OBJECTIVES: As the prevalence of diabetes increased, new diabetes medications have been approved which impact the utilization and cost of insulin. This analysis evaluates differences in insulin utilization and ex-manufacturer sales between the US and Canada by comparing data from the third quarter (Q3) of 2008 through Q3 of 2014. METHODS: Data were derived from the IMS Dataview database to assess insulin utilization measured by volume sold in international units (IU) and ex-manufacturer sales in US dollars in the US and Canada. Information was gathered at the country level, and then segmented by retail versus hospital and pens versus vials. Cross-sections of volume and sales for Q3 of 2008 through Q3 of 2014 were evaluated. Descriptive statistics were used to analyze trends in utilization and ex-manufacturer prices. RESULTS: The volume of insulin sold increased from 24.8 billion IU to 30.0 billion IU in the US and from 2.2 billion IU to 3.2 billion IU in Canada in the study period. Insulin ex-manufacturer sales increased from $1.9 billion to $5.54 billion in the US and from $78 million to $140 million in Canada. The average cost per unit of insulin sold in the retail and hospital settings increased from $0.068 to $0.184 in the US and from $0.036 to $0.044 in Canada. Beginning in 2011, utilization of insulin in the US began to plateau and the cost per unit of insulin increased at a faster rate, lending to increased total ex-manufacturer sales despite the small change in units sold during the same period. CONCLUSIONS: Although utilization of insulin increased in both countries, utilization has slowed in the US. Ex-manufacturer insulin prices increased at substantially faster rates in the US than in Canada. These differences may partially be explained by variations in pricing regulations and the time to “insulinization” in clinical practice.