Switching insulin? How to prepare and questions to ask

After being on the same insulin since junior high, I recently found myself in a situation where my insurance company required switching insulin brands. I was confused and apprehensive. What type of conversation should I have with my doctor? How could I prepare for the transition? Were there resources for accessibility or affordability?

Addressing all of those questions got me thinking more generally — what if I needed to switch insulin types during an emergency, and how would I request trying a different type of insulin for health reasons? As with most things diabetes, preparation goes a long way!

Here's what I learned from my recent experience.

Reasons to switch insulin

Switching insulin types or brands may not be at the forefront of your mind right now, but there are several reasons you might find yourself in a situation where you need to switch:

1. Emergency. Think hurricane evacuation or house fire. Both of these situations (and many others) could impact your access to, or the availability of, certain types of insulin. The Food and Drug Administration has helpful information for these scenarios.
2. Health. Insulin is categorized by when and how long it works in the body. There's a variety of insulin types, everything from rapid-acting to ultra-long acting. Different periods of your life may require you to have a different type of insulin.
3. Access. This is where I found myself just a few months ago — my insurance company only covered a certain type of rapid-acting insulin, and it happened to be different from my 20+ year historical prescription.
4. Financial. Straying from your insurance plan's preferred insulins can be expensive. Prescription discount cards can help, but they aren't available in all situations (i.e., sometimes they only apply if you already have commercial insurance or for specific insulin types).

Work with your healthcare team, always

Any time you're considering switching insulin, it's imperative that you work with your healthcare team. At a minimum, you should initiate a conversation about what to do in an emergency. Discuss which insulins can be used as substitutes and what to use as a dosing ratio. Then, if you have questions or ideas about trying new or new-to-you insulins (such as an inhalable formula), ask these questions as a secondary objective.

And don't be afraid to call your endocrinologist's office or send a message if you have questions about switching insulins between appointments. I had to use this strategy when I found out (between appointments) that my new insurance wouldn't cover my long-standing specific insulin prescription.

Do some homework, just in case

Since emergencies can happen at any time, discussing insulin swaps or substitutions is a great topic for your next endocrinologist appointment. Make yourself a cheat sheet and upload the information to the cloud or send it to a few close contacts in case your own copy is lost.

Here are some considerations to get you started:

• Insulin pump manufacturer
• Insulin pump technical support hotline
• Types of insulin approved for use in insulin pump
• Insulin temperature ranges per manufacturer (standard and alternate insulins)
• Appropriate long-acting insulin to use in case of pump failure or unavailability
• Dosing instructions for alternate insulins or alternate delivery methods (i.e., insulin pen versus insulin pump)
  

I have a running note that includes all my basal rates, long-acting insulin dosages, and short-acting insulin substitutions that I've discussed with my doctor. I also store all my emergency phone numbers related to diabetes in the same file — it's my one-stop-shop for staying healthy in any situation (and especially emergencies).

Need help navigating all the daily diabetes decisions and options? Head over to Health Insights for more thoughtful articles.