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U 500 Insulin Dosing

Concentrated Insulin Human Regular (u-500) For Patients With Diabetesp

Concentrated Insulin Human Regular (u-500) For Patients With Diabetesp

aTDD = total daily dose, CSII = continuous subcutaneous insulin infusion, SMBG = self-monitored blood glucose, 50/50 = 50% of TDD prebreakfast and 50% of TDD predinner, 60/40 = 60% of TDD prebreakfast and 40% of TDD predinner, 33/33/33 = one-third of TDD before each meal. bEmpirically reduce the conversion dose from U-100 by 1020% if baseline glycosylated hemoglobin (HbA1c) is 8%; increase the dose by 1020% if HbA1c is 10%. cU-500 bolus doses recommended 30 minutes before a meal; adjust dosage according to latest SMBG value. U-500 has prandial and basal timeaction profile characteristics. dBasal insulin (glargine, detemir, or isophane [NPH]) may be substituted for bedtime U-500 insulin to adjust fasting blood glucose values according to physician judgment. eBased on percentage of TDD. May initially use fixed ratios or distribute boluses according to proportion of carbohydrates with meal or carbohydrate-counting according to patient preference and physician judgment. aThe following dosing formulas may also be used: dose (actual units) 0.2 = unit markings in a U-100 insulin syringe, dose (actual units) 0.002 = volume (mL) in a tuberculin syringe. Alissa R. Segal, Pharm.D., CDE, Jack E. Brunner, M.D., F. Taylor Burch, Pharm.D., M.H.A. and Jeffrey A. Jackson, M.D., CDE Alissa R. Segal, Pharm.D., CDE, is Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, and Clinical Pharmacist and Diabetes Educator, Joslin Diabetes Center, Boston. Jack E. Brunner, M.D., is Director, Endocrine and Diabetes Care Center, Toledo, OH. F. Taylor Burch, Pharm.D., M.H.A., is Endocrine Medical Liaison, U.S. Medical Division, Endocrine, Lilly USA, LLC, Indianapolis, IN. Jeffrey A. Jackson, M.D., CDE, is Adjunct Clinical Associate Professor, Inter Continue reading >>

Important Safety Information For Humulin R U-500

Important Safety Information For Humulin R U-500

Humulin R U-500 is contraindicated during episodes of hypoglycemia and in patients hypersensitive to Humulin R U-500 or any of its excipients. Dosing Errors: Extreme caution must be observed in measuring the dose of Humulin R U-500 because inadvertent overdose may result in serious adverse reaction or life-threatening hypoglycemia. Hyperglycemia, Hypoglycemia or Death Due to Dosing Errors in the Vial Presentation: Medication errors associated with the Humulin R U-500 vial resulting in patients experiencing hyperglycemia, hypoglycemia or death have been reported. Instruct patients to always inspect insulin vials to confirm that the correct insulin is dispensed including the correct brand and concentration. For the Humulin R U-500 vial, particular attention should be paid to the 20-mL vial size, prominent “U-500” and warning statements on the vial label, and distinctive coloring on the vial and carton. Dosing errors have occurred when Humulin R U-500 was administered with syringes other than a U-500 insulin syringe. Patients should be prescribed U-500 syringes for use with Humulin R U-500 vials. The dose of Humulin R U-500 should always be expressed in units of insulin. Instruct patients to always check the insulin label before each injection. Use only a U-500 insulin syringe with Humulin R U-500 to avoid administration errors. Do not use any other type of syringe to administer Humulin R U-500. Adhere to administration instructions. Instruct the patient to inform hospital or emergency department staff of the dose of Humulin R U-500 prescribed. If using the Humulin R U-500 KwikPen, patients should be counseled to dial and dose the prescribed number of units of insulin (NO dose conversion is required). DO NOT transfer Humulin R U-500 from the Humulin R U-500 KwikPen int Continue reading >>

Pharmacokinetics And Pharmacodynamics Of High-dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin In Healthy Obese Subjects

Pharmacokinetics And Pharmacodynamics Of High-dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin In Healthy Obese Subjects

Pharmacokinetics and Pharmacodynamics of High-Dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin in Healthy Obese Subjects 1Eli Lilly and Company, Indianapolis, Indiana 2Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon 3Profil Institute for Clinical Research, Chula Vista, California Received 2011 Apr 15; Accepted 2011 Aug 31. Copyright 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been corrected. See the correction in volume 37 onpage2414. This article has been cited by other articles in PMC. Human regular U-500 (U-500R) insulin (500 units/mL) is increasingly being used clinically, yet its pharmacokinetics (PK) and pharmacodynamics (PD) have not been well studied. Therefore, we compared PK and PD of clinically relevant doses of U-500R with the same doses of human regular U-100 (U-100R) insulin (100 units/mL). This was a single-site, randomized, double-blind, crossover euglycemic clamp study. Single subcutaneous injections of 50- and 100-unit doses of U-500R and U-100R were administered to 24 healthy obese subjects. Both overall insulin exposure (area under the serum insulin concentration versus time curve from zero to return to baseline [AUC0-t]) and overall effect (total glucose infused during a clamp) were similar between formulations at both 50- and 100-unit doses (90% [CI] of ratios contained within [0.80, 1.25]). However, peak concentration and effect were significantly lower for U-500R at both doses (P < 0.05). Both formulations produced relatively long durations of action (18.3 to 21.5 h). Time-to-peak concentra Continue reading >>

Clinical Use Of U-500 Regular Insulin: Review And Meta-analysis

Clinical Use Of U-500 Regular Insulin: Review And Meta-analysis

Clinical Use of U-500 Regular Insulin: Review and Meta-Analysis 3Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, Illinois 1Section of Endocrinology, Department of Medicine, Rush University Medical Center, Chicago, Illinois 2Department of Health Studies, The University of Chicago, Chicago, Illinois 3Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Chicago, Chicago, Illinois Corresponding Author: Sirimon Reutrakul, M.D., Section of Endocrinology, Rush University Medical Center, 1725 W. Harrison St., Suite 250, Chicago, IL 60612; email address [email protected]_nomiris Copyright 2012 Diabetes Technology Society This article has been cited by other articles in PMC. The use of U-500 regular insulin (U-500R) to treat diabetic patients with severe insulin resistance has increased. In this review, we performed a meta-analysis of PubMed studies reporting the use of U-500R to evaluate the effects of U-500R on hemoglobin A1c (HbA1c), body weight, and total daily insulin dose (TDD). These studies included 310 patients using U-500R as multiple daily injections (MDI) and 55 patients using U-500R via continuous subcutaneous insulin infusion (CSII). Overall, the use of U-500R as MDI resulted in a significant HbA1c reduction of 1.59%, a significant weight gain of 4.38 kg, and a significant increase in TDD by 51.9 units. The use of U-500R via CSII resulted in a similarly significant HbA1c reduction of 1.64% but a nonsignificant weight gain and a nonsignificant change in TDD. The use of U-500 regular insulin both as MDI and via CSII was not reported to be associated with severe hypoglycemia but was associated with an increase in patient sat Continue reading >>

Using U-500 Insulin

Using U-500 Insulin

What is it? Humulin R U-500 is a kind of insulin that is much stronger than the more common U-100 insulin. It is used by people with diabetes who need large doses of insulin, usually because they are “insulin resistant.” That means their bodies can't use insulin well, so they need large doses to keep their blood glucose (sugar) under control. How is it used? U-500 is 5 times more concentrated than U-100 insulin. This means that every 1 unit of U-500 is the same as 5 units of your usual insulin. This makes it a more powerful medicine. It also means that you need to be careful about giving yourself the right amount of U-500. If you are using a regular insulin syringe like the kind used for U-100 insulin, the markings each correspond to one-fifth of a U-500 unit. So, if you are taking 100 units of U-500 in an insulin syringe, you would draw insulin from the vial up to the 20 mark (100 ÷ 5 = 20). Your health care provider might want you to use a different kind of syringe, called a “tuberculin syringe.” This kind of syringe is marked in milliliters (ml). If you are taking 100 units of U-500 in a tuberculin syringe, you would draw insulin from the vial up to the 0.2-ml mark. (See chart at left.) Check your insulin before you leave the pharmacy to be sure you have the right kind. U-500 insulin comes in 20-ml vials (twice as big as U-100 insulin vials) and has orange stripes on the box and label. Make sure you are also using the correct syringes. Your health care provider will tell you whether to use the usual insulin syringes or to switch to tuberculin syringes. Don't hesitiate to ask your prescriber or pharmacist any questions you may have about U-500. It can be confusing at first to make the switch, but your health care team is there to help you. Preventing lows Ins Continue reading >>

The Use Of U-500 In Patients With Extreme Insulin Resistance

The Use Of U-500 In Patients With Extreme Insulin Resistance

The Diabetes Control and Complication Trial (1) and the U.K. Prospective Diabetes Study (2,3), as well as other smaller trials (4), have established the benefit of treating type 1 and type 2 diabetes to levels of glycemia as close to normal as possible. These studies have formed the basis for the therapeutic targets set forth in the most recent American Diabetes Association (ADA) guidelines (5). There is a subset of patients classified by the ADA as having “other specific types of diabetes”; this group represents a major therapeutic challenge in terms of achieving glycemic goals (6). These patients have more extreme forms of insulin resistance than typical type 2 diabetic patients, and many manifest various syndromic classifications (Fig. 1). Furthermore, for the purpose of this discussion, we are including patients with extreme endogenous hyperinsulinemia or hyperglycemic patients who require doses of exogenous insulin of >200 units/day or in pediatric patients doses >3 units · kg−1 · day−1. This includes a subset of obese type 2 diabetic patients. Extreme forms of insulin resistance may also occur as a temporary state with pregnancy, with endocrinopathies and under various other stress conditions such as an infection, or with exogenous steroid use (Fig. 2). The practical issue of insulin management is essentially the same for all of these various patient categories. Role of insulin therapy for insulin resistance While we have defined the more extreme forms of insulin resistance whose requirements are >200 units insulin/day, this is clearly an arbitrary definition. Currently glycemic goals for both type 2 diabetes and “the other specific types of diabetes” are generally not being met. Part of the reason for this is that patients clearly are on insufficien Continue reading >>

Humulin R (u-500) (insulin Human) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Humulin R (u-500) (insulin Human) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Concentrated Insulins with Short and Intermediate Actions Hormone secreted by pancreatic beta-cells of the islets of Langerhans; essential for the metabolism and homeostasis of carbohydrate, fat, and protein Regular insulin 100 units/mL is a "short-acting" insulin; concentrated regular insulin 500 units/mL exhibits different pharmacokinetics Used for the treatment of diabetes mellitus type 1 and type 2; also used for blood glucose management due to hyperglycemia in critical care and other care settings Injectable regular insulin is available in 2 concentrations: 100 units/mL and 500 units/mL; clinicians and patients must ensure that the correct concentration is used to avoid severe overdose and hypoglycemia Humulin R, Novolin R, ReliOn, Velosulin BR Humulin R Subcutaneous Inj Sol Conc: 1mL, 500U Humulin R/Novolin R Subcutaneous Inj Sol: 1mL, 100U For the treatment of type 1 diabetes mellitus or for type 2 diabetes mellitus inadequately managed by diet, exercise, and oral hypoglycemics. When used for intermittent subcutaneous injection, the total daily dose is given as 2 to 4 injections per day, typically administered 30 to 60 minutes before meals; or administer as a sliding scale based on blood glucose monitoring several times per day. Regular U-500 insulin has a longer duration of action (up to 24 hours) compared to regular 100 units/mL, and is usually administered 2 to 3 times per day; regular 100 units/mL is usually administered 3 or more times per day and may also be used in combination with oral antihyperglycemic agents or longer-acting insulin products. A common regimen is to give an intermediate insulin (NPH or Lente) and regular insulin concomitantly and give two injections per day. About 2/3 of the daily insulin dose is given before breakfast and about 1/3 is Continue reading >>

U-500 Insulin Errors

U-500 Insulin Errors

Humulin R is the brand name for Eli Lilly's recombinant human regular insulin. The usual version of Humulin R is U-100 and contains 100 units of insulin activity per 1 milliliter of fluid. But there's also a rarely-used version called U-500. The U-500 insulin is 5 times more potent than U-100 insulin. U-500 insulin contains 500 units of insulin activity per 1 milliliter of fluid. People may need to use U-500 if their diabetes is not well-controlled with U-100. The U-500 version should be used only for patients requiring doses above 200 units a day. Important information about U-500 insulin Since the use of U-500 insulin is not as common as the use of U-100 insulin, some health professionals may not be aware of it. This by itself increases the chance of dispensing errors. The main problem with U-500 insulin is the risk of a mix-up between the insulin U-100 and insulin U-500 versions. If this occurs, it can result in very dangerous low blood sugar or very high blood sugar. A mix-up between the two insulin concentrations may occur if doctors or pharmacists select the wrong concentration (for example, selecting the U-500 regular insulin from computer screen instead of U-100). Sometimes the two concentrations appear one line apart on the computer screen, which sets up the possibility of selection errors. Depending on the screen size, the prescriber may see only the first few words of the product listing, so the drug concentration is not seen. Prescribers may assume the patient needs U-100 and may not even look for the concentration on the screen. A mix-up may also occur if U-100 insulin and U-500 insulin are stored next to each other at the pharmacy, in the hospital or even in your home. Although the colors of the vials are different, if someone is not aware to look out for Continue reading >>

The Pharmacist's Guide To U-500 Insulin Tl;dr Pharmacy

The Pharmacist's Guide To U-500 Insulin Tl;dr Pharmacy

Family photograph of U-500 insulin (yellow) and U-100 (green) ( Image ) So.what is this dinosaur and why do we need it for managing diabetes?? Humulin R U-500 is a concentrated Regular insulin used as a basalinsulin. So instead of the typical U-100 insulin (100 units/ml), this beast is 500 units/ml5x as concentrated. In contrast, Humulin R U-100 insulin is considered a short-acting, prandialinsulin. Cant you already see the potential for mix-ups?! They're both regular insulins, but U-500 is used for basal coverage while U-100 is used for prandial coverage. Our use of concentrated insulin has increased over the past 10 years due to the high incidence of insulin resistance and obesity. The obesity rate in 2015 was 30% ! On top of this, the diabetes rate in 2015 was 9.4% (30.3 million people) and another 84 million have pre-diabetes. Insulin resistance is the hallmark characteristic for type 2 diabetes. As diabetes progresses and people with type 2 diabetes get older, insulin resistance continues to become problematic, resulting in higher insulin needs. When do you need to switch your patient to U-500 insulin? When a patient requires more than 200 units of insulin a day, moving to a concentrated insulin can improve BG control and provide more comfort with fewer injections. I'll get more into the "how to transition your patient to U-500" later in this post. Understanding the normal pancreas function helps to understand how to use injectable insulin safely and effectively. The pancreas has exocrine and endocrine functions. The exocrine functions basically help you digest food. This is the amylase and lipaseyou've heard about. These enzymes get secreted whenever you eat, and they help us break down dietary proteins and fats into something usable for the body. The endocrine f Continue reading >>

Dosing Dangers Of U-500 Insulin

Dosing Dangers Of U-500 Insulin

Many health care professionals are aware of U-500 insulin, but only a select few come in contact with it on a daily basis. U-500 is a concentrated form of regular insulin prescribed when patients require more than 200 units of insulin each day. While regular U-100 delivers 100 units of insulin in each mL of fluid, U-500 delivers 5 times this amount, or 500 units of insulin in each mL of fluid. Any health care professional can imagine the potential for dosing errors with the administration of this U-500 insulin. As pharmacists know, insulin syringes are calibrated up to 100 units in a 1-mL syringe. Currently, there are no specific syringes on the market calibrated for the U-500 insulin. As a result, the same syringes used for U-100 insulin are commonly used for U-500 dosing. Rarely is a prescription written for U-500 insulin that doesn't require clarification from a pharmacist. When physicians order 25 units of U-500 insulin, do they really mean only 25 units, which would be measured at the 5-unit calibration mark of an insulin syringe, or do they need it to be measured at the 25-unit calibration mark, which is actually 125 units? Whenever U-500 insulin is prescribed, the directions need to include not only the actual dose of insulin, but also the volume of insulin to be administered. Ideally, this order would be written to administer 125 units of U-500 insulin (0.25 mL) measured at the 25-unit calibration mark on a standard insulin syringe. Through advancements in electronic prescribing, drop-down menus, and electronic health records (EHRs), any order entered into a system stays until an authorized practitioner logs into the electronic chart and changes it. When pharmacists call to clarify a U-500 insulin prescription, they need to ensure it is also changed in the EHR Continue reading >>

Conversion Chart For Humulin R U-500 Insulin Dose

Conversion Chart For Humulin R U-500 Insulin Dose

When using a U-100 insulin syringe or a tuberculin syringe, use this handy U-500 Conversion Chart. Humulin U-500 Conversion Chart Mar 2011 Continue reading >>

Humulin R U-500 Dosage

Humulin R U-500 Dosage

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist. Prescribe HUMULIN R U-500 ONLY to patients who require more than 200 units of insulin per day. HUMULIN R U-500 is available as a KwikPen or multiple dose vial. Patients using the vial must be prescribed the U-500 insulin syringe to avoid medication errors. Instruct patients using the vial presentation to use only a U-500 insulin syringe and on how to correctly draw the prescribed dose of HUMULIN R U-500 into the U-500 insulin syringe. Confirm that the patient has understood these instructions and can correctly draw the prescribed dose of HUMULIN R U-500 with their syringe [see Dosage and Administration ( 2.4 ) and Warnings and Precautions ( 5.1 )]. Advise the patient to read the FDA-approved patient labeling ( Patient Information and Instructions for Use ). Train patients on proper use and injection technique before initiating HUMULIN R U-500. Training reduces the risk of administration errors such as needle sticks and dosing errors. Instruct patients to always check the insulin label before administration to confirm the correct insulin product is being used [see Warnings and Precautions ( 5.1 )]. Inspect HUMULIN R U-500 visually for particulate matter and discoloration. Only use HUMULIN R U-500 if the solution appears clear and colorless. Instruct patients to inject HUMULIN R U-500 subcutaneously into the thigh, upper arm, abdomen, or buttocks. Rotate injection sites within the same region from one injection to the next to reduce the risk of lipodystrophy [see Adverse Reactions ( 6 )]. DO NOT administer HUMULIN R U-500 intravenously or intramuscularly. DO NOT dilute or mix HUMULIN R U-500 with any other insulin products or solutions. Instruct patients to inje Continue reading >>

116 Diabetes Spectrum Volume 22, Number 2, 2009

116 Diabetes Spectrum Volume 22, Number 2, 2009

Pharmacy and Therapeutics U-500 Insulin: When More With Less Yields Success Elaine Cochran, MSN, CRNP, BC-ADM Syndromes of severe insulin resis- tance were first reported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in 1976,1 with either inher- ited insulin receptor abnormalities or the presence of autoantibodies to the insulin receptor. These patients were some of the first with severe insulin resistance who were treated with U-500 insulin first used clinically in 1952.2,3 Initially, patients requiring this concentrated insulin preparation were those with type 1 diabetes with high antibodies to insulin resulting from the use of animal-source insulin causing antibody formation. The introduction of sulfated insulin in the 1970s and the availability of human insulin preparations starting in the 1980s has shifted the use of U-500 insulin to patients with extreme forms of insulin resistance.1,2 With the prevalence of obesity and the growing epidemic of type 2 diabetes, the utility of U-500 insulin can be expanded from syndromic forms of insulin resistance to patients with type 2 diabetes who require > 200 units of insulin per day. However, these syndromic patients have taught us a great deal about how to admin- ister and manage U-500 insulin in patients. The American Diabetes Asso- ciation (ADA) has four standard classifications of diabetes mellitus: 1) type 1 diabetes, 2) type 2 diabetes, 3) other specific types of diabetes, and 4) gestational diabetes.4 Regardless of the cause, the four classifications have one symptom in common: hyperglycemia. Chronic hyperglyce- mia from diabetes is associated with macrovascular and microvascular complications such as heart, kidney, nerve, and eye disease. Several long- term diabetes complication trial Continue reading >>

U-500 Insulin: How Much Do You Know?

U-500 Insulin: How Much Do You Know?

In the case of significant insulin resistance (defined as needing more than 200 units per day), multiple injections of insulin are needed throughout the day to keep the blood sugar in check. There is no written rule about the maximum volume of insulin that can be absorbed by the subcutaneous tissue at one time, but many prescribers will split an insulin dose into multiple injections when dose requirements are approaching 70 units in a single administration. An insulin pen can deliver 80 units, and the largest size insulin syringe can hold 100 units. So if your insulin dose is somewhere between 60 and 100 units, you might need more than one injection to deliver all of that insulin at one time. In order to avoid becoming a human needle cushion, concentrated insulins like Humulin R U-500 were developed. What is the difference in insulin concentrations? Most of the insulins on the market today are U-100 strength, meaning there are 100 units of insulin per mL. Examples are Regular insulin, NPH, 70/30 and other mixed insulin, glargine and detemir. U-500 concentrated insulin has 5 times the potency of U-100 insulin, giving 500 units per mL. By reducing the injected volume, better absorption, less injection discomfort and decreased number of injections can be experienced. Until recently, U-500 was the only concentrated form of insulin. Since 2015, two concentrated basal insulins U-300 {Glargine (Toujeo)} and U-200 {Degludec (Tresiba)} have become available in the US. These have a strength of 300 units per mL and 200 units mL, also resulting in smaller volumes injected. Dosing conversion charts are used to safely move from a U-100 insulin to U-500 insulin. Who needs U-500 insulin? Good candidates for U500 insulin are those whose total daily insulin dose exceeds 200 units per day Continue reading >>

U-500 Insulin: Not For Ordinary Use

U-500 Insulin: Not For Ordinary Use

US Pharm. 2010;35(5)(Diabetes suppl):14-17. If not already seeing them, pharmacists should anticipate encountering prescriptions for U-500 regular insulin. U-500 insulin is five times more potent than standard U-100 and is utilized in patients requiring high doses of insulin. Prescribing of U-500 is on the rise due to the obesity epidemic, adoption of tighter glucose control protocols, increased insulin resistance, and utilization of insulin pumps.1 Potential for adverse drug events exists due to unfamiliarity with U-500 and its higher potency. This review is intended to enable safe provision of U-500 insulin by increasing awareness of the drug and its correct administration. As insulin resistance worsens, greater doses of insulin are required to meet glycemic goals. This is especially true for persons with insulin resistance (IR) syndromes. These are patients with an insulin requirement of 200 U/day and greater. FIGURE 1 illustrates the body’s response to insulin as the dose increases. Note that for patients with IR syndromes, the dose response to insulin is significantly diminished. This is especially true when insulin doses exceed 100 U. However, this phenomenon does not mean greater doses are without effect.2 In fact, higher doses of insulin eventually achieve therapeutic targets. For this reason, use of high-dose insulin should not be avoided in insulin-resistant patients. Otherwise, these patients will fail to achieve glycemic goals by underdosing insulin. Use of standard insulin becomes problematic when patients require over 200 U/day or greater than 100 U per injection. At these doses, the volume of U-100 insulin is physically too large for single subcutaneous administration, and multiple injections are required to deliver a single dose. With more injections, Continue reading >>

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