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Results at ASHP 2019 suggest potential for administration errors without proper guidance.
Pharmacists are in a good position to counsel patients about Humulin R U-500 use, and should because some patients taking this highly concentrated form of insulin may not be using best practices, according to a paper presented at the 2019 Annual American Society of Health-System Pharmacists Midyear Clinical Meeting & Exposition.
Humulin R U-500 is FDA approved for use in patients who need more than 200 units of insulin per day. According to a poster presented by Alyssa Lee, PharmD, at the meeting, 12 of the 47 patients included in their retrospective evaluation were using a U-100 syringe when a U-500 syringe or Kwikpen would have been preferable. The researchers noted that these choices are if “insurance allows.”
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The study researchers retrospectively examined observational medication data on 47 patients compiled between 2017 and the present from five different internal medicine settings to evaluate Humulin R U-500 use in patients with type 2 diabetes. The research team noted that the majority of U-500 users in their study population, about 60%, were being managed by a pharmacist, while 36% were managed by a primary care physician and 6% by an endocrinologist.
The researchers noted that use of Humulin R U-500 led to improvements in A1c without causing substantial weight gain; however, they noted a trend toward more severe hypoglycemia events in patients on twice a day compared with three times a day dosing.
Lee et al also noted that although the product is only FDA approved for use in patients utilizing more than 200 units of insulin a day, 20 of the patients were using less than 200 units daily.
The authors concluded that their data revealed a few prescribing practices that could use improvement and, they noted, a dosing guide for Humulin R U-500 is being developed to address the issues.
Lee A, Carson P, Morgan K, Sheehan L.. Medication Use Evaluation – Use of Humulin R U-500 insulin in the Primary Care Setting. Presented at ASHP Midyear Clinical Meeting & Exposition. December 8, 2019. Las Vegas, Nevada.