Black Health
Insulin (basal and prandial) Type 1 diabetes Type 2 diabetes Gestational diabetes DKA

Insulin (Humalog, NovoLog, Lantus, Basaglar, Tresiba, Toujeo, Levemir, Humulin, Novolin) and Black patients

Brand names: Humalog, NovoLog, Lantus, Basaglar, Tresiba, Toujeo, Levemir, Humulin, Novolin

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What Insulin does

Insulin is the hormone that lets cells take up glucose from the bloodstream. When the body doesn't make enough (type 1 diabetes) or doesn't respond normally to its own (advanced type 2 diabetes), injected insulin is used. Modern formulations range from ultra-rapid-acting (lispro, aspart) to ultra-long-acting (degludec, glargine U-300).

What the evidence says for Black patients

Insulin itself works equally well across racial groups. But Black patients face documented disparities in insulin access, starting, and adherence that drive worse outcomes:

  • Delayed initiation. Multiple analyses of US claims data show Black adults with type 2 diabetes are initiated on insulin later, at higher A1C levels, and with more diabetes-related end-organ damage than white adults (Peek et al., Med Care Res Rev 2007;64:101S–156S). Some of this is clinical pattern (metformin plus oral agents often delays insulin); some reflects bias and under-treatment.
  • Cost barriers. Analog insulin list prices nearly tripled from 2010 to 2020. Black households have lower median wealth and are over-represented in the uninsured and under-insured population; the cost-driven insulin-rationing rate among Black adults with diabetes is measurably higher (Herkert et al., JAMA Intern Med 2019;179:112–4).
  • The 2023 $35 Medicare cap and biosimilar insulin releases (Semglee, insulin aspart-szjj) have partially narrowed this gap for Medicare beneficiaries and uninsured patients via manufacturer savings programs.
  • Hypoglycemia and driving. Older 'human' insulins (Humulin, Novolin, NPH) cost less but carry higher hypoglycemia risk than modern analogs, a hidden equity issue for patients who cannot afford analog formulations.

Common alternatives

For many people with type 2 diabetes who would previously have been started on insulin, GLP-1 receptor agonists (semaglutide, tirzepatide, dulaglutide) and SGLT2 inhibitors now delay or replace insulin initiation. They also offer cardiovascular and kidney benefits that insulin doesn't. For patients who need insulin, biosimilars (Semglee/insulin-yfgn, Rezvoglar/insulin glargine-aglr) can substantially reduce cost.

Side effects

  • Hypoglycemia — the single most important risk. Symptoms include sweating, shakiness, confusion; severe episodes can cause seizure or loss of consciousness.
  • Weight gain
  • Injection-site lipohypertrophy
  • Rarely, injection-site hypersensitivity

Factors that affect adherence

If you cannot afford your insulin, tell your clinician immediately — do not ration. Options include switching to a biosimilar, enrolling in a manufacturer savings program (Lilly $35 cap, Novo insulin savings, Sanofi Insulins VALyou), using NPH/regular combinations at much lower cost, or switching to a non-insulin regimen if clinically appropriate.

Questions to ask your doctor

Bring this list to your next appointment.

  • Can we try a GLP-1 or SGLT2 first, before insulin?
  • If I need insulin, am I eligible for a biosimilar or a manufacturer savings program?
  • What's my hypoglycemia plan — what do I do if my sugar goes low?
  • How often should I check my glucose? Am I a candidate for a continuous glucose monitor?

References

  1. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S158–S178.
  2. Herkert D, Vijayakumar P, Luo J, et al. Cost-related insulin underuse among patients with diabetes. JAMA Intern Med. 2019;179:112–114. PMID 30508012.
  3. Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(5 Suppl):101S–156S.
  4. Centers for Medicare & Medicaid Services. Inflation Reduction Act: $35 insulin cap for Medicare beneficiaries. https://www.cms.gov/inflation-reduction-act-and-medicare

Medical disclaimer

This page is patient education, not prescribing guidance. It summarizes the published evidence about how this medication has been studied in Black patients — it is not a substitute for the judgment of your personal clinician. Never start, stop, or change a prescription based on something you read here. If you have questions about your medication, call your prescriber or pharmacist. For emergencies, call 911.

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