U-500 in an insulin pump?

[delphine22]

Have a pt with such high resistance, she's blowing through about 2mls a day of Novolog on her pump. Her basal is 5 and her ratio is 1:1. I've heard u-500 is off label for the Minimeds, her endo is considering it, has anyone actually had experience with it? Obviously we would watch her like a hawk but she's not on cgm and that makes me nervous too. Thoughts?

[nkelliot]

I would never agree to U-500 in an insulin pump, even if the person used a CGM and performed fingersticks. The potential consequences could easily kill the person. (former RN diabetes educator).

[SteveDE]

I recently met with a patient that has used U500 in her insulin pump the entire 8 years she has had an insulin pump and is doing well. She has medicare, so she does not have the CGM either, monitors herself regularly which is needed for safety and success no matter what kind of insulin you use. I work out of a primary office, she has an endo that she follows up with at another clinic that mostly manages her pump. She uses about 30 units of U500 daily, generally is well controlled by using only basal insulin dosing through her insulin pump. She has taken the time to really learn through using her pump as she should, to benefit herself the best, and with consistent monitoring. She does report some occasional lows, but she manages those well by consistent monitoring and understanding how or when to temporarily stop her pump.

Her problem now is that her pump is old, she would like an update, and medicare is providing difficulties with approving an updated pump. Her endo's office nurses are trying to talk her into going with MDI with U100, but at least she is smart enough to realize that will mean less control and a lot of difficulty in getting to the right dose when her pump provides a good, consistent basal insulin dose that controls her blood sugar.

U500 will be a product used more in the near future due to the massive doses many people are on of U100 that are not getting the control they need. My question would be is it that U500 is dangerous or is it that healthcare workers just haven't taken the time to learn it and see its benefits for those patients requiring massive doses of U100?

[busylilnurse]

I think U500 isnt really understood by many nurses and pharmacists. I cant tell you how many times I've had to call back and clarify orders with LTC nurses and pharmacists. I understand the LTC nurses dont see U500 very often....but pharmacists?? And personally I dont know how comfortable with U500 in a pump even with a CGM

[schoolnurse1001]

My mother uses U-500 in her pump and has for several years. She rarely has lows.