What to Know About Shortages for Humalog and Insulin Lispro Injection
By April Hopcroft
Temporary shortages of the fast-acting insulin Humalog and its generic version may complicate diabetes care for people using pumps, automated insulin delivery, or on multiple daily injections. We spoke to experts about the best strategies to navigate insulin shortages.
Lilly announced that two of its insulins will be temporarily out of stock at distributors and some pharmacies through early April: the 10 mL vials of the fast-acting insulin Humalog and its generic version, called Insulin Lispro Injection.
Alongside these insulin shortages, Novo Nordisk has discontinued the long-acting insulin Levemir (insulin detemir). Levemir FlexPens were officially discontinued as of April 1, 2024 and vials of Levemir will not be available after December 31, 2024. This announcement is especially frustrating for many people with diabetes, as Levemir was one of the insulins included in Novo Nordisk’s price cuts.
This news has sparked concern for people who require these insulins for daily diabetes management – whether for insulin pumps, automated insulin delivery (AID) systems, or for multiple daily injections (MDI).
“It’s really distressing to people with type 1 diabetes in particular, who are dependent on insulin for life,” said Dr. Anne Peters, professor of medicine at the Keck School of Medicine of USC and director of the USC Clinical Diabetes Programs. “To suddenly not have access is scary because it means that there could be a supply chain disruption in insulin.”
Experts said people with diabetes shouldn’t panic and encouraged them to consider switching to prefilled pens or a different fast-acting insulin, such as Novolog, Admelog, or even Fiasp or Lyumjev.
All other Lilly insulins – including prefilled pens of Humalog and Insulin Lispro Injection – continue to be available in the US. Lilly is continuing to manufacture the 10 mL vials of Humalog and Insulin Lispro Injection and will ship them as soon as possible. Lilly recommends reaching out to your healthcare provider and checking with other pharmacies in your insurance network to find a supply of Humalog or Insulin Lispro Injection.
What you should do in an insulin shortage
While it’s understandable to be anxious about insulin shortages, experts advised staying calm and thinking proactively instead of letting stress consume you.
“Don’t get anxious, but get smart,” said Dr. Francine Kaufman, Distinguished Professor Emerita of Pediatrics and Communications at Keck School of Medicine of USC. “Assess supplies, don’t waste insulin, understand back up plans, and take the right amount of insulin – don’t dial back.”
If you have any worries about insulin shortages, it’s best to consult with your healthcare provider to figure out the best solution for you.
“It’s scary. But I advise people not to panic, we’re going to get people through this,” Peters said. “There are a lot of people who really care.”
1. Be prepared with extra supplies
As a first step, consider making an official emergency kit that’s ready to go in case of any natural disasters or unexpected circumstances. Note that being prepared applies to diabetes as well as any other chronic condition you may have.
At regular appointments and prescription refills, you can ask your healthcare provider to prescribe you the highest possible amount of insulin you might need. If you always have a little extra insulin with each prescription, you can slowly build up an extra reserve.
For instance, Peters said she prescribes her patients the highest amount of insulin that might be necessary. This includes extra insulin to account for the chance that her patients could develop an infection and need to take steroid medications. Steroids can lead to hyperglycemia and insulin resistance, which Peters said can double or even triple insulin needs.
To get an extra supply of insulin, it’s also possible to ask your healthcare provider for a second prescription (in addition to your regular one) and pay out-of-pocket without going through insurance, Peters noted.
For instance, people living in the US might choose to get a second prescription through Canada, or to use a website like GoodRx.com to find coupons. Of course, this does require spending additional money on insulin that you might not use in the immediate future.
“I think that it’s not a bad idea for most people to get a second prescription,” Peters said. "I’m a big believer in being prepared.”
2. Follow your usual insulin regimen, while remaining cautious about insulin usage
During a shortage, people who use insulin pumps or multiple daily injections (MDI) should continue taking the appropriate amount of insulin, said Kaufman. This means following insulin labels and expiration dates faithfully, too.
At the same time, it’s also a good idea to be cautious about insulin usage.
"Do not dial insulin doses back, but also do not overfill reservoirs or throw away pens with good insulin still in them," Kaufman said.
3. Consider using prefilled pens instead of vials
According to Lilly, the prefilled pens of Humalog and Insulin Lispro Injection are still available. This opens up two options:
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You could switch from using an insulin pump to MDI temporarily, while the shortage lasts.
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Or, you can use a syringe to pull insulin out of the vials within the pens and transfer it to your pump.
Keep in mind that the latter option is not especially straightforward, though it could help you waste less insulin. First, you’d need to ask your healthcare provider for a prescription for prefilled pens. You might also need a prescription for larger syringes, Peters noted. The exact steps may vary depending on the type of insulin you use, so make sure to consult with your healthcare provider.
Switching from using insulin from a vial to prefilled pens may come with heavy costs. For instance, Medicare B covers vials under Durable Medical Equipment, but not prefilled pens.
4. Consider switching to a different rapid-acting insulin
Another option would be to ask your healthcare provider about switching to a different rapid-acting insulin, such as NovoLog (insulin aspart) or the biosimilar insulin Admelog (insulin lispro injection).
Peters said it’s also okay to switch to Fiasp (insulin aspart), a newer formulation of NovoLog. Depending on the patient, even Lyumjev (insulin lispro-aabc) could be used, Peters noted. However, since Fiasp and Lyumjev’s onset of action is faster than that of Humalog, you would need to take your doses closer to meals.
Additionally, note that different insulins may not be reimbursed by your insurance.
Consult with your healthcare provider, as everyone responds differently to switching insulins. A small number of people have insulin allergies and may not be able to switch insulins. In this case, Peters recommended visiting an allergist to document your allergy to insulin.
“True insulin allergy is a serious allergy,” Peters said. “If you’re in fact allergic, you’d want to document it so you know what you can and can’t take.”
The bottom line: Navigating insulin shortages
Shortages can be stressful – whether for face masks and toilet paper during the Covid-19 pandemic or for insulin in 2024. Even if you’re prepared with extra supplies, shortages can disrupt your routine and may require you to change how you take your diabetes medications.
In general, Peters recommended being open minded about needing to switch the type of insulin you use while the shortage lasts.
“People have to think that there may be a situation where they just have to use some other type of insulin,” Peters said. “And that’s okay – as long as you do it along with your healthcare team.”
The Humalog shortage is the latest in a series of drug shortages for people with diabetes, following similar announcements for Ozempic as well as other GLP-1 receptor agonists and incretin medications. Shortages are frustrating to patients, who depend on medications to survive, as well as providers, who feel a duty to keep everyone safe.
“It shouldn’t be this hard to get lifesaving devices and medications for people with insurance,” Peters said. “It’s not okay with me. It’s really not okay. We should have a secure supply of insulin manufacturing.”
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