get it and you purchase it and go on about your business," Smith says.
Smith has Type 2 diabetes and she bought over the counter insulin for about 6 years back when she was uninsured. She just took the amount a doctor had told her to take years before.
It was a way to survive, she says, but no way to live.
"It's a quick high and then, it's a down. The down part is you feel icky. You feel lifeless, you feel pain and the cramps are so intense, till you can't walk, you can't sit, you can't stand. You get that when you take the R insulin, the regular and it shoots down really fast." Smith says.
MetroHealth's Dr. Jorge Calles says not taking insulin can cause death, but so can taking too much.
"Bottom line is if you take a good amount of insulin, put it into the vein or the skin of someone you can kill that person. Because the blood sugar drops down and remains low and your brain requires sugar constantly," Calles says. "So, if it doesn't have sugar it can go into a coma, prove seizures and you can die. So it's a very serious situation if they are selling over the counter without any control with a prescription specifically."
The U.S. Food and Drug Administration approves whether drugs can be sold over the counter or require a prescription. An FDA spokeswoman confirmed in an e-mail that certain older insulins are approved for over-the-counter sales nationwide.
The FDA declined multiple requests for interviews but wrote that the older insulins are available over the counter because they "did not require a licensed medical practitioner's supervision for safe use."
But many doctors would disagree, including Kevin Burke.
"The risk of diabetic complications is directly related to the level of control, so poorly controlled diabetics have more complications than better controlled diabetics," Burke says.
Those complications can include high blood pressure, kidney disease, nerve damage, loss of eyesight and stroke. And they often develop without notice over years of a person's blood sugar levels not being properly managed.
Burke was so concerned after two of his patients admitted to going off their prescriptions for the less-expensive over-the-counter insulin, that he lobbied his state of Indiana to pass a law. Last year, Indiana became the only state in the nation to require prescriptions for Humulin and Novolin.
Burke asked the American Medical Association to pass a resolution asking for all insulins to be prescription based. But the AMA turned that down, saying over-the counter availability may be an important way for some insulin-dependent patients to access the medicine.
And it's safe to say that there are plenty of people who either need or want that access. According to the consulting firm IMS Health, about 15 percent of people who buy insulin in the growing U.S. diabetes market, purchase it over the counter without a prescription. The cheapest version sells for about $25 a vial.
Executives at the two companies that produce insulin say it’s important that the drug is easily available and affordable. But, they also say it is important for diabetics to work with a doctor to manage the disease.
Carmen Smith agrees.
"It's not getting the insulin that is the problem. It is getting the right medical treatment because of that disease that you have that is insulin dependent that is the problem. Once I got connected with my physician, life as a diabetic, got a lot less complicated for me," Smith says.
Since Ohio expanded Medicaid, Smith has enrolled. She sees a doctor regularly and taking insulin is no longer a guessing game.
But for others who don't have adequate health insurance, there's still the possibility of trying to figure this out yourself, over the counter.
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