The Facebook video shows state Rep. Jeremy Munson walking into Walmart without an insulin prescription and picking up a vial for $24.88.
"I hear testimony about people rationing their insulin," Munson, a Republican from Lake Crystal, tells the camera in a video that's been viewed more than 6,600 times. "That shouldn't need to happen when there's affordable options out there."
Democrats quickly condemned Munson's advice as irresponsible and dangerous, warning that different types of insulin cannot be treated the same way. But as state lawmakers remain locked in a fierce debate over how to help Minnesotans shelling out $300 for a couple weeks of insulin — and who face deadly consequences if they cannot pay — Munson is not the only person suggesting the cheaper option.
The debate over the video comes as Republican and DFL lawmakers are holding hearings this week on competing programs to provide insulin to those who can't afford it.
That has left policymakers confronting the difference between the expensive medication diabetics travel to Canada to procure and the $25 vials that can be bought over the counter. The cheaper "regular" insulin sold at Walmart became widely available in the early 1980s. Newer analog insulin products emerged in 1996 and grew in popularity, but their price has skyrocketed in recent years. The analog insulin kicks in faster than the traditional version and is more predictable, helping people avoid potentially dangerous peaks that lead to low blood sugar, said Matt Petersen, a vice president at the American Diabetes Association.
"I'm strongly in favor of insulin analogs, just not so that the conversation goes so far to say, 'You're going to kill people if you make them use those inferior insulins,' " Petersen said. "It is far better to use the older insulins with care than it is to either withhold or even to reduce the analog insulin."
But Petersen, doctors and diabetes advocates emphasized that "with care" is a key part of that phrase.
The older, cheaper version requires diabetics to be regimented about when they eat and can increase the likelihood that they have to wake up in the night with low blood sugar, doctors said. For people who are used to the analog versions, switching to the cheaper option requires careful assistance from a health care provider.
Rep. Laurie Halverson, DFL-Eagan, who has Type 1 diabetes and uses a pump for her analog insulin, is one of the lawmakers who has criticized Munson's video.
"To approach it like somehow somebody without diabetes has the answer and it's lower-quality, outdated technology with this insulin — it's just wrong," Halverson said.
She said people have much better blood glucose control with the newer drug, and poor control of those blood sugar levels over a long period of time can result in kidney failure, blindness or heart disease.
Michelle Cmela, of Fergus Falls, Minn., offered legislators a firsthand account at an August roundtable of how the cheaper medication has damaged her health in the short term. Six months ago she switched to the regular option and said she has almost daily side effects.
It affects her mind and her muscles, Cmela told legislators. The week before, she woke up shaking and her blood sugar was so low "I should have been gone, and by the grace of God I wasn't," she said.
Symptoms like muscle aches, fatigue, headaches and nausea are not unusual for someone with low blood sugar, said Allyson Schlichte, a medication therapy management pharmacist at Fairview Health Services. While the newer version of insulin is usually taken with an injection pen or insulin pump, the older version typically requires a vial and syringe, Schlichte said. It's more challenging to measure the exact dosage, she said.
Halverson warned that someone's dosage would change if they switched from analog to regular insulin and they would need to carefully work through the math with their doctor.
Walmart spokeswoman Marilee McInnis echoed that caution in a statement.
"Human insulin can be a less expensive alternative, but it may not be right for everyone, which is why it is very important patients work with their doctor on the best way to treat their diabetes," she said.
Munson noted that he wrote at the end of a caption below his video: "Diabetics should talk to their pharmacist and doctor to understand if the traditional insulin could be used to treat their diabetes if the newer style of insulin is not available."
He said he got the idea for the video post after talking to a woman in her 60s who grew up using the older version of insulin and switched back because it was more affordable. The $25 drug is not a permanent fix, Munson said, but he wanted to people to know about the option that could save a life, adding, "I'm not giving medical advice, that's pretty clear."
But some diabetes advocates said even with his disclaimer, the video is still problematic.
"If you're not a medical professional, you probably should not be dispensing medical advice online," said Allison Bailey, the U.S. advocacy manager for Type 1 diabetes organization T1International.
What's more, the $25 option is not a broader solution to the rising cost of insulin, Bailey said. She said if lower-income people are forced to rely on a less desirable version of the drug, it creates a split between "the have and have-nots."
