Concentrated U-500 Insulin

Cayla Kass
What is U-500 Insulin?

5 TIMES THE CONCENTRATION OF U-

100 INSULIN

500 UNITS/ML VS 100 UNITS/ML

Who should • T2DM

use U-500
• Typically obese patients
• High Insulin Resistance
Insulin? • Doses > 200 units/day
Pharmacokinetic Profile

More similar to NPH Similar peak plasma

than to regular concentration as
insulin regular U-100

Longer duration of Basal and bolus

action than U-100 coverage
(up to 24 hours)

Onset: 30 minutes – 1 hour

Peak: ~ 4 hours
Dosing
Patient Advantages

Lower volume injections

Basal and bolus coverage

• Patients only need one type of insulin

Cost

• More cost-effective per unit

• Again, only one type of insulin
 • Increased risk of hypoglycemia

• Especially if patients are switching from U-100

• Can start more conservative dosing and titrate up based
on response
Safety
• Prescribers clearly notate dose and strength when
writing prescription

• Patient education
Syringes
Formulations

• Kwikpen
• Vial
 • Same as insulin
• Kwikpens work the same way
• Ensure correct dose
• Watch for signs and symptoms of hypoglycemia
• Shaky
• Sweaty

Counseling • Dizzy
• Confusion
Points • Hypoglycemia treatment
• 15 grams of carbs and recheck in 15 minutes
(until BG > 70 mg/dL)
• ½ cup of juice or non-diet soda
• Glucose tablets
• 1 tablespoon of sugar, honey, or corn
syrup
Questions?
References

• Valentine V. Don’t Resist Using U-500 Insulin and Pramlintide for Severe Insulin Resistance. Clinical Diabetes.
2012;30(2):80-84. doi:10.2337/diaclin.30.2.80
• DC_44_S1_final_copyright_stamped.pdf. Accessed January 25, 2021.
https://care.diabetesjournals.org/content/diacare/suppl/2020/12/09/44.Supplement_1.DC1/DC_44_S1_final_copyright_
stamped.pdf
• General principles of insulin therapy in diabetes mellitus - UpToDate. Accessed January 25, 2021.
https://www-uptodate-com.proxy.lib.ohio-state.edu/contents/general-principles-of-insulin-therapy-in-diabetes-mellitus?
search=u500%20insulin&source=search_result&selectedTitle=3~87&usage_type=default&display_rank=1
• Humulin Devices: U-500 KwikPen® & U-500 Vial and BDTM U-500 Insulin Syringe | Humulin R U-500. Accessed January 25,
2021. https://www.humulin.com/what-is-humulin/devices
• Hypoglycemia (Low Blood Glucose) | ADA. Accessed January 25, 2021.
https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia