The cost of insulin has skyrocketed in the past several years. But there’s another costly wastage no one is talking about. And that’s the two units of insulin you shoot into the air to prime your insulin pen. More about this below.

Regards the cost of insulin we blame Pharma who blame PBMs Pharmacy Benefits Managers. From what I can make of it they’re the middle men, and women, who are part of the cost determination for drugs and which drugs get on your health insurer’s formulary. If your drug isn’t on it, you’ll pay a significant premium to continue to use it, or be forced to switch from what your doctor recommends to what your health insurance covers.

Making a life and death drug like insulin unaffordable for large groups of people is criminal in my eyes. And then it occurred to me, when I was generously given an inpen, that the priming wastage that occurs using an insulin pen is also criminal.

I was eager to try the inpen because it’s a digital pen that keeps track of a number of dosing markers including when you took your last shot, how much you took and how much insulin you still have onboard. But when I’d prime the pen, sending two units of insulin into the air, poof, gone, for my one unit injection, I couldn’t do it. I used the pen a week and then sacrificed being sure whether I’d taken my meal time shot for conservation. My Jewish, Virgo practicality just couldn’t let me waste more insulin than I was using. And then I got mad.

If you have type 2 diabetes and dose 40, 60, 80 units for a meal or a day, maybe two units/injection doesn’t seem like a big deal. But you’re still being robbed of probably six to ten units a day. If you have type 1 diabetes like me, and eat a low carb diet, you may only be taking five or six units a day. I take one unit typically to cover a low carb meal. Taking five units of mealtime insulin a day would cost me an additional five to ten units for priming (I typically prime with one unit, sometimes I need two).

I use a Tresiba pen for my basal injection. I take six units of Tresiba every morning. Tresiba is only available in a pen so I waste the priming unit or two. I have no choice. For my bolus, either Fiasp or Humalog insulin, I draw my dose up with a syringe from an insulin pen cartridge. No priming involved. I specifically use a pen cartridge not a vial or I’d be throwing two-thirds of a vial of insulin away at the end of every month.

I don’t know if this wastage was purposely built into the design of insulin pens but I find it hard to believe we can’t create an insulin pen, or similar delivery device, where taking our insulin doesn’t cost us more than the insulin we use.

I’m also surprised I’ve never heard anyone talk about this wastage or bring this matter to the attention of pen manufacturers seeking a solution. I’m curious what you think.