Type 1 diabetes is a chronic disease in which the body does not produce sufficient amounts of insulin. Managing this condition requires the precise selection and administration of daily, life-sustaining doses of insulin. This process, in itself, is full of serious challenges, particularly for children and their parents.
Starting from March of the current year, parents of children with diabetes faced yet another difficulty: a significant delay in the supply of the rapid-acting insulin “NovoRapid,” which essentially left patients without stock in November and caused an uproar among parents.
Fortunately, on November 18, 2025, the Ministry of Health released information stating that the supply of “NovoRapid” had been restored.
The events described in this article reflect the difficult path that parents of children with diabetes have recently walked to ensure the continuous availability of a life-critical medication for their children. The parents’ accounts clearly demonstrate the systemic challenges that exist in the healthcare sector with regard to the state program for diabetes.
NovoRapid and Apidra: Key Differences and Challenges – Assessment by Pediatric Endocrinologist Mariam Oniani
First and foremost, it must be clarified that both NovoRapid and Apidra are high-quality insulins. The difference between them encompasses several aspects: the manufacturing companies and, most importantly in 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 different in the case of NovoRapid. Consequently, parents often have to withdraw insulin from the cartridge and inject it with a conventional needle, or simply correct the child’s feeding regimen.
In terms of action, both are rapid-acting insulins, but Apidra is characterized by a faster onset of action and a faster peak development. This means that when consuming a specific food, Apidra might lower blood sugar levels faster than NovoRapid.
Doctors choose insulin for a specific patient based on the following criteria: age and sensitivity to insulin. Apidra is typically prescribed from the age of 4, while NovoRapid is prescribed from the age of 2. In some cases, Apidra is better, as it is advantageous for a child’s body when insulin acts quickly, 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 upon diagnosis, share their emotions, and receive appropriate assistance. Along with a multidisciplinary approach, the implementation of modern technologies is essential for creating a healthy future.
In November, a situation arose where children receiving NovoRapid were essentially left without stock, which caused an uproar among parents. While a disruption in medication supply can happen 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 all responsibility falls on the pediatric endocrinologist, such distress causes significantly more anxiety and stress.
As we know, stress is a powerful factor that affects diabetes. The continuing distress among parents is due to the difficulty for the pediatric endocrinologist to cope with the existing number of patients.
All the criticism directed at the Ministry of Health is aimed at the fact that parents were not adequately warned about the NovoRapid shortage. Following a warning, it would have been possible to gradually switch children to alternative insulins so that parents could go through this process without worry and stress.
The manufacturer of NovoRapid began announcing from March of this year that due to the transition to more expensive, newer 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 number of misunderstandings with the company since March, and multiple contract breaches were recorded.
Parents’ Accounts
Tatia Shengelia’s Story
“My child has had diabetes for thirteen years now, at the age of 15, and in addition, she suffers from Cystic Fibrosis and Celiac Disease. Against the background of fighting all three diseases, dosing insulin with a 0.5 unit increment is vitally important for us. After so many years of experience, I have already learned the ‘language’ of her body and I know that she often needs an injection — sometimes 0.5, sometimes 1.5 units, so receiving NovoRapid with the 0.5 increment is crucial for us.
The insulin was supposed to be collected on the 9th, but due to health problems, we ended up in the hospital and could not go at the appointed time. I thought the pharmacy on 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 entitled to the medication and when? Lately, they were giving us only one ampoule anyway; for the past three years, in the full sense of the word, they have been counting every drop for us.
In addition, every 6 months, they take away one insulin cartridge from us because we supposedly took too much. No one considers that injection pen needles should be changed 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 to save the medication as much as possible.
I am very angry when they tell me to switch to another, alternative insulin. I emphasize again: it does not happen that simply! There are children who have other diseases. Replacing insulin is not soup where you can substitute pasta with rice.
My child is 15 years old and will become an adult in three years. Children who reach adulthood are left without everything at that time. For some reason, the state does not care for them.
It is very difficult for me, as a mother, when my child has such diseases—Celiac Disease (which forces us to follow a gluten-free diet) and Cystic Fibrosis, which is also under the state program—and the state treats this issue so lightly. It is very hard to sit idly by in the face of all this.
Parents have been fighting for our children’s rights for a long time, but this struggle seems endless. I think maybe they will come to their senses humanely and take our children’s pain to heart. No one is safe. This news struck me like a bolt from the blue on a clear day. Watching others’ suffering from afar is not the right thing to do when you are the state and managing this issue. The state must pay more attention to these children. We are only asking for the provision of medication.
We, the parents, truly help each other. We run short 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 is about health, not some other issue. If we want young people to be healthy and have a full life, the state must support them. Let us truly not have to leave the country—many parents are abroad and think, if only we could help from here. In European countries, no one is counting drops, they even have leftovers, and they certainly do not have to worry about such issues.
The state must ensure supplies and it should not happen that a parent runs out of medication and the state cannot provide it. These medications are hard to find even on the market, as parents actively buy them as soon as the crisis starts. You might find them on the market, but in my opinion, no one can guarantee the storage conditions.
When we address the Ministry of Health about problems, at first we 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 really being solved, we would not be in this situation. None of us enjoys this kind of “screaming.” We, the parents, need calmer nerves because we have to be on guard 24 hours a day to take care of our children.
Therefore, there should be no drug shortage, especially for children. We are only asking for medicine. Sometimes a child’s sugar level does not only rise due to food, but can also increase due to emotions. Now, if the child finds out 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 will bring the sugar down to 100. However, this is a general case, because considering carbohydrate intake, one unit may not work at all. I know what my child eats and I inject insulin accordingly, but there are teenagers for whom even adding one unit of Apidra drops their sugar to 40. That is why 0.5 increment ampoules are vitally important for insulin-dependent children.
We are not saying it’s a bad company or a bad drug. Not at all! I would never switch my child to a bad drug. 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 accurate correction that matches their sugar level. That is why Apidra is not directly prescribed 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 the information from the manufacturer’s company itself. This information is easily searchable. Apidra is not used in children under 4 because constant correction is needed, which is not possible with this insulin. It is acceptable after the age of 4, 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, then breached the contract in June, July, and August. When there was no insulin supply, parents should not hear this information from the pharmacy on Uznadze Street, but a representative of the healthcare sector should make a public statement. They should have said: “People, the Novo Nordisk company has breached contracts.” We did not know any of this, we thought NovoRapid would be available. Finally, they promised that NovoRapid will be available on November 17, and distribution will likely start from November 20.
Novo Nordisk has breached its obligations so many times. How can such a significant obligation be breached so many times? This directly indicates a failure and incorrect management of the healthcare system.
Our main demand is that insulin be distributed, but not in a form where parents are called in on different days—one day to receive one cartridge, the next day for another. A parent already has many worries. Adding to this is the fact that there will be a shortage of test strips starting from December. It can be said that the entire system is flawed.
Plus, children over 18 are doomed: they lose part of the disability status pension and other benefits. 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 will be held to correct this issue. The state is obliged to care for these children. Nothing has changed in the program in recent years, and some 18-year-olds are still schoolchildren; for example, my child will be a student at the age of 18 too.”
