Over-the-Counter (OTC) Insulin: What You Need to Know

Nonprescription insulin is made from older formulations of diabetes drugs, which some clinicians consider obsolete. While some endocrinologists support the idea of using it as an affordable treatment option under a doctor’s care, others believe that the use of OTC insulin should be reserved for rare scenarios, not everyday diabetes management.

“Maybe you are traveling, and you don’t have access to insulin, and you go to a pharmacy, and you get some,” says Paul Sack, MD, the chief of endocrinology and metabolism at Medstar Union Memorial Hospital in Baltimore.

Insulin, which is a medicine that helps people with type 1 and type 2 diabetes regulate their blood sugar levels, is sold in some pharmacies without a prescription. But you won't find it in pill form on the store shelves. The insulins available without a prescription come in vials and pens that may need to be kept refrigerated. They’re kept behind the pharmacy counter and you need to ask for them.

“These are different from ‘standard’ insulin in their duration of action and metabolism, which is why they fell out of favor,” says Ava Port, MD, an endocrinologist at Medstar Georgetown University Hospital in Washington, DC.

There are three types of OTC insulin:

• Regular insulin: It’s a shorter-acting formulation that works more slowly than more modern, rapid insulins. It takes about an hour to kick in, peaks around three to four hours, and wears off in about six to eight hours. Dr. Sack says you should be taking it about 15 to 30 minutes before a meal, and that can be hard to time properly. He notes that newer, shorter-acting insulin can be taken almost when the food is in front of you.
• NPH insulin: NPH is considered an intermediate insulin. It lasts 12 to 16 hours. That means you likely have to take two doses of NPH insulin a day. By contrast, the newer, long-acting insulins last 24 to 36 hours, according to Sack.
• 70-30 insulin: This is a premixed combination, which is 70 percent NPH and 30 percent regular insulin.

“People should know that OTC insulin can be a useful alternative to prescribed insulin, especially if cost or accessibility prevent an individual from getting prescribed insulin,” says Alyssa Lampe Dominguez, MD, an endocrinologist at Keck Medicine of USC in Los Angeles. She adds that decisions regarding insulin dosing should be made together with your medical provider to avoid dangerous high or low blood sugars.

You can buy it at pharmacies throughout the United States. Walmart teamed up with drugmaker Novo Nordisk to sell its own brand, called ReliOn insulin, which sells for as little as $25. The pharmaceutical company Novo Nordisk has products sold under the Novolin brand name, and Eli Lilly manufactures them under the Humulin name.

“It’s a good idea to call the pharmacy first to make sure they sell insulin without a prescription,” says Dr. Neumiller. “These insulin products are stored behind the pharmacy counter, so you need to speak with a pharmacy staff member and let them know you would like to purchase regular (short-acting), NPH (intermediate-acting), or premixed NPH/regular insulin without a prescription.”

Because these insulin products are provided without a prescription, they won’t come with a pharmacy label with specific instructions for use.

“It is important to talk with your usual diabetes care provider for specific administration instructions and to talk with the pharmacist if you have questions about how to properly administer the insulin and minimize the risk for side effects, such as hypoglycemia (low blood glucose),” says Neumiller.

If cost is a factor in why you’re looking to use OTC insulin, you may also want to consider Eli Lilly’s affordable options, which include a downloadable savings card that provides a $35 maximum out-of-pocket monthly cost for people who have insurance and those without it. These drug options will be the newer medications, not the outdated formulations sold without a prescription.

If your OTC insulin comes in a vial, you will need to purchase syringes to measure and administer the medicine.

“These are not necessarily easy-to-use pens like we have now that you just click,” says Sack. “You have to make sure you know what you’re doing with the vial and syringe and how to measure [the dose].”

It’s also important to understand how long it works in your body. If you’re switching from newer formulations to OTC insulin, you may need to adjust your dosing schedule. For example, Sack says the short-acting OTC insulins need to be taken earlier before a meal, so they have time to work. This may require you to plan specifically when you’re going to eat your meals and what you’re going to eat.

You’ll also want to make sure you’re taking the correct dosage of OTC insulin. “The amount of insulin somebody needs is really hard to figure out,” says Sack. Careful monitoring of your blood glucose levels with the assistance of your healthcare provider is essential for determining your ideal dose, he adds.

• Sweating
• Rapid heartbeat
• Shaking
• Confusion
• Hunger
• Fatigue
• Dizziness
• Paleness
• Anxiety or irritability
• Vision problems
• Weakness
• Seizures
• Loss of consciousness

Storage of OTC insulin is the same as prescribed insulin, says Dr. Dominguez. “Unopened insulin should be refrigerated, and opened insulin can be kept at room temperature,” she explains.

You should avoid freezing the insulin vials or exposing them to excessive heat. Dominguez says the insulin should be discarded 28 days after the date of opening.

The main benefits of OTC insulin are cost and availability, according to Dominguez. “Since they are available over-the-counter, you do not need to wait for a prescription from your doctor’s office,” she says.

You can purchase OTC insulin if you are uninsured or have health insurance. It can be a convenient, and sometimes lifesaving, option in case of an emergency.

“OTC insulin helps improve medication accessibility and provide an option that is better than taking no insulin at all, but it’s more likely to cause severe blood sugar swings,” says Dr. Port. “While these insulins are available without a prescription, they will ideally be taken under the guidance of a healthcare professional whenever possible.”

“I’ll be very specific. The over-the-counter ones are just not as good,” says Sack. “The way I like to describe it is with the newer insulins, you adjust your insulin to your life, and with the older insulins, you’re adjusting your life to your insulin.”

• Nonprescription insulins are older formulations of the drug that are sold in person by a pharmacist at select drugstores and pharmacies. They are less effective and not as predictable as newer prescription insulins, but they may be more affordable.
• OTC insulin is an option for those who are uninsured or have high copays, or who run out of their prescription insulin when they are traveling.
• You should always consult with your doctor before taking any type of insulin, whether you need a prescription for it or not.