FAQs

There are several types of diabetes, each with different causes and characteristics. The most common types include:

1. Type 1 diabetes: This is an autoimmune condition in which the body's immune system mistakenly destroys insulin-producing beta cells in the pancreas. As a result, the body produces little or no insulin. Type 1 diabetes usually occurs in children and young adults but can develop at any age. People with type 1 diabetes require daily insulin injections or an insulin pump to manage their blood sugar levels.

2. Type 2 diabetes: The most common form of diabetes, type 2 diabetes, occurs when the body becomes resistant to insulin or does not produce enough insulin to maintain normal blood sugar levels. Type 2 diabetes is more common in older adults, although it is increasingly being diagnosed in younger individuals too. It is often associated with obesity, physical inactivity, and a family history of the condition. Management involves lifestyle changes, oral medications, and, in some cases, insulin therapy.

3. Gestational diabetes: This form of diabetes develops during pregnancy and usually resolves after the baby's birth. Gestational diabetes occurs when the body cannot produce enough insulin to meet the increased insulin requirements during pregnancy. It can lead to complications for both the mother and baby if not managed effectively. Management includes dietary adjustments, regular blood sugar monitoring, and, if needed, insulin injections.

Other, less common types of diabetes include:

4. Maturity-Onset Diabetes of the Young (MODY): This is a group of rare, genetically inherited forms of diabetes caused by mutations in specific genes. MODY often develops during adolescence or early adulthood and has various subtypes, each with different characteristics and treatment requirements.

5. Latent Autoimmune Diabetes in Adults (LADA): Also known as "slow-onset type 1 diabetes" or "type 1.5 diabetes," LADA is an autoimmune form of diabetes that manifests in adults and has features of both type 1 and type 2 diabetes. It requires insulin therapy, similar to type 1 diabetes.

6. Neonatal diabetes: This rare form of diabetes occurs in infants within the first six months of life, caused by genetic mutations that impair insulin production or function. Management depends on the specific genetic mutation and may involve oral medications or insulin therapy.

7. Secondary diabetes: This type of diabetes results from other medical conditions (such as Cushing's syndrome, acromegaly, cystic fibrosis) or as a side effect of certain medications (e.g., steroids, antipsychotics). Treatment focuses on addressing the underlying cause and managing blood sugar levels with appropriate medications.

Each type of diabetes has unique causes, characteristics, and treatment approaches.

Insulin is a vital hormone produced by the pancreas that regulates the breakdown and metabolism of carbohydrates, lipids, and proteins. It plays a critical role in maintaining blood sugar levels within a healthy range by allowing cells to absorb and utilize glucose, which is the primary source of energy for the body.

Type 1 diabetes is an autoimmune condition in which the insulin-producing cells in the pancreas are destroyed. Because of this, people with type 1 diabetes need to take insulin injections that they will require for the rest of their lives.

Type 2 diabetes occurs when the body becomes resistant to insulin or when it can’t make enough of it. First line treatments include lifestyle changes, oral medications, and weight loss. However, many people with type 2 diabetes also require insulin to supplement and bring their blood glucose down to healthy levels.

Currently, there is no cure for diabetes.

For type 1 diabetes, the main treatment is insulin therapy, as the body can no longer produce its own insulin due to the autoimmune destruction of beta cells in the pancreas.

In type 2 diabetes, lifestyle changes such as making healthy food choices, engaging in regular physical activity, and maintaining a healthy weight can significantly improve blood sugar control. If necessary, oral medications and/or insulin may be added to the treatment plan.

The high cost of insulin is a complex issue with many factors involved. However, there are several key reasons why insulin has become so expensive:

Patents: The three major manufacturers of insulin, Eli Lilly, Novo Nordisk, and Sanofi, have patents on their insulin products, which means they have a monopoly on the market. This allows them to charge high prices for their insulin without competition.

Lack of generic competition: There is a lack of generic competition in the insulin market due to the complexity of the manufacturing process and the patents put in place to prevent cheaper, generic insulin from being made.

Cost of research and development (R&D): Insulin manufacturers spend money on research and development to create new and better insulin products. These costs are passed on to consumers in the form of higher prices. However, the price of insulin far exceeds the R&D costs.

Rebates and discounts: Insulin manufacturers offer rebates and discounts to pharmacy benefit managers, insurance companies, and other middlemen in the supply chain. These middlemen often pocket a portion of the rebate or discount, which can drive up the cost of insulin for consumers.

Health insurance: The cost of insulin can also be affected by the type of health insurance a person has. Some insurance plans may cover all of or a portion of the cost of insulin; however, there are many that don’t pay for it at all until a high-deductible is met.

Pharmacy Benefit Managers (PBMs) are third-party administrators that manage prescription drug benefits for health insurance plans, employers, and other organizations. PBMs negotiate drug prices with pharmaceutical manufacturers, develop and maintain a list of covered drugs (known as a formulary), process prescription drug claims, and manage the pharmacy network used by the plan.

PBMs work to reduce the cost of prescription drugs by negotiating with drug manufacturers for lower prices, promoting the use of generic drugs, and using other cost-saving measures such as mail-order pharmacies and prescription drug monitoring programs.

However, PBMs have been criticized for their lack of transparency in drug pricing and their role in increasing drug costs. Critics argue that PBMs receive large rebates and discounts from drug manufacturers that are not passed on to consumers, and that they often keep a portion of the rebate or discount for themselves. Additionally, PBMs have been accused of steering patients to higher-priced drugs in order to receive larger rebates from drug manufacturers.

Manufacturer: The process starts with insulin manufacturers, who produce and distribute different types of insulin.

Wholesaler: Manufacturers sell their insulin products to wholesalers, who buy in bulk and distribute the medications to various retail pharmacies.

Pharmacy Benefit Manager (PBM): Insurance companies work with PBMs to negotiate prices and rebates from manufacturers. PBMs manage prescription drug benefits for insurers and design drug formularies (lists of covered drugs).

Insurance Company: Insurance companies receive negotiated prices from PBMs and create healthcare plans, which include prescription drug coverage.

Pharmacy: Pharmacies buy insulin products from wholesalers and sell them to customers, billing the insurance company for reimbursement.

Patient: Patients with insurance pay a copay, coinsurance, or deductible, depending on the specific terms of their insurance policy. The insurance company covers the rest of the cost.

Manufacturer: Insulin manufacturers produce and distribute different types of insulin.

Wholesaler: Manufacturers sell insulin to wholesalers, who distribute medications to various retail pharmacies.

Pharmacy: Pharmacies buy insulin products from wholesalers and set retail prices.

Patient: Without insurance, patients are responsible for paying the full retail price of insulin at the pharmacy (around $275). However, some pharmacies or manufacturers may offer discounts, patient assistance programs, or coupons to help uninsured patients afford their medications.

Limited Eligibility: Many patients don’t qualify for these programs, and eligibility criteria can be strict, excluding many who need financial assistance.

Temporary Relief: Coupons or assistance programs may offer only short-term solutions, leaving patients searching for new ways to afford their insulin when the assistance expires.

Complex Application Process: Applying for these programs can be complicated, time-consuming, and sometimes discouraging for patients in need.

Limited Availability: Many programs have budget constraints that limit the number of patients they can serve, leaving some without assistance.

Unexpected Changes: Manufacturers can change or terminate these programs without notice, making it difficult for patients to depend on them for insulin access.

Doesn't Address Root Causes: These programs are a band-aid solution, not addressing the underlying issues of high insulin prices and lack of price transparency in the healthcare system.