Wil Dubois

Need help navigating life with diabetes? You can always Ask D'Mine!

Welcome again to our weekly Q&A column, hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil is talking about just how minimal you can get with your insulin dosing regime. 



Sydney, type 2 from Georgia, asks: Can I use insulin alternate days?

[email protected] D’Mine answers: Uhhh… I guess you could, but that’s not how it’s designed to work. As you are a type 2, I’m assuming you’re asking about a basal insulin, the one you take once daily. The goal of a basal is to help you keep your blood sugar in control overnight and between meals. At some point in the past, your body was able to generate enough insulin to take care of this on its own, but thanks to your diabetes, two things have gone wrong for you.

First, you suffer from something called insulin resistance, in which your body needs greater and greater amounts insulin to keep the same amount of sugar in check. And second, over time your body lost its ability to produce insulin at the levels it used to. At some black magic tipping point, the resistance trumped the production, and your blood sugar began to rise. The solution to this mess is to add some artificial insulin to get things back into balance.

As it’s the “background” insulin we’re talking about, the best solution is a steady application of insulin. Most basal insulins last around 24 hours, which is why you take them every day. If you took a shot every-other-day, instead of a steady state you’d create a series of peaks and valleys that would, in theory, leave you running high every other day. I suppose you could attempt to either fast or eat crazy-low-carb every other day to compensate, but I’m not honestly sure that would work. For one thing, basal insulin sorta builds up into a steady state over time, and for another thing I’m not sure you could get the digestion timing and the insulin action timing to sync up well.

But why would you want to? If it’s because you don’t like taking shots, well, it’s time to put on your big-girl panties and just deal with it. If it’s a money issue… Well, that’s where the rubber is meeting the road for a lot of us nowadays. So let’s talk about that.

I guess the first thing to think about is insurance. Now that the individual mandate has been repealed not everyone is required to have insurance, and those of us who do have it are in for big changes. But that’s a story for another day. My point is that if you have any kind of health insurance at all, there’s not much point in skimping on the insulin. Copays, even steep ones, are based on prescribed dose, not volume. If the doc says you need three vials a month, you still make one copay, not three. If you start filling your script every other month to try to save money, someone will wise up eventually. After all, the insurance companies track claim histories. What will happen is that they will suspect your doc has written a script for double what you need to try to cheat them; it will never occur to them you are trying to cheat death by taking half your prescribed meds to save money.

Now, if you don’t have insurance, that’s another issue. Then cost per vial or pen is a real issue. But I don’t think that lowering your dose to half-staff by taking it every other day is the best solution. 

Of course, if you don’t have insurance, a patient assistance program from the insulin company is a possible source of help for you. Programs like this provide free or low-cost insulin to the uninsured who are on the lower end of the economic scale, although sadly even cash-pay insulin is too dammed expensive even for people of modest means to purchase out of pocket. If you fall in this unhappy median of folks too rich for patient assistance, but too poor to afford insulin, what do you do?

Here are some ideas: Insulin resistance is keyed to weight. The more you weigh, the greater it is. The less you weigh, the less it is. One effective way of lowering your insulin dose is to simply lose weight.

Oh. Right. Except for the fact that there’s nothing simple about losing weight. I understand that. But most of us, myself included, could benefit from dropping a few pounds, and if you’re strained financially, this could perhaps save you money on two fronts.

Another option is to look at how you eat. Foods higher in carbohydrates tend to drive blood sugar higher. An easy way to recognize higher-carb foods is color. They tend to be white. Foods high in flour, potato, rice, corn, or sugar are higher in carbs than meats and veggies. If you shift your diet to be lower in carb, you usually need less insulin.

Lastly, don’t be afraid to talk to your doc about your money problems, as sometimes cheaper alternatives can be prescribed. Talking about money to a doctor sounds weird, I grant you that, and we are raised to keep such things as impending bankruptcy private, but money woes have become such a widespread problem in our society that money is now actually part of official diabetes treatment guidelines. Docs are supposed to ask about your finances and consider your plight when prescribing. But it’s all so new some docs may forget. So when your doc asks you if you are in pain, say, “Yes.”

And when he asks where you hurt, say, “In my wallet.”


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


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