Type 1 diabetes is a chronic disease in which the body cannot produce a sufficient amount of insulin. Managing this condition requires the daily, precise selection and administration of life-saving insulin doses. This process is, in itself, fraught with serious challenges, especially for children and their parents.
Starting in March of this year, the parents of diabetic children faced yet another difficulty: a significant disruption in the supply of the fast-acting insulin “NovoRapid,” which essentially left patients without stock and caused an outcry among parents.
Fortunately, on November 18, 2025, the Ministry of Health announced that the supply of “NovoRapid” had been restored.
The stories recounted in the present article reflect the difficult journey that the parents of diabetic children have recently endured to ensure the continuous availability of this vital medication for their children. The parents’ testimonies clearly illustrate the systemic challenges that exist within the healthcare sector regarding the state program for diabetes.
NovoRapid and Apidra: Key Differences and Challenges – An Assessment by Pediatric Endocrinologist Mariam Oniani
First and foremost, it must be clarified that both NovoRapid and Apidra are premium quality insulins. The difference between them encompasses several aspects: the manufacturing companies and, most importantly in the context of Georgia, the dosing capability, which is the main challenge for parents.
Specifically, the Apidra pen available in Georgia does not have a 0.5 unit increment (step), which is the case with NovoRapid. Consequently, parents often have to remove the insulin from the cartridge and inject it using a regular needle, or simply adjust the child’s feeding regimen.
In terms of action, both are fast-acting insulins, but Apidra is characterized by a faster onset of action and a quicker development of its peak. This means that when consuming specific foods, Apidra may lower blood sugar levels faster than NovoRapid.
Doctors select insulin for a specific patient based on the following criteria: age and sensitivity to insulin. Apidra is typically prescribed from the age of 4, and NovoRapid from the age of 2. In some cases, Apidra is better because a faster onset of insulin action is beneficial for a child’s body, but this is entirely individual.
Generally, Type 1 diabetes needs to be managed by a multidisciplinary team, which includes a pediatric endocrinologist, a nutritionist, a diabetes nurse, and crucially, a psychologist. Patients should have the opportunity to consult with a specialist, share their emotions, and receive appropriate support upon diagnosis. Along with a multidisciplinary approach, the implementation of modern technologies is essential for creating a healthy future.
In November, the situation arose where children receiving NovoRapid were essentially left without stock, which caused an outcry among parents. Although a disruption in the medication supply can occur in any country, in a country like Georgia, where diabetes is not managed by a multidisciplinary team, where we do not have a diabetes nurse, and where the entire responsibility falls on the pediatric endocrinologist, such distress causes considerably more anxiety and stress.
As we know, stress is a powerful factor that impacts diabetes. The distress among parents persists to this day because it is difficult for a single pediatric endocrinologist to handle the existing number of patients.
All the criticism directed towards the Ministry of Health stems from the fact that parents were not adequately warned about the NovoRapid shortage. Following a warning, it would have been possible to gradually transition children to an alternative insulin, allowing parents to go through this process without nervousness and stress.
The manufacturer of NovoRapid began announcing in March of this year that due to the transition to more expensive, new-generation medications, they expected a temporary reduction in the production of older insulins, which does not mean a complete shortage, but a reduction in quantity. As the Ministry of Health noted, they had a series of misunderstandings with the company since March, and multiple contract violations were recorded.
Parents’ Accounts
Tatia Shengelia’s Story
“My child has had diabetes for thirteen years, since the age of 15. In addition, he suffers from cystic fibrosis and celiac disease. Against the background of battling all three diseases, dosing insulin in 0.5 unit increments is vital for us. After so many years of experience, I have learned the ‘language’ of his body and I know that he often needs an injection—sometimes 0.5, sometimes 1.5 units—which is why receiving NovoRapid with 0.5 increments is of paramount importance to us.
The insulin was due to be picked up on the 9th, but due to health issues, we ended up in the hospital and could not go at the scheduled time. I thought that the pharmacy in Uznadze Street would take this circumstance into account, but I received a cold refusal—they cited the lack of NovoRapid as the reason. The state was obliged to warn us. Is there no record of who is due to receive the medication and when? Lately, they have only been giving us one ampoule at a time; in fact, for the last three years, in the full sense of the word, they have been counting drops for us.
Adding to this is the fact that every 6 months, they take away one insulin cartridge from us under the pretext that we have taken too much. No one considers that we should change the injection needles daily. My child injects insulin four times a day, and to make it less painful, I have shifted the needle change to every second or third day. We try our best to conserve the medication.
I get very angry when they tell me to switch to another, alternative insulin. I emphasize again: it doesn’t happen that simply! There are children who have other diseases. Replacing insulin is not soup where you can substitute rice for pasta.
My son is 15 and will be an adult in three years. Children who reach adulthood are left without everything at that point. The state, for some reason, does not care for them.
It is very difficult for me as a mother when my child has such diseases—celiac disease (which requires a gluten-free diet) and cystic fibrosis, which is also under the state program—and the state treats this issue so lightly. Sitting idly by in the face of all this is very hard.
Parents have been fighting for our children’s rights for a long time, but this struggle seems endless. I think perhaps they should come to their senses humanely and take our children’s pain to heart. None of us are safe from this. One beautiful day, this news hit me like a bolt from the blue. Watching others’ suffering from such a distance is not the right action when you are the state and managing this issue. The state should pay more attention to these children. We are only asking for the provision of medication.
We, the parents, truly help each other. We might run out of medicine, needles, test strips, lancets… We are one big family, and I want to thank these parents for that. We cannot leave these children like this; we must pay more attention. This concerns health, not some other issue. If we want young people to be healthy and have a full life, the state must support them. Let’s truly not have to leave the country—many parents are abroad and wonder if they could help from here. In European countries, no one counts drops; they even have leftovers, and they certainly don’t have to worry about such issues.
The state must ensure stock levels and it should not happen that a parent runs out of medication, and the state cannot provide it. It is difficult to find these medications even on the market, as parents actively buy them up as soon as a crisis begins. You might find them on the market, but in my opinion, no one can guarantee the storage conditions.
When we appeal to the Ministry of Health about problems, we initially receive a positive response, they promise us, but then we face a completely different reality. Negotiations go on for hours, but there is no result. If these problems were genuinely being solved, we would not be in this situation. None of us enjoy ‘shouting and screaming’ like this. We, parents, need calmer nerves because we have to be on guard 24 hours a day to care for our children.
Therefore, there should be no drug shortage, especially for children. We are only asking for the medicine. Sometimes sugar does not rise in a child only because of food; it can also rise due to emotions. If a child hears now that there is no medicine, gets nervous, and their sugar rises, we must be able to regulate it with NovoRapid.”
Ana Darchiashvili’s Story
“Let’s agree that every child is individual. My child, who is almost an adult (15 years old), is on Apidra, the insulin the state suggests children switch to. In our case, if the sugar is 200 and I add one unit for correction, it brings the sugar down to 100. However, this is a general case, as considering carbohydrate intake, one unit might not affect it at all. I know what my child eats and I inject insulin accordingly, but there are adolescents for whom even adding one unit of Apidra drops their sugar to 40. That is why 0.5 unit increment ampoules are vital for insulin-dependent children.
We are not saying that this is a bad company or a bad medicine. Absolutely not! I would not switch my child to bad medicine. However, when children are first diagnosed with diabetes, NovoRapid is prescribed absolutely everywhere. Do you know why? Because with the 0.5 increment, it is possible to provide an exact correction that matches their sugar level. That is precisely why Apidra is not prescribed directly to any child with a new diagnosis.
Also, I want to emphasize: Apidra is not prescribed for children under 4 years old. I am telling you this based on information from the manufacturer itself. This information is easily searchable. Apidra is not used in children under 4 because constant correction is needed, which is not feasible with this insulin. It is acceptable after 4 years, but there are children whose bodies do not tolerate Apidra at all. Therefore, the option of choice must exist.
The Novo Nordisk company put us in this situation in May, and then violated the contract in June, July, and August. When there was no insulin stock, parents should not have to find out this information from the Uznadze pharmacy; rather, a representative of the healthcare sector should make a public statement. They should have said: ‘People, the Novo Nordisk company has violated the contracts.’ We didn’t know any of this; we thought NovoRapid would be available. Eventually, they promised that NovoRapid would be available on November 17, and distribution is likely to start from November 20.
Novo Nordisk has breached its obligation so many times. How can such a vital obligation be violated so many times? This directly indicates the malfunction and incorrect management of the healthcare system.
Our main demand is that insulin be distributed, but not in a way where the parent is summoned on different days—one day to receive one cartridge, the next day for another. The parent already has a lot of worries. Added to this is the fact that there has been a shortage of test strips since December. It can be said that the entire system is faulty.
Plus, children over 18 years old are doomed: they lose part of their disability pension and other benefits provided by their disability status. For example, my child will also turn 18 soon, and young people over 18 are in an even more difficult situation. The Ministry promised that a meeting would be held to rectify this issue. The state is obliged to take care of these children. Nothing has changed in the program over the past few years, and some 18-year-olds are still schoolchildren; for example, my child will be a student at the age of 18.”
