When Insulin Is Out of Reach: “The Pitt” + the Reality of Diabetes without Health Insurance

HBO Max’s “The Pitt” has done it again. Known for its real-world depiction of working in the emergency room, the Emmy-award winning show on HBO Max nailed its portrayal of diabetes ketoacidosis (DKA) and what it’s like to live with diabetes in the U.S. but not have health insurance. 

This time, it was through the storyline of character Orlando Diaz, a construction worker and father of five who had collapsed at a job site. A coworker wheeled him into the emergency room, unconscious, where Dr. Frank Langdon smelled ketones on his breath (a distinct, fruity smell) and suspected DKA. While in surgery to treat injuries from his fall, the medical staff discovered that his blood glucose level was over 500 mg/dL and administered an electrolyte IV until tests confirmed DKA and the need for an insulin drip.

In last week’s episode, Orlando regained consciousness after the insulin drip brought his blood glucose levels down. Dr. Samira Mohan advises him to stay in the hospital for a few days to continue the insulin drip. But Orlando, like many people living with diabetes, discloses to Dr. Mohan that he rations his insulin and doesn’t check his blood sugar levels often because the test strips are too expensive for him to purchase out-of-pocket. He and his wife work multiple part-time jobs and surpass the eligible income for Medicaid, but don’t qualify for health insurance through any of their employers.

Living with diabetes without health insurance

An estimated 1.56 million adults with diabetes have no health insurance coverage. Orlando’s story is a harsh reality for many people living with type 1 or type 2 diabetes in the U.S. Without health insurance, the feeling of having to choose between buying insulin and paying rent is constantly looming. The cost of diabetes supplies can make diabetes management feel completely out reach for families wondering where their next meal is coming from.

What is insulin rationing?

Insulin rationing means underusing the prescribed amount of insulin needed to maintain blood glucose control, not filling an insulin prescription or stopping its use altogether due to financial hardship. In 2021, 37% of people reported rationing insulin because of the cost.

Insulin rationing can lead to poor glycemic management, DKA, an expensive hospital stay or—worse case scenario—can be life-threatening. 

What to do if you don’t qualify for Medicaid

If you don’t qualify for Medicaid because your income exceeds the cutoff but don’t make enough to afford insulin and other diabetes supplies, there are still resources available to you.

Check out these free resources for uninsured people with diabetes:

• Getinsulin.org. Answer a few quick questions to get a customized action plan that guides you to solutions for your unique circumstances. Available in English and Spanish.
• Patient assistance programs. This can range from financial assistance for insulin, CGMs and other diabetes supplies, and can be beneficial for those without health insurance or with low incomes. The requirements differ for each company, but it’s worth looking into.
• Insulin co-pay cards. Many copay cards apply only to people with diabetes who have health insurance, but some cost-savings programs work for people without insurance or in other situations.
• Insulin patient assistance programs. If you can’t get access to insurance coverage and make 400% or less of the federal poverty level ($62,600 for an individual or $128,600 for a family of 4), definitely look into this. A lot more people qualify for insulin patient programs than they realize.

What to do if you lose Medicaid

If you had Medicaid before but have recently lost coverage, don’t panic. Find out what your options are. Losing Medicaid is a “qualifying event,” which means you won’t have to wait until open enrollment to find coverage.

Early detection can save a life

Like Orlando, nearly half (46%) of people with type 1 diabetes are already in DKA by the time they’re diagnosed. Recognizing the warning signs early—and knowing when to seek care—can prevent a life-threatening emergency. Learn how to #SeeTheSigns and help protect yourself or someone you love.