Pharm

Humulin R U-500

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Humulin R U-500

  • Indications
  1. Diabetes Mellitus with very high Insulin Resistance
    1. Indicated for those with very high Insulin requirements (>200 units per day)
  • Mechanism
  1. See Insulin
  2. Humulin R U-500 is a Regular Insulin that is at 5-fold higher concentration than typical Regular Insulin
  3. At this very high concentration, Humulin R U-500 has Pharmacokinetics that are more like Basal insulin
    1. Despite being Regular Insulin, U-500 acts more like NPH or Insulin 70/30
  • Medications
  1. Humulin R U-500 (500 units/ml, green)
    1. Caution: This is 5-fold higher than standard Regular Insulin (U-100, at 100 units/ml)
    2. High risk for dosing errors (very concentrated Insulin)
      1. Specific U-500 green capped syringes are available as of 2016 to reduce dosing errors
      2. Pens are preferred for less dosing errors over vials and syringes
        1. Use pen dosing window (not the number of clicks to determine dose)
        2. Each click of a U-500 pen adds 5 units of Insulin (contrast with 1 unit/click with U-100)
  • Dosing
  1. See Insulin Dosing
  2. See Insulin Dosing in Type I Diabetes
  3. See Insulin Dosing in Type II Diabetes
  4. Divide dosing twice (60 and 40%) to three times (e.g. 40, 30 and 30%) daily
  5. Do not combine with other Insulins (i.e. stop basal and mealtime Bolus Insulins)
    1. Use in similar fashion to 70/30 Insulin
  • Pharmacokinetics
  1. Activity is similar to Insulin 70/30
  2. Onset: 30 minutes
  3. Duration: >12 hours
    1. Far longer duration than other Bolus Insulins (more like NPH Basal insulin)
  • References
  1. (2022) Presc Lett 29(3): 14