Contributors: Ashley Butts and Saywon Flah, PharmD students at Philadelphia College of Osteopathic Medicine Georgia School of Pharmacy
CR, a 62-year-old male with a 20-year history of type 2 diabetes, is frustrated that he is taking over 200 total units of insulin daily and four injections each day. He feels like the insulin is not being absorbed or working while enduring his frustration of feeling like a pen cushion. His best friend, David, recently told him about a concentrated insulin, Humulin R U-500, which he started utilizing a few weeks ago. David says he injects with less frequency and less volume with each injection. CG has an upcoming appointment with his medical provider and he made a note to inquire about it. In the meanwhile, he does a Google search to learn more about it.
So what is Humulin R U-500? Humulin R U-500 is 5 times more concentrated than the standard U-100 insulin. It is often selected for persons with diabetes who are insulin-resistant and require more than 200 units daily. It is typically injected two to three times daily 30 minutes before a meal.
So, does this change require the individual to recalculate insulin dose when being switched from U-100 to U-500 as the math can get tricky? Well, it all depends. U-500 pen (officially, the Kwikpen) requires no dosage changes. However, the vial and syringe method can be trickier as U-500 and U-100 insulin syringes are available. Use of U-100 syringes with U-500 insulin vial requires dose conversion as every unit of U-500 insulin contains 5 units of insulin so divide the U-500 dose by 5 to obtain units to draw up on U-100 syringe. Fortunately, a U-500 syringe is available from BD which simplifies things as no dose conversion is required.
How much insulin is in U-500 pen and vial? The pen contains 1500 units of insulin. Each click of the pen delivers 5 units of insulin, and pen can deliver 5 – 300 units with each injection. The 20 mL vial contains 10,000 units of insulin with each line indicating 5 units and allowing for 5 – 250 units with each injection.
What is the cost? Cost varies depending on insurance coverage. A good place to start is the drug formulary (list of preferred medications by tiers; higher the tier the more $$$) as this can give a ballpark of the cost. Also, checking for copay cards and additional resources to help offset the cost of the U-500 is possible by visiting https://www.lillycares.com/.
Back to CR, after researching U-500 insulin, he decides to discuss this as an alternative to his current insulin regimen with his medical provider. He is interested in the U-500 pen as he can carry it in this pocket and only inject a couple times of day for less expensive copay each month than his current insulin copay total.
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