U-500 insulin: why, when and how to use in clinical practice

Diabetes Metab Res Rev. 2007 May;23(4):265-8. doi: 10.1002/dmrr.709.


Some patients with type 2 diabetes mellitus (T2DM) have severe insulin resistance. Their insulin requirements are significantly greater. These patients need to take 2-3 injections at the same time to take the correct insulin dose or to redial the insulin pen. When daily insulin requirements are in excess of 300 units/day, the volume of the injected insulin becomes an issue. Large-volume injection can cause discomfort and lead to poor concordance with treatment. Using high-strength insulin e.g. U-500 insulin can reduce the volume of the injected insulin. Despite publications of small case reports or case series, no universal guidelines exist on the use of U-500 insulin. We discuss common sense approaches when considering the use of U-500 insulin in clinical practice.

MeSH terms

  • Diabetes Mellitus, Type 2 / drug therapy*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Costs
  • Hospitalization
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / pharmacokinetics
  • Hypoglycemic Agents / therapeutic use*
  • Injections
  • Insulin / administration & dosage*
  • Insulin / adverse effects
  • Insulin / pharmacokinetics
  • Insulin / therapeutic use*
  • Professional Practice
  • Risk Assessment


  • Hypoglycemic Agents
  • Insulin