Practice Tips and Tools for the Successful Use of U-500 Regular Human Insulin

Cochran, Elaine; Valentine, Virginia; Samaan, Karen; Corey, Ilene B.; Jackson, Jeffrey A.

doi:10.1177/0145721713508822

Cited by 23 publications

(34 citation statements)

References 42 publications

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“…In contrast, patients can initiate once‐daily IGlar300 insulin on a unit‐for‐unit basis if switching from a once‐daily U100 long‐ or intermediate‐acting insulin, or at 80% of their previous dose if switching from twice‐daily NPH insulin . After patients have transitioned from U100 insulin to U500R or IGlarU300, their insulin doses generally increase over time …”

Section: Insulin Concentrations Beyond U100mentioning

confidence: 99%

Concentrated insulins: History and critical reappraisal

Heinemann¹,

Beals

Malone

et al. 2018

Journal of Diabetes

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The earliest marketed insulins were crude acidic formulations with concentrations of ≤10 units/mL. Since the early 1920s, insulins have improved continually, via bioengineering, process, and chemical modifications. Today, most insulin formulations have a concentration of 100 units/mL (U100). However, more concentrated insulin formulations (200, 300, and 500 units/mL; U200, U300, and U500, respectively) are also available. There is a tendency to assume that concentrated insulins are similar, both to each other and to their U100 counterparts, but this is not always the case: two concentrated insulins, namely insulin degludec U200 and insulin lispro U200, are bioequivalent to their U100 counterparts, whereas regular human insulin U500 and insulin glargine U300 are not. The advent of these concentrated insulins offers greater opportunities to provide tailored therapy for patients; it also introduces potential confusion, and highlights the need for prescriber and patient education. Precise and accurate dedicated insulin delivery devices are also necessary for the safe use of these concentrated insulins. Although some clinicians only use concentrated insulin with obese and severely insulin‐resistant patients, other patients would also benefit from the reduced injection volume associated with concentrated insulins, or the modified time‐action profile of some concentrated insulins. The aim of this review is to enhance understanding of the historic development and the safe and effective use of concentrated insulins in clinical practice.

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Section: Insulin Concentrations Beyond U100mentioning

confidence: 99%

Concentrated insulins: History and critical reappraisal

Heinemann¹,

Beals

Malone

et al. 2018

Journal of Diabetes

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“…Prior to the U-500R titration-to-target trial, 1 clinicians had only their own clinical experience and largely retrospective, nonrandomized case reports/series, 25-29 real-world evidence studies, 30-32 and clinical reviews 3-5,33-37 to inform U-500R use. Treatment approaches varied among clinicians and experts, with some initiating U-500R with 1-to-1 total daily dose (TDD) transition (U-100 insulins to U-500R) evenly split over multiple daily doses (BID, TID, or 4-times-daily [QID]).…”

Section: Prior U-500r Dosing Recommendationsmentioning

confidence: 99%

“…Complex insulin regimens (up to 10 injections per day) 1 can increase patient burden and decrease adherence of all prescribed daily doses. 2,3,30,31 When switching to U-500R, if the prescriber neglects to determine the true home doses being administered and a much higher initial U-500R dose is prescribed, the patient is at an increased risk for hypoglycemia in the early transition period.…”

Section: Learnings From the U-500r Titration-to-target Rct Applied Tomentioning

confidence: 99%

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Translating U-500R Randomized Clinical Trial Evidence to the Practice Setting: A Diabetes Educator/Expert Prescriber Team Approach

et al. 2017

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PurposeThe purpose of this article is to provide recommendations to the diabetes educator/expert prescriber team for the use of human regular U-500 insulin (U-500R) in patients with severely insulin-resistant type 2 diabetes, including its initiation and titration, by utilizing dosing charts and teaching materials translated from a recent U-500R clinical trial.ConclusionsClinically relevant recommendations and teaching materials for the optimal use and management of U-500R in clinical practice are provided based on the efficacy and safety results of and lessons learned from the U-500R clinical trial by Hood et al, current standards of practice, and the authors’ clinical expertise. This trial was the first robustly powered, randomized, titration-to-target trial to compare twice-daily and three-times-daily U-500R dosing regimens. Modifications were made to the initiation and titration dosing algorithms used in this trial to simplify dosing strategies for the clinical setting and align with current glycemic targets recommended by the American Diabetes Association. Leveraging the expertise, resources, and patient interactions of the diabetes educator who can provide diabetes self-management education and support in collaboration with the multidisciplinary diabetes team is strongly recommended to ensure patients treated with U-500R receive the timely and comprehensive care required to safely and effectively use this highly concentrated insulin.

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“…Candidates for U-500 insulin are knowledgeable with the injection technique since most, if not all, will be converted from U-100 to U-500 insulin.The initial doses of insulin U-500 are derived from the total daily dose of U-100 insulin whether the patient is on basal/bolus regimen or mixed insulin.For patients whose A1C is ≤8%, total insulin dose may be reduced by 10% to 20%; dose-for-dose conversion is suggested for patients with A1C 8% to 10%; A1C ≥10%, 10% to 20% dose increase is warranted 9. A 10% dose decrease may be warranted if the patient has a history of frequent hypoglycemic events with U-100 insulin, followed by dose titration.…”

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confidence: 99%

Practical Pearls for the Management of Patients on U-500 Regular Human Insulin

Collier¹

2015

AADE in Practice

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Practice Tips and Tools for the Successful Use of U-500 Regular Human Insulin

Cited by 23 publications

References 42 publications

Concentrated insulins: History and critical reappraisal

Concentrated insulins: History and critical reappraisal

Translating U-500R Randomized Clinical Trial Evidence to the Practice Setting: A Diabetes Educator/Expert Prescriber Team Approach

Practical Pearls for the Management of Patients on U-500 Regular Human Insulin

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