Humalog 500 units

[christine.h]

My son is being put on Humalog U500 which can only be obtained at the hospital so he has to collect it is quite a dangerous dose so he will be closely monitored.
Is there anyone else on here who has the same please
Happy Christmas everyone and thank you to the moderators as well

 

[trophywench]

It's only comparatively recently - 30 ish years - that insulins as strong as even u100 have been available and only a relatively few years - 5 ish? - since u500 came into use. Scary stuff since it would be very easy to overdose on it and accidentally harm or kill yourself. I personally have not ever known anyone using it.

 

[rebrascora]

I think we may have had a couple of members on u200 but I was quite surprised to see u500 mentioned. It does sound scary! Is your son also prescribed Metformin since I am assuming the extra strong insulin is to overcome significant insulin resistance. Apologies if I am wrong with that assumption.

 

[Benny G]

One of my old work mates used to inject 200 units of Lantus basal for his type 2 each day. That's a lot to inject in one go, so I can see why someone might switch to U200 or U500 if it can bring the shots down to a smaller volume.

 

[Lucyr]

It's only comparatively recently - 30 ish years - that insulins as strong as even u100 have been available and only a relatively few years - 5 ish? - since u500 came into use. Scary stuff since it would be very easy to overdose on it and accidentally harm or kill yourself. I personally have not ever known anyone using it.

How would it be easy to overdose on it? I can’t see that it would be any easier than when using u100 insulin? You dial the dose up on the pen in the same way, to the same number of units, you just don’t dial as far on a u500 pen as it’s more concentrated? You’re dialling to the same number you would usually take though.

If you’re blind and count the clicks then yes I can imagine serious consequences but if you’re sighted and reading the numbers you’d be able to read the dose?

 

[Bruce Stephens]

How would it be easy to overdose on it?

I presume the worry is if the wrong person got it. For someone who needs it I doubt there's much risk.

 

[Lucyr]

I presume the worry is if the wrong person got it. For someone who needs it I doubt there's much risk.

But if the wrong person got it, dialling up 10u on a u500 pen gives you the same dose as dialling up 10u on a u100 pen doesn’t it? Just a fifth of the volume. So it would only be dangerous if they were using a syringe to inject.

 

[Lucyr]

And as most people won’t be on a basal dose that is a multiple of 5, theyd notice that the pen doesn’t have their dose as the dial says 5, 10, 15 etc not 1, 2, 3 and hopefully go back to the pharmacy

 

[rebrascora]

And as most people won’t be on a basal dose that is a multiple of 5, theyd notice that the pen doesn’t have their dose as the dial says 5, 10, 15 etc not 1, 2, 3 and hopefully go back to the pharmacy

I have to be honest. I can't remember the last time I looked at the display on my pens, I just count the clicks and jab, but I am guessing this would come in a single use pen rather than cartridges, so couldn't accidentally be dispensed to me.

 

[Bruce Stephens]

And as most people won’t be on a basal dose that is a multiple of 5, theyd notice that the pen doesn’t have their dose as the dial says 5, 10, 15 etc not 1, 2, 3 and hopefully go back to the pharmacy

You'd hope, sure, but I can imagine there's still more of a risk. As there is for any medication that's unexpectedly strong.

 

[Inka]

A friend was swapped to a stronger insulin and yes, their dose reduced. Except one time they forgot and dialled up their old dose, causing a massive hypo requiring paramedics. I can see why they’re being cautious.

I hope it goes well for your son @christine.h Is he Type 1 or Type 2?

 

[Benny G]

Humulin R U-500

"The key disadvantage is the lack of familiarity with the use of concentrated insulin, attendant confusion, weight gain and the risk of hypoglycaemia."

A case series of Humulin R U-500 in insulin resistant people with type 2 diabetes

https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/pdi.2366

 

[trophywench]

Err - I have never known the existence of a u500 pen.

And @Lucyr - it was and still is ALWAYS possible to take an accidental overdose of insulin, whether it was of soluble, u20,40, 80 or now 100 - as an accidental under dose. Don't worry though, I only have 50 years of sometimes doing both so perhaps every one in the world is more careful now!

 

[Lucyr]

Err - I have never known the existence of a u500 pen.

And @Lucyr - it was and still is ALWAYS possible to take an accidental overdose of insulin, whether it was of soluble, u20,40, 80 or now 100 - as an accidental under dose. Don't worry though, I only have 50 years of sometimes doing both so perhaps every one in the world is more careful now!

Surely you look at the number ok the dial before giving the dose? A u500 insulin pen has numbers on the dial just like a u100 pen. They just go 5, 10, 15 etc on a u500 pen

 

[trophywench]

I remember being invited to speak at a 'diabetes do' at an hotel about 15-20 miles away hence not a venue I had a clue about the type of buffets laid on - when I got to the buffet, I had the choice of wraps. We never buy or choose to eat wraps - so hence I guesstimated. This was well before Libre. Then had to wait several more hours before I could escape, test, go Eeek cos I'd obviously underestimated the grotty tasteless floury thing that had held my lunch.

Do you SERIOUSLY never guesstimate incorrectly - or believe that nobody else is likely to?

Oh and PS - I still don't have the foggiest clue as to the carb count in a wrap.

 

[everydayupsanddowns]

Hope it goes well @christine.h

I can understand the concerns - but as @Lucyr says, as long as the right pen is used, and the doses are dialled carefully (as always needs to be the case really!) all should be well.

 

[everydayupsanddowns]

Oh and PS - I still don't have the foggiest clue as to the carb count in a wrap.

Usually 20-30g in a supermarket one in my experience.

 

[Lucyr]

I remember being invited to speak at a 'diabetes do' at an hotel about 15-20 miles away hence not a venue I had a clue about the type of buffets laid on - when I got to the buffet, I had the choice of wraps. We never buy or choose to eat wraps - so hence I guesstimated. This was well before Libre. Then had to wait several more hours before I could escape, test, go Eeek cos I'd obviously underestimated the grotty tasteless floury thing that had held my lunch.

Do you SERIOUSLY never guesstimate incorrectly - or believe that nobody else is likely to?

Oh and PS - I still don't have the foggiest clue as to the carb count in a wrap.

The pen used is totally irrelevant to you not knowing the carbs in a wrap. I’d look it up if I didn’t know

 

[Bruce Stephens]

Usually 20-30g in a supermarket one in my experience.

But don't be too surprised if it's double that...

 

[trophywench]

Where could you look things like that up before mobile phones - even if you had one and could get a signal inside a random building - could access the internet, and anyway however would you know where that place purchased its baked goods from? - assuming they are supposed to be baked, although the couple I have tasted, have tasted like they were coated in raw flour, which is one of the reasons I think they are foul.

Are catering packs of such things the same as what's available in supermarkets - nowt else much is, like they use v small paninis to make garlic bread in most restaurants. I did at least ask Pete to try and ring his eldest daughter, the classically trained chef, but of course since she always works in restaurant kitchens - no reply! So - you guess is what you do.