What to Do If You Run Out of Insulin: The Guide I Wish I'd Had

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⚠️ If you are experiencing symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea, vomiting, shortness of breath, or confusion — stop reading and seek emergency medical help immediately. Go to your nearest emergency room or call 911.

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I've never run out of insulin completely. But I've come close enough to know exactly how that particular kind of panic feels — the moment you realise the pen in your hand might be your last one, and you're not sure where the next one is coming from.

It's a feeling that a staggering number of people with insulin-dependent diabetes know far too well.

A recent Yale study found that over 1 in 4 people with diabetes has rationed their insulin due to cost alone in the United States.

And that's before you factor in the other ways insulin runs out — spoiled pens, broken vials, travel mishaps, expired prescriptions, and the kind of bad luck that doesn't check your supply levels before it strikes.

Running out of insulin is a matter of life and death.

I want to be clear about that — not to frighten you, but because acting quickly and calmly is essential, and knowing your options in advance makes all the difference.

This guide covers exactly what to do, step by step, depending on your situation.

Step One: Assess How Urgent the Situation Is

Not all "ran out of insulin" situations are equal. The first thing to do is take a breath and assess where you actually are.

Is this an emergency?

If your blood sugar is dangerously high, you have ketones in your urine or blood, or you're experiencing symptoms of diabetic ketoacidosis (DKA) — excessive thirst, frequent urination, nausea, vomiting, fatigue, shortness of breath, fruity-smelling breath, or confusion — this is a medical emergency.

Go to an urgent care clinic or emergency room immediately. Do not wait. Doctors there will not know your exact treatment plan, but they will have insulin and they can stabilise you. Once you're treated, you can work on securing a longer-term supply.

Is it not yet an emergency?

If you still have some insulin left, your blood sugar is under control, and you have a window of time to work with — start with the steps below. The goal is to source more insulin before you reach a crisis point.

What to Do Right Now: Your Options by Situation

Call your pharmacy first

This should be your first call in almost every non-emergency situation.

• If your prescription is still valid, you can often get a same-day refill.
• If it's expired, many pharmacies can reach your doctor during business hours to update it quickly.

Many states have passed laws to specifically address emergency insulin refills, allowing pharmacists to dispense insulin on an emergency basis even from an expired prescription.

States that currently allow this include Ohio, Florida, Arkansas, Arizona, Illinois, Wisconsin, Idaho, Oregon, Pennsylvania, South Carolina, Tennessee, Colorado, Indiana, Kentucky, Oklahoma, Utah, West Virginia, and others.

Always explain the urgency clearly — some pharmacists are less familiar with the specific rules than others.

Get a prescription online

If you can't reach your regular doctor, telemedicine platforms allow you to consult with a doctor online who can issue a new prescription, often the same day.

Several platforms are well suited for this in the US:

• Teladoc — one of the largest US telehealth providers, with doctors available 24/7 and nationwide coverage
• Amwell — strong for chronic condition management including diabetes, with integration into many major health systems
• GoodRx Care — one of the most affordable options, with visits starting from $19 and same-day prescriptions available
• Sesame Care — rated best overall telehealth by Healthline, covers primary care and chronic condition management
• MDLive — available 24/7 with urgent care and primary care options

All of these allow you to consult with a licensed physician, have your situation assessed, and receive a prescription sent directly to your chosen pharmacy — often within hours.

Use backup insulin

If you have over-the-counter Walmart insulin as a genuine emergency backup, it can buy you time while you secure your prescribed insulin.

Be aware that ReliOn Regular insulin works differently from modern rapid-acting analogues — it takes longer to start working and has a longer duration.

Only use it as an emergency backup and never without understanding the differences, and contact your doctor as soon as possible.

Go to an urgent care clinic or emergency room

If all other options have failed, or if you're already experiencing high blood sugars with no insulin available, go to a hospital.

You do not need a prior appointment. Medical staff will have insulin and will treat you. Ask specifically for an endocrine consult or diabetes educator if available.

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👉 If you're traveling internationally and run out of insulin, the situation is more complex — different countries have different availability, different brand names, and sometimes different insulin concentrations entirely. Our Complete Guide to Traveling with Diabetes covers what to do in an emergency abroad, including how to source insulin when you're far from home.

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What NOT to Do When You Run Out of Insulin

When you're stressed, scared, and without insulin, it's easy to make decisions that feel logical in the moment but can actually make things worse. Here are the things to avoid:

❌ Don't panic and skip doses entirely. It might be tempting to stretch what little insulin you have left by skipping injections, but for type 1 diabetics especially, going without insulin even for a short period can rapidly lead to dangerously high blood sugar and ketoacidosis. If you have any insulin left, use it as directed while you work on sourcing more.

❌ Don't dramatically reduce your doses to make your supply last longer. Rationing insulin by taking significantly less than your body needs is one of the most dangerous things you can do. It won't keep you safe — it will just slow down the progression toward a crisis while giving you a false sense of control. This is a situation that has cost lives. If you're at risk of running out, use what you have correctly and act urgently to find more.

❌ Don't use someone else's insulin without medical guidance. Borrowing insulin from a friend or family member with diabetes might seem like an obvious solution, but different types, concentrations, and brands of insulin work very differently. Using the wrong type without understanding the differences in timing and dosing can lead to severe hypoglycaemia or hyperglycaemia. If this is truly your only option, speak to a healthcare professional first.

❌ Don't assume the situation will resolve itself. Blood sugar can rise to dangerous levels faster than most people expect when insulin is unavailable — particularly for type 1 diabetics. This is not a wait-and-see situation. Act quickly, explore every option, and don't hesitate to go to an emergency room if needed.

❌ Don't rely on diet alone to manage blood sugar. Restricting carbohydrates may slow the rise of blood sugar temporarily, but it cannot replace insulin for someone with insulin-dependent diabetes. For type 1 diabetics, the body will begin producing ketones regardless of food intake if insulin is absent. This is not a safe strategy — it buys very little time.

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👉 If the insulin you have left is close to or past its expiration date and you're wondering whether you can still use it — our guide on Can You Use Expired Insulin? explains exactly what the risks are and when it might be safe as a last resort.

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Why You Might Have Run Out of Insulin

Running out of insulin rarely happens out of nowhere. The most common causes are:

An expired prescription.

In the US, insulin prescriptions are typically valid for one year. Once yours lapses, you'll need a new one before your pharmacy can refill — which is why keeping track of your prescription renewal date matters as much as tracking your supply.

Spoiled or damaged insulin.

Insulin exposed to excessive heat, freezing temperatures, or direct sunlight can degrade and become unusable — often without looking any different. A pen left in a hot car, a vial placed too close to the freezer element, or a cooling case that failed on a long trip can all mean losing insulin you thought you had.

A broken vial.

Insulin vials are glass, and glass breaks. Dropping your last insulin vial is the kind of bad luck that happens in an instant. A silicone insulin vial protector is a simple, inexpensive solution worth having if you use vials regularly.

 

Not packing enough insulin for a trip.

Travel is one of the most common situations where people run short — delayed flights, extended trips, or a bag that doesn't arrive can all leave you without enough insulin far from home. 

Financial reasons.

As mentioned above, around 1 in 4 people with diabetes in the US has rationed insulin due to cost. If this is your situation, the manufacturer assistance programmes listed below are specifically designed for you.

A Note on the 2026 Insulin Shortage

It's worth acknowledging something that the diabetes community has been dealing with increasingly in recent years: insulin shortages.

As of early 2026, certain formulations of Insulin Aspart — including Fiasp FlexTouch pens and some NovoLog products — are experiencing shortages due to manufacturing delays at Novo Nordisk and the discontinuation of the unbranded generic version in late 2025.

If your specific insulin is unavailable at your pharmacy, tools like Medfinder allow you to check real-time availability at pharmacies near you. 

Your doctor may also be able to prescribe an alternative insulin temporarily. Contact your manufacturer's patient assistance line directly — NovoCare is reachable at 1-888-668-6444 for Novo Nordisk products.

How to Make Sure This Never Happens Again

The best solution to running out of insulin is preventing it — and most of the causes above are preventable with the right habits in place.

✅ Keep a running inventory.

Know exactly how many pens or vials you have stored in your refrigerator at all times.

I do a quick count every Sunday — it takes thirty seconds and has saved me from several close calls.

Some people use a whiteboard on the fridge; others set a recurring phone reminder. Whatever works for your routine, make it consistent.

✅ Refill before you're on your last pen.

Don't wait until your insulin supply is almost gone to request a refill. Most prescriptions can be refilled when you have a few days' supply remaining. Build this into your routine.

I request a refill when I open my second-to-last pen, never the last one.

✅ Ask your doctor for a slightly larger prescription.

Insulin use varies day to day, and your prescription is always an estimate. It's completely reasonable to ask your doctor for a prescription that includes a small buffer above your average daily use.

Most doctors are happy to accommodate this — it's a simple way to avoid the situation where you run out a few days before your next scheduled refill.

✅ Sign up for automatic refills.

Most pharmacies offer this service. It removes the cognitive load entirely and ensures you're never caught out by a missed refill window. Set it up once and let it run.

✅ Track your prescription renewal date separately from your supply.

Your prescription expiring and your insulin running out are two different problems that can compound each other badly.

I keep my prescription renewal date in my phone calendar with a two-week advance reminder — enough time to book an appointment with my doctor before the prescription lapses.

✅ Store insulin correctly, every time.

Spoiled insulin is wasted insulin.

• Unopened pens and vials belong in the fridge between 36°F–46°F (2°C–8°C), away from the freezer compartment and the back wall.
• Opened insulin needs to be protected from heat — below 77°F–86°F (25°C–30°C) depending on your brand.

In warm weather or while traveling, a proper insulin cooling case is essential.

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👉 Proper insulin storage is the foundation of never running out of usable insulin. Our guide on How to Store Insulin at Home covers fridge placement, temperature monitoring, and the everyday mistakes that quietly put your supply at risk.

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✅ When traveling, always pack double insulin supplies.

This is non-negotiable for me — at minimum fifty percent extra, ideally double what I expect to need. Split supplies across separate bags so that losing one doesn't mean losing everything. The extra weight is nothing compared to the peace of mind.

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👉 Spoiled insulin on a trip is one of the most avoidable reasons for running out — and one of the most stressful. Whether you're dealing with a long-haul flight, a hot destination, or a hotel fridge you can't trust, my guide on How to Keep My Insulin Cool When Traveling covers every situation so your supply stays safe from the moment you leave home to the moment you arrive.

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No More Insulin: Your Questions Answered

• What should I do if I run out of insulin and can't get more immediately?

If you have symptoms of DKA — excessive thirst, nausea, vomiting, shortness of breath, confusion — go to an emergency room immediately. If you don't have symptoms, call your pharmacy first. If they can't help, try telemedicine for an urgent prescription, or go to an urgent care clinic.

• Can I get insulin without a prescription?

In the US, ReliOn brand human insulin is available over the counter at Walmart for approximately $25 per vial — no prescription needed. This is older insulin that works differently from modern analogues. Use it only as a temporary last resort and consult your doctor as soon as possible.

• What if my insulin prescription has expired?

Call your pharmacy — during business hours they can often contact your doctor to update the prescription the same day. Several states allow pharmacists to dispense an emergency supply from an expired prescription. Outside business hours, go to an emergency room.

• Can I get an insulin prescription online?

Yes. Multiple telemedicine platforms allow you to consult with a doctor who can prescribe insulin, often the same day. This can be a fast solution when you can't reach your regular doctor.

• What if I run out of insulin while traveling abroad?

Go to any hospital — they will have insulin available. Carry your prescription and doctor's letter to assist with sourcing your specific brand at local pharmacies. Be aware that some countries use U-40 insulin rather than the U-100 standard, which requires different syringe sizing.

• How do I prevent running out of insulin?

Refill prescriptions before your last pen or vial. Keep a running inventory. Ask your doctor for a slightly larger prescription to create a buffer. Sign up for automatic refills. When traveling, always carry at least double your expected supply, split across separate bags.

• Can I use expired insulin if that's all I have?

Using expired insulin is not recommended — its potency cannot be guaranteed, and it may no longer lower blood sugar effectively, which can lead to dangerous highs or DKA. That said, in a genuine emergency where no alternative is available and you cannot reach medical help, some healthcare providers acknowledge that using recently expired insulin that has been correctly stored is preferable to using none at all. This should only ever be a last resort — seek medical help or a replacement supply as urgently as possible.

• Can I split my remaining insulin doses to make them last longer?

No — this is one of the most dangerous things you can do. Rationing insulin by taking significantly less than your body needs slows the progression toward a crisis without actually preventing it, and gives a false sense of safety. Use whatever insulin you have left correctly while urgently pursuing one of the solutions in this guide.

• Can I borrow insulin from another diabetic?

Only with extreme caution and ideally with medical guidance. Different insulin types, brands, and concentrations work very differently — using the wrong type without understanding the timing and dosing differences can cause severe hypoglycaemia or hyperglycaemia. If this is your only option, call a healthcare professional or emergency line first.

• Will a hospital give me insulin if I have no prescription?

Yes. Hospitals and emergency rooms always have insulin available and will treat you regardless of whether you have a current prescription. If your blood sugar is high or you have no insulin and cannot obtain it any other way, going to an emergency room is always the right call.

• Can I get insulin at a pharmacy without a prescription?

In most US states, you cannot get prescription insulin without a valid prescription. However, ReliOn brand human insulin is available over the counter at Walmart for approximately $25 per vial — no prescription required. This is older insulin that works differently from modern analogues and should only be used as a temporary last resort. Additionally, several states allow pharmacists to dispense an emergency supply from an expired prescription — always ask your pharmacist about this option first.

• What should I do if my insulin pen is broken?

A malfunctioning pen is a different problem from running out of insulin — but it can feel just as urgent. Check for a blocked needle, air bubbles, or a jammed dosing mechanism before assuming the pen is unusable. Our guide on How to Fix a Jammed Insulin Pen covers the most common issues and how to resolve them quickly. If the pen is genuinely broken and you have no replacement, treat it as an out-of-insulin situation and follow the steps in this guide.

💬 We'd Love to Hear From You

Have you ever run out of insulin — at home, while traveling, or because of financial reasons? What did you do, and what would you tell someone else in that situation?

Share it in the comments below! These real-world experiences are exactly what helps the community navigate situations that no one plans for.