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U500 Insulin And Weight Gain

Treatment Approach To Patients With Severe Insulin Resistance

Treatment Approach To Patients With Severe Insulin Resistance

Go to: Evaluating Patients There are several known causes of severe insulin resistance, including several rare disorders and genetic conditions (Table 1) (3). Several medications are known to contribute to insulin resistance, including glucocorticoids, protease inhibitors, atypical antipsychotics, and calcineurin inhibitors. In patients with severe insulin resistance, an effort should be made to discontinue such agents or switch to alternative medications if possible (5). Poor medication-taking behaviors or “pseudoresistance” should be ruled out before modifying or intensifying therapy. Pseudoresistance may be the result of nonadherence, poor injection technique, improper insulin storage, or malingering for secondary gain. Pseudoresistance can be ruled out by conducting a modified insulin tolerance test (3). During such a test, patients are administered a witnessed dose of short-acting insulin in the clinic, and their blood glucose is monitored every 30 minutes for a period of 4–8 hours. Patients should be fasting for the test and should have a blood glucose level >150 mg/dL. A witnessed insulin dose approximately equal to what an average person with diabetes might require (insulin dose [units] = blood glucose [mg/dL] – 100 / (1,500 / weight [kg] × 1.0)] should be given. If there is not an appropriate drop in blood glucose within 4 hours, a second dose should be given. If normoglycemia or hypoglycemia is not achieved after either dose, the test confirms that a patient likely has severe insulin resistance. 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 >>

U-500 Insulin: Is It Right For You?

U-500 Insulin: Is It Right For You?

If you take insulin, chances are, you use a strength of insulin called U-100 insulin (strength is not the same thing as type). U-100 insulin is the most common strength of insulin in the US. The U-100 means that there are 100 units of insulin per milliliter of liquid. If youve traveled abroad, you may have used or seen another strength of insulin called U-40 insulin. As the name implies, this insulin has 40 units of insulin per milliliter of liquid. U-40 insulin is not used in this country. And theres yet another strength of insulin, U-500, that is used in cases of insulin resistance. Before we discuss U-500 insulin, lets back up for a moment and address the issue of insulin resistance . Its a popular term thats thrown around a lot lately, and chances are, if you have it, you know it. But in case you need a refresher, heres what it means: Insulin resistance occurs when your body makes insulin (or otherwise has enough available) but cant use it effectively. As a result, glucose levels climb higher and higher in the bloodstream simply because the insulin isnt doing its job of allowing glucose to enter cells to be used for energy. The beta cells in the pancreas struggle to keep up with the insulin demand and begin to work overtime, but eventually, they burn out and stop making enough. Theres only so much these cells can do. If someone does not yet have diabetes, but they have insulin resistance, its not hard to figure out where this leads: Type 2 diabetes . But it can also occur in people who already have diabetes. There are many factors that can lead to insulin resistance, including excess body weight, lack of physical activity, ethnicity, hormones, certain medications, smoking, and lack of sleep. Of course, its helpful to tackle the cause of insulin resistance, and heal Continue reading >>

Concentrated Insulins: The New Basal Insulins

Concentrated Insulins: The New Basal Insulins

Go to: Introduction The use of insulin is a mainstay of treatment for all individuals with type 1 diabetes mellitus (T1DM) and for many individuals with type 2 diabetes mellitus (T2DM). In T1DM, basal insulin in combination with rapid-acting mealtime insulin provides a close but imperfect substitute for endogenous physiologic insulin production. T2DM is characterized by insulin resistance and progressive beta-cell dysfunction. Obesity adds to inherent insulin resistance in T2DM and may be an independent cause of insulin resistance in T1DM. As body mass index (BMI) increases, the rate of diabetes increases, reaching >25% among morbidly obese individuals (BMI >40).1 As insulin resistance increases and insulin secretion declines, increasing doses of insulin may be required to maintain even near euglycemia. Insulin may be the desired therapy in individuals with T2DM with critical beta-cell failure with significant glucotoxicity, intolerance to or failure of oral anti-hyperglycemic therapy, or patient preference. Insulin treatment is generally initiated at weight-based doses, and individuals with high insulin resistance can require doses of insulin as high as 2 units/kg or greater. As the dose of insulin increases, the volume of insulin injected subcutaneously increases. This can result in unpredictable absorption, increased pain, discomfort, and leakage. The most commonly prescribed insulins are referred to as “U100” insulin in which 100 units of insulin are suspended or dissolved in 1 mL of liquid. The U100 basal insulins include neutral protamine Hagedorn (NPH), glargine, degludec, and detemir, as well as short-acting human regular insulin and short-acting insulin analogs (such as lispro, aspart, and glulisine). Only Humulin-R U500 (U-500R) has provided basal insulin Continue reading >>

Humulin R

Humulin R

Humulin R (insulin (human recombinant)) is a hormone that is produced in the body used to treat diabetes. Common side effects of Humulin R include: injection site reactions (e.g., pain, redness, irritation). Low blood sugar (hypoglycemia) is the most common side effect of Humulin R. Symptoms of low blood sugar include headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Tell your doctor if you have serious side effects of Humulin R including: signs of low potassium level in the blood (such as muscle cramps, weakness, irregular heartbeat). Each patient's diabetes is different, and the injection schedule and use of Humulin R is individualized. A doctor determines which insulin to use, how much, and when and how often to inject it. Humulin R may interact with albuterol, clonidine, reserpine, guanethidine, or beta-blockers. Tell your doctor all medications you are taking. Tell your doctor if you are pregnant before using Humulin R. If you are planning pregnancy, discuss a plan for managing your blood sugars with your doctor before you become pregnant. Your doctor may switch the type of insulin you use during pregnancy. This medication does not pass into breast milk. Consult your doctor before breastfeeding. Insulin needs may change while breastfeeding. Our Humulin R (insulin (human recombinant)) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Continue reading >>

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 >>

Helping Type 2 Hubby With Weight Loss, Diet, And Insulin Levels Using Pump

Helping Type 2 Hubby With Weight Loss, Diet, And Insulin Levels Using Pump

Helping Type 2 Hubby with weight loss, diet, and insulin levels using pump New Member My husband has type 2 and is on the pump. Helping Type 2 Hubby with weight loss, diet, and insulin levels using pump My husband has been trying for years to lose weight, was injecting 240+ Units of insulin a day (up to 8 injections daily) and was steadily gaining weight. (He has so much back pain that exercise has been pretty much out of the question.) At around 215 pounds, (he's 5' 5.5") he started using an insulin pump with U-500 insulin and we also started on a low carb diet with him eating around 2 carbs a meal of mostly fat and protein. Within a few weeks he lost around 18 pounds and then reached a standstill. We then switched to a low carb diet (without the fat) and around 10 carbs a meal consisting mostly of broccoli, cauliflower, chicken and a few slices of sauteed mushrooms. He has this twice a day with a salad in between and now he's losing around a pound a day and has more energy than before. One thing interesting is that I'm finding out that I have to lower his overnight basal rate 5% every other night and he's still waking up with blood sugars in the 50's and 60's. Apparently, as he loses weight, both his Insulin Sensitivity and I:C ratios are changing as well as his basal needs. He's only been on the pump three months and we both feel that the big factor in his weight loss has mainly been because of the pump giving the small basal injections every 3 minutes around the clock. Because of this, his insulin amounts have been reduced to about one-third of the amount of what he was taking before with the MDIs. 1. Would you say that the reduction in insulin would account for his weight loss? 2. When he reaches another plateau, will it help to jump start his system if he switche Continue reading >>

Counseling Patients On How To Avoid Weight Gain From Insulin

Counseling Patients On How To Avoid Weight Gain From Insulin

A lot of people with type 2 diabetes delay going on insulin for as long as possible because they’ve heard horror stories about how much weight it can make them gain (or maybe they just don’t like shots), but people with type 1 don’t have a choice. While it is true that insulin treatment is often associated with weight gain and more frequent bouts of hypoglycemia (low blood sugar), the real question is, why? Some theories to explain insulin-induced weight gain are that when using insulin, your blood sugar is (usually) better controlled and you stop losing some of your calories (as glucose in your urine when your blood sugars exceed your urinary threshold) and that you may gain weight from having to eat extra to treat any low blood sugars caused by insulin. If you’re taking oral medications to lower your blood sugar and they are not working, however, insulin may be your main option for better control. A few research studies have looked at whether weight gain is simply a result of eating more when you’re on insulin. One such study found that weight gain was not due to an increase in food intake, but rather that your body may increase its efficiency in using glucose and other fuels when your glycemic control improves — making you store more available energy from the foods you eat as fat (even if you’re eating the same amount as before you went on insulin) (1). So, what can you do to avoid weight gain if you have to take insulin? First of all, you should try to keep your insulin doses as low as possible because the more insulin you take, the greater your potential for weight gain is. The best way to keep your insulin needs in check is to engage in regular physical activity. By way of example, some people with type 2 diabetes who were studied gained weight from Continue reading >>

Humulin R U-500

Humulin R U-500

Generic Name: insulin human Dosage Form: injection, solution Indications and Usage for Humulin R U-500 HUMULIN R U-500 is a concentrated human insulin indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus requiring more than 200 units of insulin per day. Limitation of Use The safety and efficacy of HUMULIN R U-500 used in combination with other insulins has not been determined. The safety and efficacy of HUMULIN R U-500 delivered by continuous subcutaneous infusion has not been determined. Humulin R U-500 Dosage and Administration Important Administration Instructions 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 Continue reading >>

Learning From Practice

Learning From Practice

Clinical use of Humulin R U-500 insulin in the UK: results of the first Association of British Clinical Diabetologists’ U-500 audit UMESH DASHORA,1 ANDREW MACKLIN,2 BOB RYDER,3 ERWIN CASTRO,1 ABCD NATIONWIDE U-500 AUDIT CONTRIBUTORS4 Abstract Human soluble insulin Humulin R U-500 has been in use worldwide for marked insulin resistance but is not specifi- cally licensed in the UK. The Association of British Clinical Diabetologists conducted a nationwide audit of Humulin R U-500 to understand its use in the UK. The results show that 67 out of 119 clinicians who responded to the survey are using U-500R. The commonest indication for using it was a high daily insulin dose. These results are the first glimpse of the practical usage of high strength insulin in the UK and may help our approach to patients with high insulin resist- ance and the use of newly available higher concentration insulins. Br J Diabetes 2016;16:185-187 Key words: U-500, insulin, type 2 diabetes, weight, hypoglycaemia, ABCD Introduction HumulinTM R regular U-500 (U-500) has been in use worldwide for many years and is generally used in patients with high insulin resist- ance to reduce the volume and number of injections. There are no data on its use in the UK, where it is not currently licensed for use. The activity profile for U-500 is shorter in onset, with a delayed but prolonged peak and extended duration compared with human soluble insulin U-100 (U-100).1,2 Efficacy studies of U-500 have already been published.3,4 In a retrospective database analy- sis, U-500 was found to be more economical in pharmacy and overall cost and compliance but with a slightly higher rate of hy- poglycaemia compared with U-100.5 Variability in absorption from day to day and from different parts of the body appears to Continue reading >>

Important Safety Information For Humulin R U-500

Important Safety Information For Humulin R U-500

If you have liver, kidney, or heart problems or any other medical conditions. If you are pregnant, plan to become pregnant, or are breast-feeding. About all the medicines you take, including prescription (especially ones commonly called TZDs [thiazolidinediones]) and over the counter medicines, vitamins, and herbal supplements. Before you start using Humulin R U-500, talk to your healthcare provider about low blood sugar and how to manage it. Read the detailed Instructions for Use that come with your Humulin R U-500. Take Humulin R U-500 exactly as your healthcare provider tells you to. Your healthcare provider should show you how much Humulin R U-500 to use and when to use it. Know the dose of Humulin R U-500 you use. Do not change your dose unless your healthcare provider tells you to. Check your insulin label each time you give your injection to make sure you are using the correct insulin. Humulin R U-500 KwikPen: The U-500 KwikPen is specially made to dial and deliver doses of Humulin R U-500 insulin. Do not use any syringe to remove Humulin R U-500 insulin from your U-500 KwikPen. The markings on certain syringes will not measure your dose correctly. A severe overdose can happen, causing low blood sugar, which may put your life in danger. Humulin R U-500 vial: There is a special U-500 insulin syringe to measure Humulin R U-500. Use only a U-500 insulin syringe to draw up and inject your Humulin R U-500. If you do not use the right syringe type, you may take the wrong dose of Humulin R U-500. This can cause you to have too low blood sugar (hypoglycemia) or too high blood sugar (hyperglycemia). Your healthcare provider should show you how to draw up Humulin R U-500. Use Humulin R U-500 30 minutes before eating a meal. Inject Humulin R U-500 under your skin (subcutan 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 (concentrated) (u-500)

Humulin R (concentrated) (u-500)

Insulin is a hormone that works by lowering levels of glucose (sugar) in the blood. Concentrated (U-500) insulin is a long-acting insulin that starts to work several hours after injection and keeps working evenly for 24 hours. U-500 insulin is five times more concentrated than regular U-100 insulin. U-500 insulin is used to improve blood sugar control in adults and children with diabetes mellitus who have significant daily insulin needs (more than 200 units per day). U-500 insulin may also be used for purposes not listed in this medication guide. It's In The Genes - Record Your Family Health History Never share an injection pen, cartridge, or syringe with another person, even if the needle has been changed. You should not use this medicine if you are allergic to insulin, or if you are having an episode of hypoglycemia ( low blood sugar ). To make sure U-500 insulin is safe for you, tell your doctor if you have: low levels of potassium in your blood ( hypokalemia ). Tell your doctor if you also take pioglitazone or rosiglitazone (sometimes contained in combinations with glimepiride or metformin ). Taking certain oral diabetes medicines while you are using insulin may increase your risk of serious heart problems. Follow your doctor's instructions about using insulin if you are pregnant or breast-feeding a baby. Blood sugar control is very important during pregnancy, and your dose needs may be different during each trimester of pregnancy. Your dose needs may also be different while you are breast-feeding. U-500 insulin is concentrated and contains 500 units of insulin in each milliliter (mL). This is five times more concentrated than regular U-100 insulin, which contains 100 units per mL. Measure each dose of U-500 insulin carefully. Using too much insulin can lead to ins Continue reading >>

Humulin R U-500 (concentrated) Side Effects

Humulin R U-500 (concentrated) Side Effects

Applies to insulin regular: injectable solution, subcutaneous solution Frequency not reported: Transitory, reversible ophthalmologic refraction disorder, worsening diabetic neuropathy[ Ref ] Transitory, reversible ophthalmologic refraction disorder and worsening of diabetic retinopathy has been reported with insulin initiation and glucose control intensification. Over the long-term, improved glycemic control decreases the risk for diabetic neuropathy.[ Ref ] Uncommon (0.1% to 1%): Lipodystrophy[ Ref ] Long-term use of insulin can cause lipodystrophy at the site of repeated insulin injections. Lipodystrophy includes lipohypertrophy (thickening of adipose tissue) and lipoatrophy (thinning of adipose tissues).[ Ref ] Uncommon (0.1% to 1%): Local reactions such as redness, swelling, or itching at the injection site Very rare (less than 0.01%): Anaphylactic reactions[ Ref ] Hypersensitivity reactions have included both local and systemic reactions. Anaphylaxis has been reported. Local reactions have presented as erythema , local edema , and pruritus at the injection site. Most minor reactions to insulin at the injection site resolve in a few days to a few weeks. In some instances these reactions have been caused by other factors such as irritants in a skin cleansing agent or poor injection technique. Localized reactions have been reported with metacresol, which is an excipient in many insulin products. Generalized allergy to insulin may present as a whole body rash, dyspnea , wheezing , hypotension , tachycardia , or diaphoresis.[ Ref ] Increases in titers of anti-insulin antibodies that react with human insulin have been observed; some data indicates the increase is transient. The clinical significance of these antibodies is unknown; it does not appear to cause deteriorati Continue reading >>

How To Avoid Insulin-related Weight Gain

How To Avoid Insulin-related Weight Gain

Managing diabetes sometimes requires insulin treatment, which may lead to weight gain. Find out why and learn how to manage your weight while using insulin. When diet, exercise, and oral diabetes medications aren't enough to control diabetes, adding insulin can help get your blood sugar under control. Although insulin is an important part of diabetes treatment, some people may have an issue with weight gain after starting on it. If insulin has been prescribed as part of your treatment plan, you may need to pay extra attention to your weight management efforts in addition to blood sugar management. "Insulin weight gain is a well-known problem and concern for people with type 2 diabetes," says Amber L. Taylor, MD, an endocrinologist who directs the Diabetes Center at Mercy Medical Center in Baltimore. "This is problematic because weight gain can make managing diabetes more difficult." Why Is Weight Gain an Insulin Side Effect? A study published in the journal Clinical Medicine Insights: Endocrinology and Diabetes focused on 102 people with type 2 diabetes who had recently started taking insulin. After the first year of insulin therapy, both men and women in the study had increased their body weight by about 2.5 percent. The science behind why this happens is clear. When you’re not managing diabetes well, your body can't use the glucose (sugar) from your food for energy. That means the sugar builds up in your blood, which can lead to diabetes complications. You may feel hungry because you’re not getting enough energy, and thirsty because your body is trying to flush all that sugar out of your bloodstream. Here’s what happens when you add insulin: Insulin helps the sugar in your blood to be absorbed by your cells, where it's used and stored for energy. Because you’r Continue reading >>

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