title: U-500 insulin: why, when and how to use in clinical practice.
abstract: Some patients with type 2 diabetes mellitus (T2DM) have severe insulin resistance. Their insulin requirements are significantly greater. These patients need to take 2-3 injections at the same time to take the correct insulin dose or to redial the insulin pen. When daily insulin requirements are in excess of 300 units/day, the volume of the injected insulin becomes an issue. Large-volume injection can cause discomfort and lead to poor concordance with treatment. Using high-strength insulin e.g. U-500 insulin can reduce the volume of the injected insulin. Despite publications of small case reports or case series, no universal guidelines exist on the use of U-500 insulin. We discuss common sense approaches when considering the use of U-500 insulin in clinical practice.
authors.affiliation: Department of Diabetes and Endocrinology, Institution of Origin, Leicester Royal Infirmary, Infirmary Squire, Leicester, UK. ranjnagarg@yahoo.com
authors.forename: R
authors.initials: R
authors.lastname: Garg
authors.forename: V
authors.initials: V
authors.lastname: Johnston
authors.forename: P G
authors.initials: PG
authors.lastname: McNally
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.forename: I G
authors.initials: IG
authors.lastname: Lawrence
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016527:Drug Costs; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007267:Injections; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011364:Professional Practice; D018570:Risk Assessment
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin