Insulin Special Edition, July 2014

For many years insulin has been looked at as a treatment of last resort for patients with type 2 diabetes and so patients can be highly resistant to exogenous insulin when they start on injections and this resistance often grows as they continue to gain weight with the added insulin. Many of our patients are required to ramp up their doses very quickly and it is not unusual to see them using 200-300 or more units of insulin a day. 

Since these type 2 patients are usually taking a basal as well as a bolus insulin with meals they often have to give themselves 4 or more shots a day just to cover their glucose. In addition, these doses are often large and can alter the absorption of the insulin and affect the release times leading to unpredictability and the increased risk of hypoglycemia.

In order to address these issues, the use of Humulin R U-500 insulin been increasing. This regular insulin is 5 times as strong U-100 and surprisingly has a pharmacological profile that does not behave in the same way as U-100. For many the use of U-500 is not a comfortable or well known process and so often times patients don’t get to take advantage of this therapy for their highly insulin resistant diabetes.

Because of this increased interest in the use of U-500 insulin we’ve prepared thisa newsletter in order to help you feel comfortable using this product with your patients. We start off with three items that hopefully will start you on the right path to understanding the use of Humulin R U-500 with your patients. Our first item is a primer on U-500 with some valuable links from the ADA. Our second item is a form that you can use to convert your patients from U100 to U500 when working with carb ratios, correction factors and sliding scale dosing. Our third article is a primer to help you calculate new dosing levels, total insulin to write the new prescriptions for, and how to calculate the days supply.

We’ve also included our new Comprehensive List of Insulins which includes all the insulins currently available so that you can have this detailed information at your fingertips.