Picture this: You’re on vacation with your last vial of insulin in hand when — oops — you accidentally drop it, a hotel fridge turns it into a mini ice block overnight, or you simply forgot to pack enough to last the whole trip. Suddenly, you’re without insulin.

These “what-if” moments happen more often than you’d think, says Diana Isaacs, PharmD, CDCES at Cleveland Clinic. Here, Isaacs shares practical strategies to keep you safely managing type 1 diabetes (T1D) when supplies run low — or out — whether you’re traveling or at home.   

 

What are the first steps you recommend when someone realizes they’re running low on insulin? 

[Diana Isaacs]:  

Ideally, there’s already a prescription at the pharmacy, and refilling it is the best option. However, if you’re already on your last vial, you may need changes in the prescription to provide a small buffer for instances like this (more below).

Being proactive with insulin and supplies is a necessary part of managing T1D. By keeping track of your inventory — including the number of refills you have and when they’re refillable — you can avoid the stress of running out. 

 

✔️Be proactive by asking for increases in amounts of prescribed insulin and refilling your prescription regularly 

✔️Bring extra when you’re traveling, just in case you need more  

 

I’ve run out of insulin. Can a pharmacist help bridge the gap? 

It depends. 

If someone comes into a pharmacy and says, “I’m all out of insulin. Can I get a vial or pen without going to the ER?” A pharmacist may or may not be able to help, explained Isaacs. Although insulin is a life-sustaining medication, it is a prescription drug, and it has regulations.

[DI]: We can try contacting your prescriber to get a new prescription. If they can’t be reached, in certain circumstances we can provide an emergency supply — and continue to follow up. 

This option is only available in states with laws that allow pharmacists to dispense an emergency supply of insulin, and they must follow up within a week. In this case, pharmacists can give you insulin on the spot.

If it’s after hours — or even the middle of the night — most health systems have an on-call provider you can reach about your prescription. As a pharmacist, I find the trickiest part of these emergent situations is the coverage question: “Will their insurance pay for it?”  

An on-call provider may not be familiar with the nuances of updating the prescription to ensure proper coverage. It’s easier if it’s your usual prescriber, or if you ask the on-call prescriber to update your prescription by increasing the amount you typically receive. This way, you’ll receive more and will be allowed to fill it earlier.

Going through the last vial of insulin every month isn’t ideal. Having a little extra on hand is the safest approach in case something unexpected happens. 

 

✔️Ask the pharmacist if they can reach out to your prescriber  

✔️Investigate if the state you’re in allows pharmacists to provide a short-term emergency fill of insulin 

✔️Utilize the on-call provider number for urgent prescription needs  

 

How can I secure a backup of insulin to prevent running out in the future? 

[DI]: If you refill your prescriptions on time, you’ll hopefully have enough and not run out. If you’re running low, it’s best to contact your provider proactively and ask for a new prescription with an increased amount of insulin.

It’s easy to see your total daily insulin use on a pump report. From that, your provider estimates the amount of insulin you’ll need over the course of a month. If something changes and you’re using more insulin, or you were using less during the two-week snapshot they looked at, it’s possible you could run out of insulin early. 

Here’s the thing: Predicting insulin needs is an estimate. This means no one really knows how much you’ll go through in 30 or 90 days, so it’s reasonable to ask for a little extra on your prescription.

Be sure to check expiration dates. That way, you won’t end up discarding expired insulin, and over time, you’ll build a safety buffer of extra pens or vials.

If you’re on a pump, ask for backup insulin in case of pump failure. Then, you’ll have fast-acting and long-acting insulin pens or vials. If needed, you can draw fast-acting insulin from a pen and use it for your pump.  

  

✔️Ask for a new prescription with an increased amount of insulin and backup insulin in case of pump failure 

✔️Check expiration dates on your insulin to avoid discarding insulin 

 

Can you explain which insulin formulations are acceptable as short-term replacements and which aren’t? 

There are many types of insulin, which can be confusing. While some are sold over the counter, it’s safest to have your diabetes care team’s support before switching to a new product.

[DI]: You can pick up some insulins, like regular and NPH, at a pharmacy without a prescription. When compared with fast-acting insulins, regular insulin lasts longer in the body, so there’s a greater risk of hypoglycemia.  

Relion brand insulin, for example, costs about $25 a vial and $44 for a pack of pens at Walmart. It’s also sold at other pharmacies, like CVS or Walgreens, though prices may vary.  

Checking GoodRx can help you find the best local price on the insulin you’re looking for — take Humalog, for example.

Generic insulins such as NovoLog and Humalog are available as insulin lispro and insulin aspart. They cost considerably less, but you’ll still need a prescription from an authorized provider.

💡 Fast-acting insulins, such as NovoLog, Humalog, Fiasp, or Lyumjev, are approved for use in insulin pumps and automated insulin delivery (AID) systems. Regular insulin is not. Pump algorithms have not been tested with regular insulin, which lasts longer in the body than fast-acting insulins and increases the risk of low glucose.

 

✔️Ask about over-the-counter and generic insulin options, as many pharmacies offer more affordable options 

✔️Check with your diabetes care team to confirm the correct dosing before switching insulin types or moving from an insulin pump to injectable insulin  

 

If a pharmacy can’t help me, should I go to an urgent care or emergency department? 

Yes, time is of the essence. Without insulin, you can quickly develop diabetic ketoacidosis (DKA), a potentially life-threatening emergency. This may mean a trip to the ER for quick attention and safe care.

[DI]: If you’re not getting the help you need and are out of insulin, getting insulin as quickly as possible is the top priority.   

There are three options: make a telehealth appointment, go to urgent care, or head to an ER for immediate care and a prescription. Having a prescription will generally make insulin (even generics) more affordable, and with commercial insurance, you can use co-pay cards.   

 

✔️Seek an immediate solution because without insulin, your body can’t use glucose for energy, so it begins to break down fats, causing ketones 

 

Do I need a prescription for insulin syringes or pen needles? 

[DI]: No. In most places, you can get syringes and pen needles without a prescription. They’re usually available over the counter, but they may be cheaper with a prescription. 

 

How likely is it that someone in this position could resolve their issues at a pharmacy window? 

[DI]: If you go to the pharmacy that normally fills your insulin prescription, they’ll likely provide an emergency supply. If it’s not your regular pharmacy, and you don’t have a prescription, you may leave empty-handed and be sent to an ER or urgent care, where they can meet your immediate needs.

A second option could be switching to an over-the-counter insulin — if the pharmacy carries them (that’s another potential hiccup).

💡 Keep in mind: A pharmacist can’t verify that you have diabetes. A prescription is legally required, and there’s no way to bypass that. A pharmacist can’t dispense insulin without one — unless it’s an over-the-counter brand.  

 

If I’m traveling out of state, can my doctor call in a prescription?

[D.I.]: Usually, yes, as long as you’ve been seen in your home state. Rules may differ by licensure. Meaning physicians can always call in a prescription, but nurse practitioners and physician assistants may have state-specific restrictions.

As a pharmacist, under my collaborative practice agreement, I can send a prescription on behalf of a physician. So, if someone contacts me, I can forward that prescription.

💡 At chain pharmacies, like Walgreens or CVS, it’s typically easier to have the prescription pulled and transferred to another chain location, making it easy to access your insulin prescription for a refill. 

 

Are there cost-saving measures or manufacturer coupons to improve affordability? 

Typically, yes. If you’re taking brand-name insulin, check out the manufacturer’s website for coupons that can lower the cost.   

  • Lilly, Novo Nordisk, and Sanofi each have savings programs 
  • Co-pay cards can often lower the cost of brand-name insulin to a point that’s cheaper than the generic version 

 

💡 Remember, manufacturer coupons are mostly for those with commercial insurance or who pay cash. People with government plans, like Medicaid or Medicare, often can’t use them. 

   

What does it mean when a pharmacy or durable medical equipment (DME) supplier provides a “partial” supply? 

[D.I.]: You may ask for a “partial” supply to hold you over for a particular timeframe, especially if it’s too early to fill the prescription. Then, you can get the full amount later (like when you’re back from vacation).

Getting a “partial” supply can help reduce the out-of-pocket costs compared with using your insurance. 

 

✔️Ask about receiving a “partial” supply of insulin to tide you over until you can refill or receive an updated prescription 

  

How can someone coordinate with their provider and insurance to avoid running out of insulin between refills? 

[D.I.]: We get a lot of phone calls about people who are running out early, or they’ve completely run out and didn’t realize it. There are a few barriers, but the goal is to have enough insulin prescribed while avoiding any interruptions in supply.

What I encourage people to do is figure out how much insulin they’re using and advocate for themselves when they see their prescriber, to be sure that they’re getting enough — and a little bit extra. Remember, it’s an estimate, and use varies day to day. Be sure to: 

 

  • Double-check your insulin supply and reach out before you run out 
  • Sign up for automated refills to help eliminate time gaps in refilling 
  • Ask about shipping insulin to your home 

 

✔️Keep track and refill by setting reminders or using automatic refill options, which can also help to create a little buffer stock 

 

Your diabetes care team may know of additional resources where you live. At Cleveland Clinic, our social workers started an emergency insulin program because they were sometimes struggling to find a good solution.

We now have emergency supplies that we can provide while working on a more permanent solution. Blue Circle Health is part of a growing network of states and has been instrumental in issues such as insulin access. We’re fortunate to have them, too.

 

__________________________________________ 

 

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCP, is an Endocrine Clinical Pharmacist at the Cleveland Clinic. She advocates access and choice to the latest technologies and therapeutics for all people with diabetes and speaks on diabetes-related topics nationally and internationally. She was the 2020 ADCES Diabetes Care and Education Specialist of the Year.