A Practical Guide to Concentrated Insulin for Pharmacists

Abstract

Concentrated insulin works in the same mechanism as U-100 insulin formulations for treating type 1 and type 2 diabetes. Pharmacists are knowledgeable about managing the disease and can identify patients who will benefit with treatment of concentrated insulin. They can provide recommendations to prevent and resolve situations, such as dosing errors, which arise in patients on concentrated insulin and can educate patients and health care professionals on dosing conversions and titration.

Challenges With Insulin in the Inpatient Setting

“…When obtaining information about patients’ preadmission insulin regimen, it is strongly suggested to confirm both the dose in units and the volume (e.g., insulin glargine 20 units equals 0.2 mL) (4,9). Unlike the U-100 forms of insulin, the concentrated formulations do not correspond to the dose markings on a regular U-100 insulin syringe.…”

“…The list should also be compared to medications already ordered for the patient to identify and resolve discrepancies. Several factors such as infection, concomitant medications known to increase blood glucose, and stressors also should be taken into consideration because they may warrant additional insulin to control hyperglycemia (4). Management strategies will be discussed later in this article.…”

“…The purpose, dosage, administration times, and frequency of each medication should be reviewed with patients (4). The following topics also should be reviewed with patients: 1 ) the HCP who is responsible for diabetes management after discharge; 2 ) patients’ level of understanding related to the diabetes diagnosis, self-monitoring of blood glucose, and home blood glucose goals; 3 ) the definition, recognition, treatment, and prevention of hypoglycemia and hyperglycemia; 4 ) patients’ nutrition and diet habits; 5 ) when and how to administer insulin; 6 ) sick-day management; and 7 ) the proper use and disposal of needles and syringes (3,17).…”

“…The most common concentration ordered to control blood glucose, regardless of its pharmacokinetic profile, is U-100 (100 units/mL) (4). Dosing of U-100 generally ranges from 0.2 to 1 units/kg/day, with some patients requiring ≥3 units/kg/day.…”

Response to Letter to the Editor

“…As described in our review, directions regarding the use of U-500 insulin should include units and volume, regardless of the syringe being used. 1 As the letter indicates, regular U-100 syringes can be used safely in patients administering U-500 insulin, with adequate education by a certified diabetes educator, pharmacist, or other specialized health care professional. As stated in the letter and our review, the patient must be able to describe the insulin dose in units and in volume for the syringe of use.…”