4.5.5.0 Con­cen­trat­ed In­sulin Prod­ucts

Sev­er­al con­cen­trat­ed in­sulin prepa­ra­tions are cur­rently avail­able. U-500 reg­u­lar in­sulin is, by defini­tion, five times more con­cen­trat­ed than U-100 reg­u­lar in­sulin. Reg­u­lar U-500 has dis­tinct phar­ma­coki­net­ics with de­layed onset and longer du­ra­tion of ac­tion, char­ac­ter­is­tics more like an in­ter­me­di­ate-‍act­ing in­sulin. U-300 glargine and U-200 degludec are three and two times as con­cen­trat­ed, re­spec­tiv­ely, as their U-100 for­mu­la­tions and allow high­er doses of basal in­sulin ad­min­is­tra­tion per vol­ume used. U-300 glargine has a longer du­ra­tion of ac­tion than U-100 glargine but mod­estly lower efficacy per unit ad­min­is­tered (80,81). The FDA has also ap­proved a con­cen­trat­ed for­mu­la­tion of rapid-‍act­ing in­sulin lispro, U-200 (200 units/‍mL). These con­cen­trat­ed prepa­ra­tions may be more con­ve­nient and com­fort­able for pa­tients to in­ject and may im­prove ad­her­ence in those with in­sulin re­sis­tance who re­quire large doses of in­sulin. While U-500 reg­u­lar in­sulin is avail­able in both prefilled pens and vials (a ded­i­cat­ed sy­ringe was FDA ap­proved in July 2016), other con­cen­trat­ed in­sulins are avail­able only in prefilled pens to min­i­mize the risk of dos­ing errors.