The Benefit of Concentrated Insulins in Diabetes Care

FEBRUARY 22, 2018
MD Magazine Staff

Serge Jabbour, MD: When we use concentrated insulins, we have a few advantages. One is that you get less volume when you inject the insulin. When you have less volume in the soft tissue, the absorption can splatter. So that’s 1. Number 2 depends on which concentrated insulin we’re talking about. I’ll give one example for it. There’s an insulin that is called degludec. That’s a basal insulin. It comes in U-100 and U-200. With U-100, you cannot inject more than 80 units at once using the pen. If patients are on 100 units a day, they need to inject it twice. But if they use the U-200 degludec, they can inject up to 160 units per 1 injection. So then there are fewer injections, and there is better compliance.

Third, when we use a concentrated insulin called U-500, for example, that’s when we switch patients from U-100. Typically, these patients are on 4 shots a day of basal mealtime at a dose of more than 200 units per day. Again, compliance is a big factor here. When we switch them, we use 2 to 3 injections a day of U-500. With the U-500 pen, they can dial it up to 300 units for 1 injection. So not only is the volume smaller, but the absorption is better and compliance is much better and patients can also save on co-pays. When they go from 2 different insulins to 1 insulin like U-500, it’s 1 co-pay versus 2 co-pays.

Davida F. Kruger, MSN, APN-BC, BC-ADM: It’s a really exciting time in terms of diabetes. It’s never a good time to have diabetes, but it’s a very exciting time in terms of the availability of newer insulins and the concentrations we have available. We have U-200 insulins, we have U-300 insulins, and then we have, which is not new, U-500 insulin. Let me talk first about U-200 and U-300. How are those different from U-100 insulin?

They’re actually not. We call them concentrated insulins, but it’s all about the volume. If you’re dosing a patient on a U-200 or a U-300 insulin, you’re going to tell them that they take the same amount of insulin as a U-100 insulin. The difference for the patient is the volume under the skin. For instance, a U-200 insulin is going to give you 50% less volume under the skin than the U-100 insulin. And U-300 is going to give you a third less volume under the skin than a U-100 insulin. Now, they don’t act any differently; it’s just all about volume. Even though we call them concentrated, remember, it’s all about volume.

U-500 is in its own class. It’s been around for a while. We use that for insulin-resistant patients. It works in a fun way because it’s both basal and bolus. And yes, it is concentrated, but it’s concentrated to give to those patients who need larger doses of insulin who are really insulin resistant. It’s a nice insulin that covers them both in the basal mode and in the bolus mode.
 
Transcript edited for clarity.

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