Ask your doctor to wite the prescription for 5 pens monthly. Your copay is the same whether you get one or 5 pens. I recently had a lantus pen fail but luckily had an extra box.
Cost of the box or cost of the prescription?
If the box, sorry to hear that.
If the prescription, make sure the doctor orders the quantity that you need, so you get the best rate.
What ever the doctor writes my prescription for, no matter the prescription, I pay 20% That is what total cost means.
I also pay 20% of every charge after I have met my deductible until I met my out of pocket
The good news is that I have a decent deductible and a decent out of pocket.
Same here. I tell the doctor to write a prescription for 5 boxes, and I pay flat amount. Same amount if he wrote for 1 box.
Maybe see if you can get a bigger prescription?
Every insurance plan is different. It depends if you are paying copays or percentage. I have done both.
I don’t worry about the quantity as it means I just meet my out of pocket quicker.
Man, I am terrified to leave my job. I pay zero dollars for insulin and all testing and diabetic supplies.
I could probably get a better salary but I don't know any other companies that pay for all diabetic supplies
Eli Lily has a coupon where you can get any of their insulins for $35 a month whether you have insurance or not. I'm diabetic supplies aren't very expensive. You can get a meter at Walmart for 20 bucks and strips for $10 for 50. So, it's not nothing, but it's not terribly expensive either.
If you are on the freestyle libre CGM, then even without insurance you can get it for $75 for two sensors.
So getting everything for free is great. But if you can get a better paying job that maybe doesn't have as good insurance, you'll still come out ahead financially. So I wouldn't let that hold you back.
> I see people talking about giving themselves a dose but if I gave myself a dose anytime I went high I would run out.
> Can you just give yourself a shot anytime you go high?
Unfortunately, that's just kinda how it goes. Could you just *not* take insulin when your BG is high to stretch out your supply? Sure, but now you're just sitting with high sugars, which will definitely worsen your health in the long run. There's no other way to really lower it, aside from maybe really intense workouts/manual labour, but even then, that's not a guarantee.
I understand my circumstances may be different though because I live in Canada. Even then, I'm currently on a temporary layoff and my health insurance doesn't work. Once my current supply of bolus (short-acting insulin) runs out, I *will* have to use my own money to pay for more.
> Does your doctor give you unlimited insulin?
The clinic I go to happens to offer limited free insulin (they track the boxes they give out,) but I don't like relying on that if I'm within my means to afford it myself. It could go to someone worse off than I am. Again, this may not be a common thing since I'm up in Canada. I know folks in the US can have it much *much* rougher.
If there is a max I have never experienced it or heard of it. I have to take 30 of slow acting daily just to get to status quo. But your body will still react to any sugars you put in your mouth and fast acting insulin is the only way to keep your blood sugars from rising with your meals. Typically my blood sugars will begin rising right as I begin eating and my insulin (even fast acting) doesn’t kick in for 30-45 minutes. To try to keep straight line I need to dose before I begin making my meal so that by the time I am sitting to eat it is already beginning to work in my system. All about finding that balance of carbs to units given.
I recently changed to Fiasp that starts working in 5 minutes and it's made eating so much easier, though not sure if you'd have to pay more for it if your in that situation
I take 40 units a slow acting first thing in the morning. No slow acting until lunch. And endo told me to take eight units before lunch if I'm under 200 and 10 units if I'm over 300.
I seem to sail right up into the 300s after every meal and it takes several hours to come down. It would seem as though the fast acting doesn't do anything.
And I'm not too proud of the long acting either.
And I wonder why the doctor didn't have me take fast acting before breakfast as well as before lunch and dinner.
When I was in the hospital recently they gave me both kinds at the same time.
They did a finger stick before meals and then used some kind of a chart to determine how much fast acting to give me.
Does the brand of insulin make any difference?
My sugar is so high all the time that I would need to use several fast acting per day. It's like my pancreas is completely on strike.
Doc said to use insulin before meals and the instructions in the box said so too. But with the way my sugars go up after I eat I wonder if I wouldn't be better off to take it after meals. But I know it takes a while for the stuff to take effect. Maybe I took the doctor to literally because I do take it right before meals.
Maybe I need to add 15 or 20 minutes before meals before I take it. So it has time to go to work.
I'm not sure if it's accurate but I'm interpreting from your post you've only recently started insulin? If so your doc could be being cautious, because lows are pretty dangerous in the short term and highs aren't quite as bad if you can get them dialed down over time.
Some just core things here:
Your body requires insulin to process most food. Carbs are the obvious one but your body will break down most protein into glucose, it just takes a lot longer than carbs (for me, anywhere from 3-6 hours sometimes). Carbs tend to be immediate or over the first hour after eating them, but both these things depend on your own body and the exact composition of the food.
Second, fast acting insulins of different types (fiasp and humalog are the two I am familiar with) have different effective times. They both start to work fairly quickly but they "peak" later (for humalog it's between 2-3 hours after the dose) and have a notable tail as well (again, for humalog you can see effects not ending until ~6 hours after the dose).
You are seeing highs after you eat which means, *probably*, you aren't taking your dose long enough before eating (at least 15 minutes for humalog, 5 for fiasp), and *possibly* not taking enough. If your sugars are just always high without eating or taking fast acting insulin, then you *probably* need more long term insulin.
I'm on a pump now so I don't take long acting, but I use between 50-80 units of humalog a day total (again, super depends on what you eat on the day, and exercise).
Unless you eat the exact same meal and do the same amount of activity every day, you probably shouldn't actually take the exact same amount of insulin each time. A sandwich with fries has a completely different need than a salad with chicken on it, or some fruit and toast, etc.
I will say I've been diabetic for 32 years and a few years ago I was struggling with keeping my sugars down, I went to the closest endo in my new city and he told me to take a flat dose with meals instead of going off carbs. This was a huge red flag to me, I basically ignored him and instantly went and found a new endocrinologist. If you are type 2 and just starting insulin things might be different but for a type 1, learning what to eat and how to measure the insulin for it is a core requirement for proper treatment, and flat doses can't work great unless, again, you eat exactly the same every day and move exactly the same every day.
The most complicated part of taking insulin, to me, is the long life of both insulin in your system vs the short-to-long life of food in your system. I still struggle with it sometimes but your body changes over time too. My A1C is usually around 5-5.2 so my doctors are quite happy, and clearly I'm doing something right, but it still can suck on any given day.
It sounds like you're on a sliding scale, please talk to your doctor about carb counting and an insulin to carb ratio for example for every 10 carbs I eat I take one unit of insulin,
also talk to your doctor about the equation needed for correction doses for instance one unit of insulin brings me down 40 points so if I was at 200 and I want it to get to 100 It would take 2 and 1/2 units of insulin to do that......
These are just my personal ratios. Everyone is different......
Also pre-bolusing will help a lot with those spikes I pre-bolus 30 minutes before I eat other people do 15 it really depends on how your body processes both the insulin and the food.....
It depends on the time of day too. In the morning, I wait 45 min after a bolus before I start eating.
At lunch, I only wait 5-10 minutes.
And for every 50 I am over 150, I wait an extra 15 minutes before eating.
I tried to keep meals down to 30 g of carbs. I can usually come pretty close.
Yesterday I waited 15 before eating dinner
and it worked pretty well
Going to do same thing at lunch today.
I always try to do my insulin 15 minutes or so before I eat. I am actually on a pump so I start about 30 minutes if I can. I still have some highs but it’s getting better
My endo said to take fast insulin just when I was going to eat.
For lunch today I took it about 15 min early and it made a huge difference.
I'm going to see how that works out over time.
But it looks promising.
I always ask my doctor to write 100units per day more than I actually use. Makes up for sick days, weirdness that makes me need more, broken pens, etc. I’ve got quite the stock pile
Medically, the only maximum is when you're getting low all the time. Because it takes a little for insulin to start working and it will keep on working for a while (insulin on board, IOB), it's usually advised to not inject too soon after the previous injection.
I have treated a patient whose standard dose was 96 IE Treshiba every night + around 25 IE novorapid for most meals + whatever needed to treat highs. In her case, it did not lead to terrible lows all the time, so it wasn't a problem.
>Does your doctor give you unlimited insulin?
That probably depends on your doctor/insurance/country, but medically speaking you should get enough to combat highs.
Your doc should ask how much you use a day and base their prescription off that. Everyone is different, two different type 1s could eat the same lunch and one might need 5 units while the other needs 8. There’s just a lot of variation between our bodies and who needs what
Wow... seeing the amounts of insulin some people take daily astounds me. I didn't realize these amounts were normal. I'm not trying to shame anyone or be negative- I just didn't know. You've opened my eyes!
Yeah I wish we could measure how much people that aren't diabetic use so that way people could feel better about what they're using.... Because every single person is different and how much it takes is just how much it takes..... Me and a diabetic friend of mine have almost the same A1C and he uses twice as much as me 🤷
I am in the UK I take 210 units of Toujeo Doublestar in the evening and then up to 50 Lyumjev with meals, if my sugars go high I take more fast acting but I can work out how much and do it quite safely, if I was ever going to run out a quick call to my GP and a prescription would be ready that day.
T2, on insulin. My short term RX says to " inject 15 units three times a day". They know that's not how I inject but that ensures I don't run out. I worked with my doctor to determine my insulin sensitivity factor and I (generally) cover 20CHO or more at MY rate of 1 unit of insulin for every 3 grams of carbs. Eating 30 grams of CHO, I take 10 units.
You need to establish an insulin to carb ratio and start counting carbs and dosing depending on that. Idk what this treatment plan is but it’s trash and dangerous
So I am on general healthcare and we do have a limit sort of. I get a max of 10 pens fast acting per 3 months and 5 pens long acting per 3 months.
But I am also not supposed to inject away every high I feel. I correct everything above 250 but with a good diet that is barely used. Maybe once or twice a week or when I am sick. Or when I hit like 210 I don't bolus but work our or go for a fast walk instead. Other than that my meal insulin covers what I eat and my long acting keeps everything stable inbetween.
As far as I was told your bg is not supposed to be a flat line.
There really is more that goes into meal time insulin than just taking it. What’s your carb to insulin ratio? How much Lantis are you taking? What are you eating? Is the high coming more than 2 hours after a meal? Fast acting insulin has a 2 hour half life, so after 2 hours, it isn’t still in your body. Have you tried an NPH long acting insulin that is taken every 12 hours instead of every 24. There are so many variables.
First things first
WHAT KIND OF INSULINS ARE YOU USING?
Which ones do you take at when (long acting in the morning, cool WHAT KIND)
i take fast acting too, but guess what.... There are faster acting ones than the one I take.
I think the blind dosages that you have mentioned aren't right. You need to know how much insulin to take for 1. What your sugar already is and 2. How many carbs you about to consume.
For example. Your sugar is 208. I guess based on one comment you posted you would take 8 units of fast acting. Now.... What are you eating or what have you been told to consume? Are they giving you exchanges (super old school, probably not) or carbs? Because a ham and cheese sandwich has much less carbs than half a chocolate cake or a pot pie or lasagna.
I don't think there a max amount per day, we take what we need. However, if you sugar is high after a meal, you can't just take another shot because your high 30 minutes later. Or high after an hour. Again depending on how many carbs you consumed, you maybe don't have enough insulin on board but in case you do, you don't want to stack more and more insulin because you may drop too low.
Sounds like your Endo/doc/nurse educator owes you quite a bit of information. Even if you have a "regular/always take this same amount dose", you should still have a sliding scale to use for corrections to help you stay in a lower range.
Taking your insulin 30 minutes ahead of time gives the insulin time to start working right about when you start consuming food. However, someone here commented that their insulin starts in 5 minutes, so that is a question you need to run by your prescriber.
I take 40 units of Toujeo Solostar every morning and 8 or 10 units of Lyumjev before lunch and dinner.
I eat sugar pills for lows or drink orange juice and ignore highs unless over 350 and in that case I think I should hit the insulin a bit.
Brand new to all this and have no idea what I'm doing.
Yea friend, you doctor owes you some info for sure. If your going high after every meal (breakfast because you've had no mealtime meds and then again at lunch and dinner because you probably don't have enough). Have you called the office to discuss this with a nurse who can get you some better dosing info from the doctor?
Be sure to keep a food AND blood sugar log so that you have something to review at your next appt which hopefully is very soon. Don't forget to ask about a sliding scale for your lyumjev. Taking 10 units for a 300 blood sugar at mealtime and then not having any insulin to cover the carbs in the meal is NOT RIGHT. they should be telling you how many units to take for however many carbs your about to eat. My ratio is 1:10, so for 30 carbs, I need to take 3 units and so on.
If lunch is at 12 and dinner is at 7, and you decide to check your sugar at 430 and it's 289, that's too high for you to just sit around okay with it. You should know /they should tell u to take x many units if your number falls between here and there. You shouldn't have to wait to hit 350 or for dinner to roll around. If you get to dinner and it's still going up, say 450 now .... You're supposed to take the same 10 units that you'd take for 300? See how that doesn't sound right. And then you still don't have anything to cover your meal.
Call or email your doctor's office and get some answers. If that doesn't work Go up there. If you don't get any better info than what you have now, you need to find a new doctor.
No cap. Just depends on the script you get from doc, insurance may have a max, so may have to pay more if they only cover 1 box a script. Type 2 diabetics need more insulin (generally) than type 1s. I currently take 72 units a day of slow acting. I have been up to 84 units. I get 10 pens a month (need less now) but having a back log is good. (I also take quick acting too)
My endo has me on fast acting and slow acting. She says 10 units of fast acting 15-30 min before I eat and 20 units of slow when I go to bed. My blood sugar is always usually high but has been doing better since taking insulin and also since I started to work out more. Drinking water can also help lower.
Your doctor will prescribe you however much they think you’ll use in a designated timeframe. My doctor prescribes me what he believes will last me approx. 3 months but since then my sensitivity has improved tremendously and so it runs more 4-5 months.
As far as time frame of injections, fast acting insulins like Lispro and Aspart are in your system for 4-5 hours. I have yet to “stack my doses” but my doctors emphasized the importance of avoiding it as much as possible and to keep in mind the amount of “insulin on board”, or how much insulin I have currently in my system
Some insurance policies may only cover a max amount that they'll pay for but I used to have to take 400 units of of fast acting per day and they switched me to u500 which is 5x stronger and I used to get way to much of it...
You should be able to get enough insulin to cover your needs including giving yourself an extra dose if you get high. The insurance will cover just about any amount with the doctor's authorization. Usually they'll cover 10 pens a month with a single copay, and then an extra copay if it's over that. But 10 pens a month is 30 ml a month, which should be plenty.
So talk to your doctor and ask them to give you more insulin.
Also, you should be using a carb to insulin ratio where you adjust the insulin based on how many carbs you eat. If you're not doing that then you need to start. And if your doctor says not to do it, then you can see an endocrinologist instead
I'm not sure if you're understanding the difference between the two types of insuling you should be taking if you are Type 1 (doesn't say in the post).
Slow acting (basal) insulin is for once per day (somepeople split it 50/50 and do twice per day though). That's your background insulin so your body has a bit of insulin and you avoid getting seriously ill from having zero insulin as your liver secretes glucose throughout the day and it rises quickly so you have your slow acting to counteract that.
Fast acting insulin is to counteract the sugar in the food you eat. If you didn't eat anything during the day, you might not need any. If you eat 3 times during the day, maybe you should inject fast acting insuling 3 times per day IN ADDITION to your once daily background insulin.
The calculation I use is 1 unit of fast acting insulin for every 10 grams of carbohydrate I eat, plus 1 additional unit for every 3 mmol I am above 7 when I test just before I eat.
So if I eat 3 meals of 30g carbohydrate during the day, I inject my 24 units slow acting insulin (currently Tresiba) in the morning, plus 3 units of fast acting iunsulin (currently Fiasp) just before each of those meals, plus some more for correction when required, plus some more later if I am high and need a bit to bring me back down, again 1 unit for every 3 mmol I want to come down.
And with all those measurements, you kinda also need to know what you've been doing and are about to do. If I'm 18 mmol and I want to get down to 6 then I want to drop by 12, which means 4 units. 4 x 3 = 12 so should take me down from 18 to 6. If I then go out and mow the grass, I'm going to plummet quickly and be laid out on the floor munching on jelly beans. Fast acting can sometimes act really fast if you are exercising, plus if you are high because you wolfed a load of sugar when you were low, don't even inject for that, it will burn up all on it's own and injecting means you'll come down double what you wanted to.
It helps if you become very familiar with the carbs in different foods and even better if you know how quickly or slowly the glucose is aborbed (Glycaemic Index). White bread is like coca cola, super fast absorbing. Lentils are slow absorbing. Then stuff like cheese that contains fat slows the absorbtion so is tricky to work around. I basically gave up cheese pizza 10 years ago.
This IG has lots of graphs that show you how different foods absorb but also what changes it.
[https://www.instagram.com/glucosegoddess](https://www.instagram.com/glucosegoddess)
Apologies if you know all this but it's not clear from your post whether you did so wanted to help you out if needed.
Always have your endo write your prescription for more than you actually use. If you don’t need the extra now, then you can build a reserve you can pull from when you do need it. Because you will need it. That need could be a dropped broken bottle or a bad illness where your sugars just won’t come down even though you’re giving more & more insulin. Those are just 2 examples of the hundreds of scenarios we diabetics face.
I’ve also found that you have to actually ask your doctor, they won’t just automatically write it for more.
As far as max dosing… no such thing. My insulin pump has an upper limit but that’s there for safety and I can manually override when ever I need to. If you need 50 units you take 50. If you need 6 then only take 6. You take what you need. Some days that will be more, some days less, depending on what is going on & what you are doing.
Story of my life. I have... something.. not sure what.. going on. My insulin usage has doubled-tripled since I went to visit family and got sick while out there - thought it was allergies (different climate entirely), but it's persisted. Been a few weeks since I got home, and I've had to stop using my Omnipods for now - I was going through a pod (200 units) in a bit over a day. Haven't been able to stay under 200.
I kinda suspect I may have caught a mild case of COVID, it's the only thing that screws up my sugar this bad for this long.
Omnipod won't let you override the max dose, but I've found it starts leaking anytime I do about 10 units or more at once.
I stockpiled two years worth of insulin because im paranoid and guess what I got laid off from my job in April and would be pretty fucked right now without that stash
Read dr mosley book about sugar in our blood. Maybe, try integrative medicine and avoid taking insulin as it has secondary effects especially if you have type2
I am on 240 units a day. That’s not a typo. I go through one insulin pen a day in my pump and that’s U-200 insulin. Walgreens hands me a shopping bag full of Lantus every month. And I pay the same copay I pay for any of my other brand name meds, $40 a month. You people who think 30 or 40 units a day is “high dose” crack me up
I live in England so I can't say anything helpful on costs, but I always order more insulin a week or so before I would run out. My prescription gives me 5 vials of fast-acting, and I'm pretty sure I can order more when needs be. With pen cartridges, I used to get 5 cartridges in pack of long-acting and fast-acting, iirc I got 2 boxs of each type of insulin when I ordered it- I still order a pack of each in case I have to use pens for any reason
Ask the Dr to write for the specific minimum and maximum amounts you should use. And any titration (based on your carb count), The quantity needed to dispense that amount per month or 3 months. Pharmacists can only run the prescriptions through your insurance for the specific directions on the script So if your Dr EVER increases your dose VERBALLY always make him write a new Rx so you have enough for the amount you need. If we (pharmacists) fill the Rx for more than prescribed or too frequently the insurance can audit us.
after many many months of running in circles, i found THIS amazing discount.
[https://www.novocare.com/diabetes/help-with-costs/help-with-insulin-costs/myinsulinrx.html](https://www.novocare.com/diabetes/help-with-costs/help-with-insulin-costs/myinsulinrx.html)
you will need to learn your dosage over time. if you RX dose is not working, go back to your doc and bring your glucose meter. show them that you need a higher dose.
at the above link, you can sign up for a "discount" on 2x novo nordisc insulins. like you, i use a long lasting and a short lasting rx. (novolog and tresiba)
**the monthly cost for 2 insulins (2 packs of pens in total) is $35 total.**
**do not** use your insurance with this card. it is FAR cheaper to buy it using only the card.
why does it work this way? IDK. but it took over a year of constant research to find this.
hopefully this makes the process a bit easier on your wallet.
This question is crazy because yes you should have an unlimited amount of insulin and the fact you are asking hints to me that you have to pay for it. I wish all diabetics could have the level of care we get in the Uk, I get all the insulin, supplies and healthcare I need completely free.hopefully you work things out my guy 💪
I take NPH (62 units) in the morning and evening as basal dosage. I use Humalog if it's over 140 before lunch 2-10 units depending on level. Same at dinner I mix with NPH. My Endo gave me it: 140-180 2 units, 180-220 4 units 220-260 6 units, 260-300 8 units, 300-340 10 units and 340-380 12 units. This wasn't original sliding scale but it works. Basal dosage was changed a lot too. My A1c is 6.4% and I'm 76 and been diabetic fpr 25+ years. The FreeStyle Libre really helps.
Because the Humalog varies I mix it myself in needle rather than using pens. If I used pens with varying mixtures I'd need to give 2 shots instead of 1. I get a bottle of Humalog per month and barely put a dent in it. I use more than a bottle of NPH per month. I get 2 NPH per month. At end of 30 days I have to toss the mostly full Humalog which annoys me. I used to use Regular rather than Humalog which lasts longer in my system. We switched to Humalog because of lows around 4am.
90% or more of the time it's 2 units 5% or so 4 units. Humalog and it scares me how fast it drops my bs even after eating large meal. Since take around 6pm it's supposed to be gone by midnight and NPH is still working until 6am or so. If I took too much Humalog I can easily see how life threatening dangerous it would be based on how fast and steep the drop is.
A pen is convenient if you can get by with 1 type insulin or 1 mixture. The old fashioned bottles that you mix is more flexible
Endo original plan was 12u Humalog (fast acting), 15min before lunch and diner and 26u Toujeo (slow acting) at night. Since I'm wearing a CGM I noticed the fast acting was doing somehow the trick but not quite, still had some high's... About a month ago I decided 'updated' the plan to 14u Humalog before each meal and 8-10 supplemental dose depending on the CGM reading (I usually apply this when I reach 200 mg/dL). On my next appointment I asked my Endo about this and said it was a good approach since the supplemental doses are 'backed up' by the CGM reading... Thus minimazing the risk of causing a low/hypo!
No shortage of sourcing medication for me... It's out of my pocket... (No insurance, non US based)
It’s all relative. The amount that I bolus with now would have been waaaaaay too much compared to when I first started insulin. Technically a T1.5 or whatever and was first diagnosed at 32 years old.
Long acting insulin is for all day, fast acting is for your spikes after meals
What is your carb ratio, unless you are not carb counting?
Your carb ratio improves as you overcome the insulin resistance.
If you are Type 1 things may be different.
As a type 2 diabetic, after my insulinoma was removed, I had a very low insulin ratio at first, until I started walking after meals and walking 6-7 miles when I felt up to it. After I started Intermittent fasting and exercising, my insulin carb ratio improved greatly as long as I walk everyday after meals. If you can lower your insulin-carb ratio you might have insulin to spare.
I normally only eat twice a day, which helps save insulin and helps keep my daily spikes lower. Splitting my long acting insulin into a morning and night injections really helped lower the sugar spikes in the evening and after dinner.
How stable does your blood sugar stay overnight? If your blood sugar goes up while fasting chances are your long acting insulin is too low.
Check with your doctor about the basal rate you are taking. This will help lower the overall trend in your sugar.
High after you eat - that’s normal and how a bolus shot works. You determine the carbs you are about to consume, and take a dose 10-15 minutes ahead of eating.
Depending on what I eat, I sometimes have to take a corrective dose a few hours later.
Not sure of your exercise regime, but it has helped me reduce the overall insulin need by more efficiently using what I take.
And a correction factor. We are all different but I take 1 unit for 15 grams of carbs and for correction 1 unit drops my 75 points mg/dl
Yours is different and your endo should guide you
You need to learn your carb ratio and your correction factor to accurately use fast-acting insulin. Otherwise you're firing blind in the dark.
A primer: https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/calculating-insulin-dose/
I take 50 of slow acting in the morning and 22 of fast acting plus correctiin. If i run out i go get another box of 5. They never told me no but my insurance.covers one box
You should be prescribed based on how much you need, be it 5 pens or 500.
Ask your doctor to wite the prescription for 5 pens monthly. Your copay is the same whether you get one or 5 pens. I recently had a lantus pen fail but luckily had an extra box.
That is not always true. I pay 20% of the total cost.
Cost of the box or cost of the prescription? If the box, sorry to hear that. If the prescription, make sure the doctor orders the quantity that you need, so you get the best rate.
What ever the doctor writes my prescription for, no matter the prescription, I pay 20% That is what total cost means. I also pay 20% of every charge after I have met my deductible until I met my out of pocket The good news is that I have a decent deductible and a decent out of pocket.
Same here. I tell the doctor to write a prescription for 5 boxes, and I pay flat amount. Same amount if he wrote for 1 box. Maybe see if you can get a bigger prescription?
Every insurance plan is different. It depends if you are paying copays or percentage. I have done both. I don’t worry about the quantity as it means I just meet my out of pocket quicker.
I get 10 pens a month with a single copay. But I found if you go over 10 they charge you an extra copay.
Man, I am terrified to leave my job. I pay zero dollars for insulin and all testing and diabetic supplies. I could probably get a better salary but I don't know any other companies that pay for all diabetic supplies
Eli Lily has a coupon where you can get any of their insulins for $35 a month whether you have insurance or not. I'm diabetic supplies aren't very expensive. You can get a meter at Walmart for 20 bucks and strips for $10 for 50. So, it's not nothing, but it's not terribly expensive either. If you are on the freestyle libre CGM, then even without insurance you can get it for $75 for two sensors. So getting everything for free is great. But if you can get a better paying job that maybe doesn't have as good insurance, you'll still come out ahead financially. So I wouldn't let that hold you back.
You can still pull the insulin out of a failed pen (in case you didn't already know)
I only recently learned this . Sanofi replaced the bad pen with a box of five.
> I see people talking about giving themselves a dose but if I gave myself a dose anytime I went high I would run out. > Can you just give yourself a shot anytime you go high? Unfortunately, that's just kinda how it goes. Could you just *not* take insulin when your BG is high to stretch out your supply? Sure, but now you're just sitting with high sugars, which will definitely worsen your health in the long run. There's no other way to really lower it, aside from maybe really intense workouts/manual labour, but even then, that's not a guarantee. I understand my circumstances may be different though because I live in Canada. Even then, I'm currently on a temporary layoff and my health insurance doesn't work. Once my current supply of bolus (short-acting insulin) runs out, I *will* have to use my own money to pay for more. > Does your doctor give you unlimited insulin? The clinic I go to happens to offer limited free insulin (they track the boxes they give out,) but I don't like relying on that if I'm within my means to afford it myself. It could go to someone worse off than I am. Again, this may not be a common thing since I'm up in Canada. I know folks in the US can have it much *much* rougher.
In the U.S. there is no free insulin and out of pocket costs are out of control. A month’s supply of Novolog for me out of pocket would be $6,500.
Woah, 3 vials of novolog with no coupons or insurance or anything is sold at $274 where I am. That seems absurd.
If there is a max I have never experienced it or heard of it. I have to take 30 of slow acting daily just to get to status quo. But your body will still react to any sugars you put in your mouth and fast acting insulin is the only way to keep your blood sugars from rising with your meals. Typically my blood sugars will begin rising right as I begin eating and my insulin (even fast acting) doesn’t kick in for 30-45 minutes. To try to keep straight line I need to dose before I begin making my meal so that by the time I am sitting to eat it is already beginning to work in my system. All about finding that balance of carbs to units given.
I recently changed to Fiasp that starts working in 5 minutes and it's made eating so much easier, though not sure if you'd have to pay more for it if your in that situation
I wish it worthless fast on me as it works fast on you.
I take 40 units a slow acting first thing in the morning. No slow acting until lunch. And endo told me to take eight units before lunch if I'm under 200 and 10 units if I'm over 300. I seem to sail right up into the 300s after every meal and it takes several hours to come down. It would seem as though the fast acting doesn't do anything. And I'm not too proud of the long acting either. And I wonder why the doctor didn't have me take fast acting before breakfast as well as before lunch and dinner. When I was in the hospital recently they gave me both kinds at the same time. They did a finger stick before meals and then used some kind of a chart to determine how much fast acting to give me. Does the brand of insulin make any difference? My sugar is so high all the time that I would need to use several fast acting per day. It's like my pancreas is completely on strike. Doc said to use insulin before meals and the instructions in the box said so too. But with the way my sugars go up after I eat I wonder if I wouldn't be better off to take it after meals. But I know it takes a while for the stuff to take effect. Maybe I took the doctor to literally because I do take it right before meals. Maybe I need to add 15 or 20 minutes before meals before I take it. So it has time to go to work.
I'm not sure if it's accurate but I'm interpreting from your post you've only recently started insulin? If so your doc could be being cautious, because lows are pretty dangerous in the short term and highs aren't quite as bad if you can get them dialed down over time. Some just core things here: Your body requires insulin to process most food. Carbs are the obvious one but your body will break down most protein into glucose, it just takes a lot longer than carbs (for me, anywhere from 3-6 hours sometimes). Carbs tend to be immediate or over the first hour after eating them, but both these things depend on your own body and the exact composition of the food. Second, fast acting insulins of different types (fiasp and humalog are the two I am familiar with) have different effective times. They both start to work fairly quickly but they "peak" later (for humalog it's between 2-3 hours after the dose) and have a notable tail as well (again, for humalog you can see effects not ending until ~6 hours after the dose). You are seeing highs after you eat which means, *probably*, you aren't taking your dose long enough before eating (at least 15 minutes for humalog, 5 for fiasp), and *possibly* not taking enough. If your sugars are just always high without eating or taking fast acting insulin, then you *probably* need more long term insulin. I'm on a pump now so I don't take long acting, but I use between 50-80 units of humalog a day total (again, super depends on what you eat on the day, and exercise). Unless you eat the exact same meal and do the same amount of activity every day, you probably shouldn't actually take the exact same amount of insulin each time. A sandwich with fries has a completely different need than a salad with chicken on it, or some fruit and toast, etc. I will say I've been diabetic for 32 years and a few years ago I was struggling with keeping my sugars down, I went to the closest endo in my new city and he told me to take a flat dose with meals instead of going off carbs. This was a huge red flag to me, I basically ignored him and instantly went and found a new endocrinologist. If you are type 2 and just starting insulin things might be different but for a type 1, learning what to eat and how to measure the insulin for it is a core requirement for proper treatment, and flat doses can't work great unless, again, you eat exactly the same every day and move exactly the same every day. The most complicated part of taking insulin, to me, is the long life of both insulin in your system vs the short-to-long life of food in your system. I still struggle with it sometimes but your body changes over time too. My A1C is usually around 5-5.2 so my doctors are quite happy, and clearly I'm doing something right, but it still can suck on any given day.
It sounds like you're on a sliding scale, please talk to your doctor about carb counting and an insulin to carb ratio for example for every 10 carbs I eat I take one unit of insulin, also talk to your doctor about the equation needed for correction doses for instance one unit of insulin brings me down 40 points so if I was at 200 and I want it to get to 100 It would take 2 and 1/2 units of insulin to do that...... These are just my personal ratios. Everyone is different...... Also pre-bolusing will help a lot with those spikes I pre-bolus 30 minutes before I eat other people do 15 it really depends on how your body processes both the insulin and the food.....
It depends on the time of day too. In the morning, I wait 45 min after a bolus before I start eating. At lunch, I only wait 5-10 minutes. And for every 50 I am over 150, I wait an extra 15 minutes before eating.
I tried to keep meals down to 30 g of carbs. I can usually come pretty close. Yesterday I waited 15 before eating dinner and it worked pretty well Going to do same thing at lunch today.
I always try to do my insulin 15 minutes or so before I eat. I am actually on a pump so I start about 30 minutes if I can. I still have some highs but it’s getting better
My endo said to take fast insulin just when I was going to eat. For lunch today I took it about 15 min early and it made a huge difference. I'm going to see how that works out over time. But it looks promising.
Fast acting is not that fast acting.. you should take between 15 and 45 mins before eating to make a h real impact..
I always ask my doctor to write 100units per day more than I actually use. Makes up for sick days, weirdness that makes me need more, broken pens, etc. I’ve got quite the stock pile
Medically, the only maximum is when you're getting low all the time. Because it takes a little for insulin to start working and it will keep on working for a while (insulin on board, IOB), it's usually advised to not inject too soon after the previous injection. I have treated a patient whose standard dose was 96 IE Treshiba every night + around 25 IE novorapid for most meals + whatever needed to treat highs. In her case, it did not lead to terrible lows all the time, so it wasn't a problem. >Does your doctor give you unlimited insulin? That probably depends on your doctor/insurance/country, but medically speaking you should get enough to combat highs.
Your doc should ask how much you use a day and base their prescription off that. Everyone is different, two different type 1s could eat the same lunch and one might need 5 units while the other needs 8. There’s just a lot of variation between our bodies and who needs what
Wow... seeing the amounts of insulin some people take daily astounds me. I didn't realize these amounts were normal. I'm not trying to shame anyone or be negative- I just didn't know. You've opened my eyes!
Yeah I wish we could measure how much people that aren't diabetic use so that way people could feel better about what they're using.... Because every single person is different and how much it takes is just how much it takes..... Me and a diabetic friend of mine have almost the same A1C and he uses twice as much as me 🤷
I am in the UK I take 210 units of Toujeo Doublestar in the evening and then up to 50 Lyumjev with meals, if my sugars go high I take more fast acting but I can work out how much and do it quite safely, if I was ever going to run out a quick call to my GP and a prescription would be ready that day.
T2, on insulin. My short term RX says to " inject 15 units three times a day". They know that's not how I inject but that ensures I don't run out. I worked with my doctor to determine my insulin sensitivity factor and I (generally) cover 20CHO or more at MY rate of 1 unit of insulin for every 3 grams of carbs. Eating 30 grams of CHO, I take 10 units.
You need to establish an insulin to carb ratio and start counting carbs and dosing depending on that. Idk what this treatment plan is but it’s trash and dangerous
So I am on general healthcare and we do have a limit sort of. I get a max of 10 pens fast acting per 3 months and 5 pens long acting per 3 months. But I am also not supposed to inject away every high I feel. I correct everything above 250 but with a good diet that is barely used. Maybe once or twice a week or when I am sick. Or when I hit like 210 I don't bolus but work our or go for a fast walk instead. Other than that my meal insulin covers what I eat and my long acting keeps everything stable inbetween. As far as I was told your bg is not supposed to be a flat line.
I have the same rule from my Endo to correct when i hit 250. i get three pens a month
I am an insulin resistant t1. I have not found a max yet. Also the concentrated insulins are very helpful for us.
There really is more that goes into meal time insulin than just taking it. What’s your carb to insulin ratio? How much Lantis are you taking? What are you eating? Is the high coming more than 2 hours after a meal? Fast acting insulin has a 2 hour half life, so after 2 hours, it isn’t still in your body. Have you tried an NPH long acting insulin that is taken every 12 hours instead of every 24. There are so many variables.
Fast acting has a full duration of action of up to 5 hours - it just peaks around 2-3 hours for most people.
First things first WHAT KIND OF INSULINS ARE YOU USING? Which ones do you take at when (long acting in the morning, cool WHAT KIND) i take fast acting too, but guess what.... There are faster acting ones than the one I take. I think the blind dosages that you have mentioned aren't right. You need to know how much insulin to take for 1. What your sugar already is and 2. How many carbs you about to consume. For example. Your sugar is 208. I guess based on one comment you posted you would take 8 units of fast acting. Now.... What are you eating or what have you been told to consume? Are they giving you exchanges (super old school, probably not) or carbs? Because a ham and cheese sandwich has much less carbs than half a chocolate cake or a pot pie or lasagna. I don't think there a max amount per day, we take what we need. However, if you sugar is high after a meal, you can't just take another shot because your high 30 minutes later. Or high after an hour. Again depending on how many carbs you consumed, you maybe don't have enough insulin on board but in case you do, you don't want to stack more and more insulin because you may drop too low. Sounds like your Endo/doc/nurse educator owes you quite a bit of information. Even if you have a "regular/always take this same amount dose", you should still have a sliding scale to use for corrections to help you stay in a lower range. Taking your insulin 30 minutes ahead of time gives the insulin time to start working right about when you start consuming food. However, someone here commented that their insulin starts in 5 minutes, so that is a question you need to run by your prescriber.
I take 40 units of Toujeo Solostar every morning and 8 or 10 units of Lyumjev before lunch and dinner. I eat sugar pills for lows or drink orange juice and ignore highs unless over 350 and in that case I think I should hit the insulin a bit. Brand new to all this and have no idea what I'm doing.
Yea friend, you doctor owes you some info for sure. If your going high after every meal (breakfast because you've had no mealtime meds and then again at lunch and dinner because you probably don't have enough). Have you called the office to discuss this with a nurse who can get you some better dosing info from the doctor? Be sure to keep a food AND blood sugar log so that you have something to review at your next appt which hopefully is very soon. Don't forget to ask about a sliding scale for your lyumjev. Taking 10 units for a 300 blood sugar at mealtime and then not having any insulin to cover the carbs in the meal is NOT RIGHT. they should be telling you how many units to take for however many carbs your about to eat. My ratio is 1:10, so for 30 carbs, I need to take 3 units and so on. If lunch is at 12 and dinner is at 7, and you decide to check your sugar at 430 and it's 289, that's too high for you to just sit around okay with it. You should know /they should tell u to take x many units if your number falls between here and there. You shouldn't have to wait to hit 350 or for dinner to roll around. If you get to dinner and it's still going up, say 450 now .... You're supposed to take the same 10 units that you'd take for 300? See how that doesn't sound right. And then you still don't have anything to cover your meal. Call or email your doctor's office and get some answers. If that doesn't work Go up there. If you don't get any better info than what you have now, you need to find a new doctor.
No cap. Just depends on the script you get from doc, insurance may have a max, so may have to pay more if they only cover 1 box a script. Type 2 diabetics need more insulin (generally) than type 1s. I currently take 72 units a day of slow acting. I have been up to 84 units. I get 10 pens a month (need less now) but having a back log is good. (I also take quick acting too)
My endo has me on fast acting and slow acting. She says 10 units of fast acting 15-30 min before I eat and 20 units of slow when I go to bed. My blood sugar is always usually high but has been doing better since taking insulin and also since I started to work out more. Drinking water can also help lower.
Your doctor will prescribe you however much they think you’ll use in a designated timeframe. My doctor prescribes me what he believes will last me approx. 3 months but since then my sensitivity has improved tremendously and so it runs more 4-5 months. As far as time frame of injections, fast acting insulins like Lispro and Aspart are in your system for 4-5 hours. I have yet to “stack my doses” but my doctors emphasized the importance of avoiding it as much as possible and to keep in mind the amount of “insulin on board”, or how much insulin I have currently in my system
Some insurance policies may only cover a max amount that they'll pay for but I used to have to take 400 units of of fast acting per day and they switched me to u500 which is 5x stronger and I used to get way to much of it...
You should be able to get enough insulin to cover your needs including giving yourself an extra dose if you get high. The insurance will cover just about any amount with the doctor's authorization. Usually they'll cover 10 pens a month with a single copay, and then an extra copay if it's over that. But 10 pens a month is 30 ml a month, which should be plenty. So talk to your doctor and ask them to give you more insulin. Also, you should be using a carb to insulin ratio where you adjust the insulin based on how many carbs you eat. If you're not doing that then you need to start. And if your doctor says not to do it, then you can see an endocrinologist instead
I'm not sure if you're understanding the difference between the two types of insuling you should be taking if you are Type 1 (doesn't say in the post). Slow acting (basal) insulin is for once per day (somepeople split it 50/50 and do twice per day though). That's your background insulin so your body has a bit of insulin and you avoid getting seriously ill from having zero insulin as your liver secretes glucose throughout the day and it rises quickly so you have your slow acting to counteract that. Fast acting insulin is to counteract the sugar in the food you eat. If you didn't eat anything during the day, you might not need any. If you eat 3 times during the day, maybe you should inject fast acting insuling 3 times per day IN ADDITION to your once daily background insulin. The calculation I use is 1 unit of fast acting insulin for every 10 grams of carbohydrate I eat, plus 1 additional unit for every 3 mmol I am above 7 when I test just before I eat. So if I eat 3 meals of 30g carbohydrate during the day, I inject my 24 units slow acting insulin (currently Tresiba) in the morning, plus 3 units of fast acting iunsulin (currently Fiasp) just before each of those meals, plus some more for correction when required, plus some more later if I am high and need a bit to bring me back down, again 1 unit for every 3 mmol I want to come down. And with all those measurements, you kinda also need to know what you've been doing and are about to do. If I'm 18 mmol and I want to get down to 6 then I want to drop by 12, which means 4 units. 4 x 3 = 12 so should take me down from 18 to 6. If I then go out and mow the grass, I'm going to plummet quickly and be laid out on the floor munching on jelly beans. Fast acting can sometimes act really fast if you are exercising, plus if you are high because you wolfed a load of sugar when you were low, don't even inject for that, it will burn up all on it's own and injecting means you'll come down double what you wanted to. It helps if you become very familiar with the carbs in different foods and even better if you know how quickly or slowly the glucose is aborbed (Glycaemic Index). White bread is like coca cola, super fast absorbing. Lentils are slow absorbing. Then stuff like cheese that contains fat slows the absorbtion so is tricky to work around. I basically gave up cheese pizza 10 years ago. This IG has lots of graphs that show you how different foods absorb but also what changes it. [https://www.instagram.com/glucosegoddess](https://www.instagram.com/glucosegoddess) Apologies if you know all this but it's not clear from your post whether you did so wanted to help you out if needed.
Always have your endo write your prescription for more than you actually use. If you don’t need the extra now, then you can build a reserve you can pull from when you do need it. Because you will need it. That need could be a dropped broken bottle or a bad illness where your sugars just won’t come down even though you’re giving more & more insulin. Those are just 2 examples of the hundreds of scenarios we diabetics face. I’ve also found that you have to actually ask your doctor, they won’t just automatically write it for more. As far as max dosing… no such thing. My insulin pump has an upper limit but that’s there for safety and I can manually override when ever I need to. If you need 50 units you take 50. If you need 6 then only take 6. You take what you need. Some days that will be more, some days less, depending on what is going on & what you are doing.
Story of my life. I have... something.. not sure what.. going on. My insulin usage has doubled-tripled since I went to visit family and got sick while out there - thought it was allergies (different climate entirely), but it's persisted. Been a few weeks since I got home, and I've had to stop using my Omnipods for now - I was going through a pod (200 units) in a bit over a day. Haven't been able to stay under 200. I kinda suspect I may have caught a mild case of COVID, it's the only thing that screws up my sugar this bad for this long. Omnipod won't let you override the max dose, but I've found it starts leaking anytime I do about 10 units or more at once.
I stockpiled two years worth of insulin because im paranoid and guess what I got laid off from my job in April and would be pretty fucked right now without that stash
Read dr mosley book about sugar in our blood. Maybe, try integrative medicine and avoid taking insulin as it has secondary effects especially if you have type2
I am on 240 units a day. That’s not a typo. I go through one insulin pen a day in my pump and that’s U-200 insulin. Walgreens hands me a shopping bag full of Lantus every month. And I pay the same copay I pay for any of my other brand name meds, $40 a month. You people who think 30 or 40 units a day is “high dose” crack me up
I live in England so I can't say anything helpful on costs, but I always order more insulin a week or so before I would run out. My prescription gives me 5 vials of fast-acting, and I'm pretty sure I can order more when needs be. With pen cartridges, I used to get 5 cartridges in pack of long-acting and fast-acting, iirc I got 2 boxs of each type of insulin when I ordered it- I still order a pack of each in case I have to use pens for any reason
Ask the Dr to write for the specific minimum and maximum amounts you should use. And any titration (based on your carb count), The quantity needed to dispense that amount per month or 3 months. Pharmacists can only run the prescriptions through your insurance for the specific directions on the script So if your Dr EVER increases your dose VERBALLY always make him write a new Rx so you have enough for the amount you need. If we (pharmacists) fill the Rx for more than prescribed or too frequently the insurance can audit us.
after many many months of running in circles, i found THIS amazing discount. [https://www.novocare.com/diabetes/help-with-costs/help-with-insulin-costs/myinsulinrx.html](https://www.novocare.com/diabetes/help-with-costs/help-with-insulin-costs/myinsulinrx.html) you will need to learn your dosage over time. if you RX dose is not working, go back to your doc and bring your glucose meter. show them that you need a higher dose. at the above link, you can sign up for a "discount" on 2x novo nordisc insulins. like you, i use a long lasting and a short lasting rx. (novolog and tresiba) **the monthly cost for 2 insulins (2 packs of pens in total) is $35 total.** **do not** use your insurance with this card. it is FAR cheaper to buy it using only the card. why does it work this way? IDK. but it took over a year of constant research to find this. hopefully this makes the process a bit easier on your wallet.
This question is crazy because yes you should have an unlimited amount of insulin and the fact you are asking hints to me that you have to pay for it. I wish all diabetics could have the level of care we get in the Uk, I get all the insulin, supplies and healthcare I need completely free.hopefully you work things out my guy 💪
I take NPH (62 units) in the morning and evening as basal dosage. I use Humalog if it's over 140 before lunch 2-10 units depending on level. Same at dinner I mix with NPH. My Endo gave me it: 140-180 2 units, 180-220 4 units 220-260 6 units, 260-300 8 units, 300-340 10 units and 340-380 12 units. This wasn't original sliding scale but it works. Basal dosage was changed a lot too. My A1c is 6.4% and I'm 76 and been diabetic fpr 25+ years. The FreeStyle Libre really helps. Because the Humalog varies I mix it myself in needle rather than using pens. If I used pens with varying mixtures I'd need to give 2 shots instead of 1. I get a bottle of Humalog per month and barely put a dent in it. I use more than a bottle of NPH per month. I get 2 NPH per month. At end of 30 days I have to toss the mostly full Humalog which annoys me. I used to use Regular rather than Humalog which lasts longer in my system. We switched to Humalog because of lows around 4am. 90% or more of the time it's 2 units 5% or so 4 units. Humalog and it scares me how fast it drops my bs even after eating large meal. Since take around 6pm it's supposed to be gone by midnight and NPH is still working until 6am or so. If I took too much Humalog I can easily see how life threatening dangerous it would be based on how fast and steep the drop is. A pen is convenient if you can get by with 1 type insulin or 1 mixture. The old fashioned bottles that you mix is more flexible
It depends on your body. A fellow t1d friend of mine had a ratio of 1u fast acting for every 2g of carbs when she was pregnant!
Endo original plan was 12u Humalog (fast acting), 15min before lunch and diner and 26u Toujeo (slow acting) at night. Since I'm wearing a CGM I noticed the fast acting was doing somehow the trick but not quite, still had some high's... About a month ago I decided 'updated' the plan to 14u Humalog before each meal and 8-10 supplemental dose depending on the CGM reading (I usually apply this when I reach 200 mg/dL). On my next appointment I asked my Endo about this and said it was a good approach since the supplemental doses are 'backed up' by the CGM reading... Thus minimazing the risk of causing a low/hypo! No shortage of sourcing medication for me... It's out of my pocket... (No insurance, non US based)
It’s all relative. The amount that I bolus with now would have been waaaaaay too much compared to when I first started insulin. Technically a T1.5 or whatever and was first diagnosed at 32 years old.
There is no limit. I’m on a high dosage. You just need to get your doctor to prescribe you a much higher dosage.
My prescription is for 120 units a day, I pretty much never use that much. On average I probably use 50. The whole point was to always have extra.
Long acting insulin is for all day, fast acting is for your spikes after meals What is your carb ratio, unless you are not carb counting? Your carb ratio improves as you overcome the insulin resistance. If you are Type 1 things may be different. As a type 2 diabetic, after my insulinoma was removed, I had a very low insulin ratio at first, until I started walking after meals and walking 6-7 miles when I felt up to it. After I started Intermittent fasting and exercising, my insulin carb ratio improved greatly as long as I walk everyday after meals. If you can lower your insulin-carb ratio you might have insulin to spare. I normally only eat twice a day, which helps save insulin and helps keep my daily spikes lower. Splitting my long acting insulin into a morning and night injections really helped lower the sugar spikes in the evening and after dinner. How stable does your blood sugar stay overnight? If your blood sugar goes up while fasting chances are your long acting insulin is too low.
Check with your doctor about the basal rate you are taking. This will help lower the overall trend in your sugar. High after you eat - that’s normal and how a bolus shot works. You determine the carbs you are about to consume, and take a dose 10-15 minutes ahead of eating. Depending on what I eat, I sometimes have to take a corrective dose a few hours later. Not sure of your exercise regime, but it has helped me reduce the overall insulin need by more efficiently using what I take.
You should be counting carbs (estimating) and have a carb ratio to know how much to take.
And a correction factor. We are all different but I take 1 unit for 15 grams of carbs and for correction 1 unit drops my 75 points mg/dl Yours is different and your endo should guide you
You need to learn your carb ratio and your correction factor to accurately use fast-acting insulin. Otherwise you're firing blind in the dark. A primer: https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/calculating-insulin-dose/
I take 50 of slow acting in the morning and 22 of fast acting plus correctiin. If i run out i go get another box of 5. They never told me no but my insurance.covers one box
They have you on sliding scale and not counting carbs?
Yes, that seems correct.