Related Experiment Video
Updated: Jun 25, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
High-dose insulin therapy: is it time for U-500 insulin?
Wendy S Lane1, Elaine K Cochran, Jeffrey A Jackson
1Mountain Diabetes and Endocrine Center, Asheville, North Carolina 2880, USA. mountaindiabetes@msn.com
Summary
U-500 regular insulin is effective for patients with severe insulin resistance requiring high insulin doses. Switching to U-500 can improve glycemic control and reduce costs for carefully selected individuals.
Area of Science:
- Endocrinology
- Pharmacology
- Metabolic Disorders
Background:
- The rising prevalence of obesity contributes to increased type 2 diabetes and higher insulin demands.
- Patients with severe insulin resistance often require daily insulin doses exceeding 200 units.
- Administering large insulin volumes with standard U-100 insulin can be challenging and inconvenient.
Purpose of the Study:
- To review the action and clinical studies of U-500 regular insulin.
- To provide guidance for endocrinologists on identifying suitable candidates for U-500 regular insulin therapy.
- To discuss the implementation and management of U-500 regular insulin.
Main Methods:
- Literature search of published studies on U-500, insulin resistance, and diabetes management (1969-2008).
- Synthesis of relevant literature and authors' clinical experience.
- Development of a treatment algorithm for U-500 regular insulin implementation.
Main Results:
- U-500 regular insulin offers a viable solution for delivering high insulin volumes in insulin-resistant patients.
- Multiple daily injections or continuous subcutaneous insulin infusion with U-500 are effective delivery methods.
- A treatment algorithm is presented for managing patients requiring 150 to over 600 units of insulin daily.
Conclusions:
- Conversion to U-500 regular insulin therapy can lead to better glycemic control for appropriately selected patients.
- Switching from high-dose U-100 insulin to U-500 regular insulin may result in cost savings.
- Careful patient selection and regimen conversion are key to successful U-500 therapy.
More Related Videos
Related Concept Videos
01:16Insulin: Dosing Regimen and Adverse Effects
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:27Insulin Formulations: Types and Delivery
Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into rapid-acting...
Short-acting insulins are divided into rapid-acting...
01:30Production of Pharmaceuticals
Industrial insulin production uses genetically engineered E. coli expressing a proinsulin gene controlled by a tryptophan promoter and containing a methionine linker for later cleavage. The cells also carry ampicillin resistance for selective growth. Seed cultures are stored at −80 °C and production begins by thawing a small amount to inoculate starter cultures, which are progressively scaled to a 50,000-L bioreactor. In the bioreactor, E. coli grow in nutrient-rich media under sterile, tightly...
01:25Insulin: Biosynthesis, Chemistry, and Preparation
The endoplasmic reticulum (ER) of pancreatic β-cells synthesizes preproinsulin, which consists of a signal peptide, A and B chains, and a C-peptide. Preproinsulin is then cleaved and folded into proinsulin, which translocates to the Golgi apparatus for sorting and packaging into secretory granules. In these granules, enzymatic clipping generates insulin and C-peptide.
Damage or functional impairment of β-cells inhibits insulin production, leading to diabetes. Diabetes treatment primarily uses...
Damage or functional impairment of β-cells inhibits insulin production, leading to diabetes. Diabetes treatment primarily uses...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
01:15Hypoglycemia and Glucagon
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...