Patient Care

Concentrated Insulins: A Review and Recommendations

For diabetes mellitus patients who require higher doses of insulin, pen-delivered concentrated insulins offer smaller volumes and potentially a lower risk of dosing errors.

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For a long time, 500 U/mL (U-500) insulin was the only concentrated insulin available on the market. With many diabetes mellitus (DM) patients requiring larger doses, additional 200 U/mL (U-200) and 300 U/mL (U-300) concentrations became available. As clinical guidelines lack specific recommendations for optimal use of U-200 and U-300 insulins, clinical discretion is warranted in identifying patients for whom use of these insulins is appropriate. U-500 insulin is recommended in cases that require ≥ 200 U/d or > 2 U/kg/d. Given the ongoing DM and obesity epidemics, increased use of concentrated insulins is likely. Clinicians must stay well informed about the characteristics and benefits of concentrated insulins to remain confident recommending, prescribing, and adjusting these medications.

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