Syringe-Insulin-Pill-Diabetes Have you heard of u-500 insulin, or perhaps you are taking it, or know someone that takes it? U-500 insulin is five times the strength of U-100 insulin. It is more concentrated, so the total volume of insulin is less. For example if someone was taking 200 units of u-100 insulin, they would only need 40 units of u-500 insulin.

There is a certain group of patients classified by the American Diabetes Association as having, “other specific types of diabetes”. (1) Within this group of people, huge therapeutic challenges arise when trying to achieve optimal glucose levels. “These patients have more extreme forms of insulin resistance than typical type 2 diabetic patients. (1) “Extreme forms of insulin resistance may also occur as a temporary state with pregnancy, with endocrinopathies and under various other stress conditions such as an infection or with steroid use”. (1) 

Who should consider U-500 Insulin

You have Type 2 Diabetes and you are on more than 200 units of insulin a day and have a difficult time controlling your glucose despite the large amount of insulin you take, you may want to discuss with your healthcare provider U-500 insulin. More insulin or different types of insulin can always be added, you want to remember there are other things that factor into your total Diabetes Plan, which include food habits/meal decisions and physical activity! If you do everything you can possibly do with food choices and movement, it is a medication issue. If there are changes to be made, it may be time to meet with a Diabetes Educator. 

Onset, Peak, Duration 

Compared to U-100 insulin which has a peak effect 2-4 hours after injecting, and duration of 5- 7 hours, U-500 has a duration of up to 24 hours. (1)  U-500 insulin is only available in vials. It must be administered at least 2 times a day, before breakfast and before dinner, but more injections could be added if needed. (1) If the person uses more than 300 units/day this is best delivered three times/day, if the person is on greater than 750 units/day the prescriber should consider adding a bed time dose of U-500. (1) 

Confusion when Prescribing

The correct way to write a prescription for U-500 is as follows, for example “ Regular Insulin u-500, 150 units, inject 0.3ml subcutaneously, three times daily before meals”. (1) In this example, it is important that the patient understands that they are filling their syringe to the 30 line marking, but it is not 30 units, but really 150 units. 


“Despite U-500 costing more per milliliter, there is a reduction in the volume of insulin used with U-500, which translates into a reduced cost per unit of insulin versus other forms of insulin,” (1). Also, less injections means less syringes which would also provide some savings. 

Growing Trend 

As the rate of diabetes grows, so does the rate of insulin resistance. More and more people are needing larger doses of insulin. “The use of U-500 insulin may be another treatment option in helping severely insulin resistant, type 2 diabetic patients reach their desired therapeutic targets”. (1) Regardless of what medication you take for your diabetes, the only way your doctor knows how well the medication is working is by reviewing your glucose logs. Bringing your glucose logs to your doctor appointment is a must if you desire better glucose control.