Abstract

Human regular insulin 500 (U-500) is a form of concentrated insulin that allows injection of high insulin doses with 5 times less volume compared with regular insulin. This concentrated insulin is indicated in patients with type 2 diabetes who require more than 200 units of insulin per day. Insulin U-500 displays both prandial and basal actions, and therefore can be injected as monotherapy in a convenient twicedaily regimen. Available data, mainly retrospective, suggest that insulin U-500 is effective, associated with better adherence, and decreased injection pain compared with non-concentrated insulins. Its main limitations are hypoglycemia and weight gain, and possibility of dosing errors. Randomized trials are needed to compare long-term efficacy and safety of insulin U-500 with other forms of insulin regimens.