If you are taking 200 units of insulin a day...

and your A1c is still over 8%, maybe you're not taking the right type of insulin. First, see your diabetes educator to determine that you are eating and injecting appropriately. Taking your meal time insulin an hour after you eat is an easy way to keep your A1c over 9%.

If Everything is in order, maybe you need U500 R insulin. That's right, a 5x concentrated insulin. The vial is 20 cc so you effectively get 10 bottles of insulin for one copay. The retail price of $230 may seem high but that works out to $23 a bottle of 'ordinary' insulin. The high concentration given before meals can break through severe insulin resistance. Some people may still need a little basal insulin at bed time to keep the morning sugar in target range. You may need to ask around to find a doctor who is familiar with this insulin and will work closely with you to get optimal results.