title: A primer on concentrated insulins: what an internist should know.
abstract: The common insulin concentration in most preparations of insulin is 100 units per mL or U-100. Human regular U-500 insulin was the first concentrated insulin introduced and it has been available in the United States since the 1950s. Humulin R is the only human regular U-500 available on the market. Human regular U-500 is five times more concentrated than U-100 and because of its pharmacodynamic properties, works as both a basal and a bolus insulin. Human regular U500 allows for delivery of a larger insulin dose with a smaller volume leading to better absorption compared to U-100 and has traditionally been used in patients with moderate to severe insulin resistance. More recently other forms of concentrated insulin have become available and the newer concentrated insulin preparations can be used in diabetic patients with or without insulin resistance. Our intent is to provide primary care physicians with a review of the pharmacology and current literature on concentrated insulins as well as recommendations for patient selection, dose initiation, and dose adjustment.
authors.affiliation: a Wheaton Franciscan Healthcare - Endocrinology , Wauwatosa , WI , USA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Barnosky
authors.affiliation: b Loyola University Medical Center Ringgold Standard Institution - Endocrinology , Maywood , IL , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Shah
authors.affiliation: c Edward Hines Junior VA Hospital Ringgold Standard Institution - Endocrinology , Hines , IL , USA.
authors.forename: Farah
authors.initials: F
authors.lastname: Meah
authors.affiliation: c Edward Hines Junior VA Hospital Ringgold Standard Institution - Endocrinology , Hines , IL , USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Emanuele
authors.affiliation: d Loyola University Medical Center - Endocrinology , Maywood , IL , USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Emanuele
authors.affiliation: b Loyola University Medical Center Ringgold Standard Institution - Endocrinology , Maywood , IL , USA.
authors.forename: Alaleh
authors.initials: A
authors.lastname: Mazhari
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004339:Drug Compounding; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000737:chemistry / Q000494:pharmacology*; D007328:Insulin / Q000097:blood / Q000737:chemistry / Q000494:pharmacology*; D000069036:Insulin Glargine / Q000737:chemistry / Q000494:pharmacology; D061268:Insulin Lispro / Q000494:pharmacology; D007333:Insulin Resistance; D049528:Insulin, Long-Acting / Q000494:pharmacology; D018579:Patient Selection; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000188:drug therapy*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; D061268:Insulin Lispro; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human; C571886:insulin degludec
keywords: Diabetes mellitus type 2; concentrated insulin; insulin administration and dosage; insulin resistance; regular insulin administration and dosage; regular insulin pharmacokinetics; regular insulin pharmacology; subcutaneous injection