Indication for Humulin® R U-500. November 17, 2016

Humulin R U-500 is a concentrated human insulin indicated to improve glycemic control in adults and children with diabetes mellitus requiring more than 200 units of insulin per day.

As usual, there are something missing in the medical diagnose and treatment how to treat the medical condition one diagnosed with. Say me, what does it mean that diabetic needs more then 200 units of insulin per day?

What is Humulin 70/30? Humulin 70/30 contains a combination of insulin isophane and insulin regular. Insulin is a hormone that works by lowering levels of glucose (sugar) in the blood. Insulin isophane is a intermediate-acting insulin.

Another dosages are 50/50 or 30/70. So, really what does it mean that Humalin R U-500 Rx for? It is easy to say that diabetic needs to take 200 units of insulin. Which type of it? There are different types of insulin, short acting, long acting insulin, rapid acting insulin, and combination of all and every one of them. Humalin is type of insulin where long acting insulin and short acting insulin combined. So, to say '200 units' mean that there is no any info what %%% of any one of these  types.
There is another point, for whom this type of insulin would be Rx? Type 2 diabetics? Type 1 diabetic, LADA? MODY?  It is all the time presented that oral medications are not for type 1 diabetics. They need to take insulin to control blood sugar level. They do have pancreas which do not secret insulin or immune system attacks own Beta Cells and destroy them. Diabetics type 1 diagnosed as children or teens, and they all the time on insulin therapy. Dose of insulin drops with time. It is healing process. Even it probably never would be 100% sufficient, with time dose of insulin drops, in any type of diabetic with insulin therapy. So, really is this true that diabetics type 1 need 200 units of insulin? Who need to inject 200 units of insulin and even more?
      It is diabetics type 2. With time and treatment with Metformin and SU our Beta Cells destroyed and insulin secretion practically not possible. This is why C Peptide level in my blood was 5 or less, I do not remember right now. What does it mean? I have no clue. I do not care about any tests as long as I do have medicine I need.
      Now, when dose of insulin over 200 units daily, how to dose insulin?

“One of the questions that our colleagues wondered about was whether giving the insulin twice a day versus three times a day might be better… This trial gave us the answer.”

       It is medical web side. They are talking about how many shots daily diabetic will take. They pretend it is so important. Of cause it is important, but how important is it? They do not know how to determine dose of insulin, how to find how many units inject with every injection, and they pretend, it is most important how many times to take a shot? Sorry, the first things are first, dose of insulin. As it is said, diabetic need more then 200 units of insulin. I injected 400 a day, highest dose I injected. And now someone will say to me how many times I have to put need into my belly?  But when it is time to take a shot? No one word about it. It is easy to speculate that if there are two shots a day then it is morning and evening. But in the morning my sugar is 63 mg/dl today, and in the eve it can be also 63, but in another day. So, if sugar is 63 mg/dl I have to inject 100 units of insulin?  really I am not so brave. The count of shots two or three they studied. The treatment regime they missed  to study, like it is not important part of insulin therapy. At the same time, it is Humalin, combination type of insulin which combined short acting and long acting types of insulin.
 

Dosing Errors: Extreme caution must be observed in measuring the dose of Humulin R U-500 because inadvertent overdose may result in serious adverse reaction or life-threatening hypoglycemia.

          
It is so simple, be careful, and it is all what they were able to say how to dose insulin. Really? Who suppose to find out this dose and how? Diabetic type 2 who just started insulin therapy and dose of insulin one must inject is higher then 200 units? Dose of insulin to inject as it is recommended by ADA is Weight in Lbs :4= dose of insulin in units. So, what weight it suppose to be if diabetic needs more then 200 units of insulin? 200units*4=800 pounds. How many diabetics type 2 do have such weight?
      It is all the time presented that we are, diabetics type 2 do have high blood sugar level because of our obesity, really? I am not sure that one with weight more then 800 pounds do have diabetes. Usually we die before our weight hit this level.

Hyperglycemia, Hypoglycemia, or Death Due to Dosing Errors in the Vial Presentation: Medication errors associated with the Humulin R U‑500 vial resulting in patients experiencing hyperglycemia, hypoglycemia, or death have been reported.

Dosing errors also have no clear meaning. If I do take 300 units instead of 200 units as Rx by doctor it is error. But what if I injected dose of insulin as it was Rx by doctor, 200 units, one day after another, Humalin U-500, would be it is danger for me or it is just fine? Not at all. This is the problem, biggest problem in diabetes type 2 treatment. This is why medical providers all treat diabetics type 2, but no one of them Rx insulin. They easy to Rx all medicine such as Invokana and Metformin, but insulin, no to insulin, they are all Insulin -Resistant.
     It is most important to find right dose for every day injections, and there still no clue how to find this dose. Today my fasting sugar is 63 mg/dl. It was very low in the morning. I hardly was able to get to the kitchen and take my bite. Yesterday I injected 220 units of Lantus Solo Star. My fasting sugar Yesterday was 118 mg/dl, and insulin dose for day before Yesterday was 219 units. Why so big gap between two fasting readings? It is easy to speculate that I need to reduce dose of insulin. If I do so, sugar going up, and I have to increase insulin dose.  Who will say me how many units I have to take with every injection, regardless it is two shots a day or three? No one doctor will be able to answer to this question.
      ADA very reach in publications and in education how we suppose to eat. ADA never published the pattern how to inject insulin. So simple, they ignore it as it has no any importance. There are plenty  recipes on ADA web, there is no one table how dose of insulin come together with glucose readings. They educate diabetics how many types of insulin on market. They never educate diabetic how different types of insulin effect blood sugar level. For instance, I cannot take Novolog, Humalog, Apidra, or any combination long acting insulin and short acting insulin. I cannot take Toujeo, long acting insulin. It simple do not work for me. Newly diagnosed diabetic type 2 have no experience in diabetes treatment. They simple trust in doctors, and they take all Trash Medicine such as Metformin or Invokana their doctors Rx for them. Then with time they get heart failure and eventually if they are lucky they will need to take insulin, more then any type 1 diabetic, more then 200 units daily dose.
     Now, after reading all this info, what can I think if my doctor try to Rx Humalin U-500 to me? This type of insulin is not for me. I prefer to take two shots but different types of insulin in different shot. I will not take in one shot short acting insulin and long acting insulin. Why? Simple, I do not see reason to take both at the same time. It is insulin. It is not easy to deal with it. Any error can lead if not to Death then to many complications and lost of concussions. Also I do not see why take short acting insulin in first place? I see no reason in this therapy, and this therapy never worked for me. I can give a try to concentrated insulin, but without any add-ons to it as it is in Toujeo. So, my choice still stand: Lantus Solo Star. Easy to use. Reliable. Trusted.

via Ravenvoron