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. U-500 vials have been discontinued in the U.S. in 2026, and are replaced by U-500 Pens
        1. Each 20 ml vial of U-500 contains 10,000 units and expires 40 days after opening
        2. Each carton of U-500 pens contains 3000 units (one third of a vial)
      3. 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)
        3. Each KwikPen lasts expires after 28 days
  • 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