# Question about Insulin Prescription **URL:** \ **Category:** Factual Questions\ **Created:** [May 5, 2019, 11:35pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530 "2019-05-05T23:35:42Z")\ **Posts on this page:** 17\ **Page:** 2
**Author:** ![Surreal](https://avatars.discourse-cdn.com/v4/letter/s/eada6e/32.png) [@Surreal](https://boards.straightdope.com/u/Surreal)\ **Post date:** [May 6, 2019, 6:37pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/21 "2019-05-06T18:37:59Z")
> [@Can\_Handle\_the\_Truth](#): > > I was just diagnosed as a diabetic. I was prescribed insulin. I took the prescription to a pharmacy and they gave me a vial of insulin but no syringes to inject myself. Is that normal? Do I have to get the syringes separately? There’s no one I can call right now because it’s the weekend. Do yourself a huge favor and get yourself of a copy of Dr. Richard K. Bernstein’s Diabetes Solution. ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [May 6, 2019, 9:10pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/22 "2019-05-06T21:10:15Z")
Many diabetics use insulin pumps. If that was the case they’d have no reason to buy syringes with the insulin. Also how would the pharmacist know you need syringes unless you tell him or her? Maybe you already have a couple of hundred count boxes at home. ---
**Author:** ![Mean\_Mr.Mustard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mean_mr.mustard/32/3865_2.png) [@Mean\_Mr.Mustard](https://boards.straightdope.com/u/Mean_Mr.Mustard)\ **Post date:** [May 6, 2019, 11:03pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/23 "2019-05-06T23:03:58Z")
> [@Mdcastle](#): > > Many diabetics use insulin pumps. If that was the case they’d have no reason to buy syringes with the insulin. Someone using an insulin pump should have back-up supplies - including syringes - in the event of pump failure. > [@Mdcastle](#): > > Also how would the pharmacist know you need syringes unless you tell him or her? Maybe you already have a couple of hundred count boxes at home. I don’t think the OP’s issue is with the pharmacist. It is the provider who should have recognized the need for - and prescribed - the syringes. mmm ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [May 7, 2019, 12:02am UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/24 "2019-05-07T00:02:43Z")
> [@Surreal](#): > > [Risk of hypoglycemia following intensification of metformin treatment with insulin versus sulfonylurea - PMC](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818151/) Yeah, we docs know that. But some patients with type II need to go right to insulin, given how out of control they are. Maybe they can get off it later, and on to a sulfonylurea. Maybe not. But what they need to do is get under better control in relatively short order. I’m not a doc who demands tight control for many/most of my patients, at least not to start. Too much risk of hypoglycemia, which can be a lot worse than hyperglycemia. But I see patients all the time with A1C levels at 13 or higher; my record is 20. That means some folks are averaging glucose levels of 400 or more in the previous 3 months. That will NOT respond quick to oral meds only. ---
**Author:** ![Springtime\_for\_Spacers](https://avatars.discourse-cdn.com/v4/letter/s/a3d4f5/32.png) [@Springtime\_for\_Spacers](https://boards.straightdope.com/u/Springtime_for_Spacers)\ **Post date:** [May 7, 2019, 1:15am UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/25 "2019-05-07T01:15:57Z")
> [@Surreal](#): > > [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818151/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818151/) > [@](#): > > Among patients using metformin who could use either insulin or sulfonylurea, the addition of insulin was associated with a higher risk of hypoglycemia than the addition of sulfonylurea. This finding should be considered by patients and clinicians when discussing the risks and benefits of adding insulin versus a sulfonylurea. I am a counter example to this. I was prescribed glyclazide, a sulfonylurea, alongside metformin and several times my blood sugar dropped suddenly. On one occasion I happened to be in hospital visiting my dad when it happened and I went dangerously low in the space of a few minutes. I was sat talking to my brother at dad’s bedside when I began to find it hard to follow what he was saying. I thought I need some air but had to sit down on the way off the ward. At this point I realised what the problem was and sent bro to find chocolate. Luckily he ran into the doctor who was treating dad whilst hunting for a snack machine. The doctor had me plied with hot chocolate and biscuits and my blood sugar taken. It was around 3. Yes, I started carrying sugary things after that and had my prescription changed to insulin instead. I’ve still had a couple of low blood sugar episodes but it hasn’t happened so ridiculously fast. ---
**Author:** ![audiobottle](https://avatars.discourse-cdn.com/v4/letter/a/bc8723/32.png) [@audiobottle](https://boards.straightdope.com/u/audiobottle)\ **Post date:** [May 7, 2019, 3:58am UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/26 "2019-05-07T03:58:52Z")
> [@Qadgop\_the\_Mercotan](#): > > I’m not a doc who demands tight control for many/most of my patients, at least not to start. Too much risk of hypoglycemia, which can be a lot worse than hyperglycemia. But I see patients all the time with A1C levels at 13 or higher; my record is 20. That means some folks are averaging glucose levels of 400 or more in the previous 3 months. That will NOT respond quick to oral meds only. 20?! You have my record beat by at least 6. Impressive. Well, maybe not the best word choice but it certainly made an impression. As **Qadgop** said, when A1cs are high enough, oral pills alone won’t cut it, at least not at first. I would assume that the OP’s PCP made the appropriate initial treatments. DM management still has a lot of art to it. It is definitely not a one size fits all, and more education is always a good thing. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [May 7, 2019, 4:13am UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/27 "2019-05-07T04:13:33Z")
> [@panache45](#): > > Just be glad you don’t have to take two different types of insulin in the same syringe, like I do, 3x a day. I have to be very careful to get the dosages correct. > > And I really wish someone would re-design syringes, to be used by one hand. Instead of those two little “wings” on the sides, they need a collar that goes all the way around. Syringes can twist while they’re being handled, and it’s a real PitA. Syringes have gotten crappier over the long time I’ve been using them. I agree they need more than the little wings. ---
**Author:** ![Si\_Amigo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/si_amigo/32/2877_2.png) [@Si\_Amigo](https://boards.straightdope.com/u/Si_Amigo)\ **Post date:** [May 7, 2019, 4:37pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/28 "2019-05-07T16:37:51Z")
> [@audiobottle](#): > > 20?! You have my record beat by at least 6. Impressive. Well, maybe not the best word choice but it certainly made an impression. As **Qadgop** said, when A1cs are high enough, oral pills alone won’t cut it, at least not at first. I would assume that the OP’s PCP made the appropriate initial treatments. DM management still has a lot of art to it. It is definitely not a one size fits all, and more education is always a good thing. Well a lot of QTM’s patients lead extremely sedative lives and never get any exercise. Also their options for meals is limited and very routine, so they probably eat a lot of junk food. ---
**Author:** ![Athena](https://avatars.discourse-cdn.com/v4/letter/a/35a633/32.png) [@Athena](https://boards.straightdope.com/u/Athena)\ **Post date:** [May 7, 2019, 6:47pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/29 "2019-05-07T18:47:34Z")
> [@Surreal](#): > > Do yourself a huge favor and get yourself of a copy of Dr. Richard K. Bernstein’s Diabetes Solution. Or don’t. This book caused me no end of frustration and fright when I was initially diagnosed. Though some folks may choose to follow Bernstein’s next-to-no-carb diet, it’s only one of many ways to control blood sugar and certainly not the easiest/only way. (For those not familiar, Dr. Bernstein advocates extremely tight blood sugar control in part by adhering to a very low carb diet - 30 grams or less per day for an adult divided between breakfast, lunch, and dinner. For clarity, an average slice of bread is around 25 grams of carbs. I have no doubt his diet works, but for me, it represented a life style change that I absolutely did not want, and turned out to be unneeded for decent blood sugar control, and caused me no end of angst to keep hearing people tell me to use it.) ---
**Author:** ![Bijou\_Drains](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bijou_drains/32/2814_2.png) [@Bijou\_Drains](https://boards.straightdope.com/u/Bijou_Drains)\ **Post date:** [May 7, 2019, 8:33pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/30 "2019-05-07T20:33:10Z")
It’s not well known but you don’t need a prescription for insulin in the US except for Indiana. Wal Mart and other places will sell the older style insulins to anyone at a pretty low cost. The newer insulin types such as Humalog are way more expensive and if you want insurance to pay then you need a Rx. ---
**Author:** ![Surreal](https://avatars.discourse-cdn.com/v4/letter/s/eada6e/32.png) [@Surreal](https://boards.straightdope.com/u/Surreal)\ **Post date:** [May 7, 2019, 9:41pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/31 "2019-05-07T21:41:44Z")
> [@Athena](#): > > Though some folks may choose to follow Bernstein’s next-to-no-carb diet, it’s only one of many ways to control blood sugar and certainly not the easiest/only way. It’s not the easiest but it certainly is the most effective way: [https://pediatrics.aappublications.org/content/141/6/e20173349](https://pediatrics.aappublications.org/content/141/6/e20173349) > [@](#): > > RESULTS: Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. **Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia.** An HbA1c of 5.67% corresponds to an average blood sugar of 116 mg/dl. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [May 7, 2019, 10:07pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/32 "2019-05-07T22:07:59Z")
> [@Si\_Amigo](#): > > Well a lot of QTM’s patients lead extremely sedative lives and never get any exercise. Also their options for meals is limited and very routine, so they probably eat a lot of junk food. These are the guys coming into prison, been on the run (but not running real hard, apparently), avoiding medical care and insulin and other meds. I generally can get their A1Cs into single digits. Mostly. Some refuse to do a damn thing to take care of their diseases though. ---
**Author:** ![Mean\_Mr.Mustard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mean_mr.mustard/32/3865_2.png) [@Mean\_Mr.Mustard](https://boards.straightdope.com/u/Mean_Mr.Mustard)\ **Post date:** [May 7, 2019, 10:21pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/33 "2019-05-07T22:21:59Z")
> [@Qadgop\_the\_Mercotan](#): > > …But I see patients all the time with A1C levels at 13 or higher; my record is 20. That means some folks are averaging glucose levels of 400 or more in the previous 3 months… It’s significantly more than that. An A1c of 20 = a 90-day blood sugar averaging 527 by my calculation.\* That dude not only needs insulin, he needs it IV. I actually saw a 16.9 today, which may be my record. mmm \*(28.7 - A1c) - 46.7 = average blood glucose ---
**Author:** ![Athena](https://avatars.discourse-cdn.com/v4/letter/a/35a633/32.png) [@Athena](https://boards.straightdope.com/u/Athena)\ **Post date:** [May 8, 2019, 11:33am UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/34 "2019-05-08T11:33:28Z")
> [@Surreal](#): > > It’s not the easiest but it certainly is the most effective way: > > [https://pediatrics.aappublications.org/content/141/6/e20173349](https://pediatrics.aappublications.org/content/141/6/e20173349) > > An HbA1c of 5.67% corresponds to an average blood sugar of 116 mg/dl. I disagree with “most effective.” I (and many other T1Ds) maintain similar or lower numbers using non-Bernstein methods. (I’d actually be worried if I had an A1c as high as 5.67%, mine is typically between 5 - 5.3) I don’t want to hijack this thread, but you’re sort of doing what caused me so much angst way back when. Bernstein is ONE method, and great if someone wants to use it! But for me (and many others) to adopt such an austere diet would be so miserable in so many ways & represents a life change MUCH larger than the life change that any T1 has to take on in order to manage the disease. Touting it as the “best” or “necessary” method is a scare tactic IMO. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [May 8, 2019, 1:18pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/35 "2019-05-08T13:18:33Z")
> [@Mean\_Mr.Mustard](#): > > It’s significantly more than that. An A1c of 20 = a 90-day blood sugar averaging 527 by my calculation.\* That dude not only needs insulin, he needs it IV. > > I actually saw a 16.9 today, which may be my record. I distrust the lab accuracy, frankly. I’ve seen an A1C on a patient one day be 9.8 and a week later when accidentally repeated it’s 10.7 :mad: ---
**Author:** ![Mean\_Mr.Mustard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mean_mr.mustard/32/3865_2.png) [@Mean\_Mr.Mustard](https://boards.straightdope.com/u/Mean_Mr.Mustard)\ **Post date:** [May 8, 2019, 2:53pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/36 "2019-05-08T14:53:47Z")
> [@Qadgop\_the\_Mercotan](#): > > I distrust the lab accuracy, frankly. I’ve seen an A1C on a patient one day be 9.8 and a week later when accidentally repeated it’s 10.7 > > :mad: Yep. We do point-of-care A1c testing and often send a sample to the lab to verify/correlate. They are typically off by a percent or so. If things really look funky we do a fructosamine. mmm ---
**Author:** ![Surreal](https://avatars.discourse-cdn.com/v4/letter/s/eada6e/32.png) [@Surreal](https://boards.straightdope.com/u/Surreal)\ **Post date:** [May 8, 2019, 7:38pm UTC](https://boards.straightdope.com/t/question-about-insulin-prescription/833530/37 "2019-05-08T19:38:02Z")
> [@Athena](#): > > I disagree with “most effective.” I (and many other T1Ds) maintain similar or lower numbers using non-Bernstein methods. (I’d actually be worried if I had an A1c as high as 5.67%, mine is typically between 5 - 5.3) Dr. Bernstein has said his A1c is consistently 4.5%, even though he’s been a Type 1 diabetic since 1946 so he likely doesn’t have any pancreatic beta cells remaining. Point being that anecdotes such as these don’t prove anything. > [@Athena](#): > > I don’t want to hijack this thread, but you’re sort of doing what caused me so much angst way back when. Bernstein is ONE method, and great if someone wants to use it! But for me (and many others) to adopt such an austere diet would be so miserable in so many ways & represents a life change MUCH larger than the life change that any T1 has to take on in order to manage the disease. Touting it as the “best” or “necessary” method is a scare tactic IMO. I’m not aware of other methods of diabetes management that have been scientifically proven to be as effective as Dr. Bernstein’s, but the logic of his “law of small numbers” is absolutely incontrovertible. Small amounts of carbohydrates require smaller insulin boluses and result in smaller errors; large amounts of carbohydrates require large insulin boluses and result in larger errors. [Previous page](https://boards.straightdope.com/t/question-about-insulin-prescription/833530.md?page=1)