Has any used 200U insulin in their pump?

[Capt-Slog]

I use a lot of insulin compared to many. About 150 units a day (72 Levemir and 78 Novarapid).
This has factored in my evaluation of pumps.
I have heard of double strength insulin, or 200U insulin. This means that 100 units of 200U insulin is equivalent to 200 units of standard insulin.
Has anyone used this type of insulin, or even the 300U variety?
More specifically, is anyone using this in their pump?

 

[Bluey1]

I can’t comment on high strength insulin, but when you go onto a pump you use about 20% less insulin. I was on 55uLantus and 50 Novorapid. I now get by with about 65u a day on a fairly high carb diet and quite good control

 

[Capt-Slog]

I can’t comment on high strength insulin, but when you go onto a pump you use about 20% less insulin. I was on 55uLantus and 50 Novorapid. I now get by with about 65u a day on a fairly high carb diet and quite good control

Thanks for the reply Chowie.
Yes, my DSN has told me it MAY be nearer to 30%.
However, if you do the numbers, then my 150u less 30% still comes to 105u per day! This means having to refill at least every 3 days, and that is if I use a pump with a 300u+ reservoir.

I don't know if there are any issues with using 200U insulin in pumps. That is why I am hoping to find someone who does.

 

[Deleted Account]

My pump (Medtrum A6) explicit does NOT support 200U insulin.
It is worth checking the specs of others.

 

[DunePlodder]

@Capt-Slog It's not usually recommended to use an infusion site for more than 3 days anyway. If I use the Trusteel cannula with my pump it should be changed every 2.

 

[Capt-Slog]

My pump (Medtrum A6) explicit does NOT support 200U insulin.
It is worth checking the specs of others.

I think I will have to contact some of them direct as this information is not always available on the websites.

Do they say why your pump can't use 200U insulin?
Is it a physical property of the insulin? Like, is it thicker or something?
Or is it to do with the pump software.
For example, unless the pump software has a particular setting for you to specify that you are using high strength insulin, then the pump will think it is normal insulin.
Therefore a calculation from the pump for 10 units would result in a dose of 20u.
This could be dangerous if you are not on the ball yourself.

This is one of the reasons I started this thread, to see whether it is possible.

 

[Capt-Slog]

@Capt-Slog It's not usually recommended to use an infusion site for more than 3 days anyway. If I use the Trusteel cannula with my pump it should be changed every 2.

OK, good to know.
The few pumpers that I personally know, say that they try to keep their cannula in for 3 days, so I just sort of assumed that this was the norm.

Also, looking at another thread this morning, I noticed someone talking about disconnecting their pump during "adult activity". I hadn't realised that you could plug and unplug a pump without changing the cannula.

Does this mean that you can refill the pump too? Or do you have to start from scratch if you want to add more insulin?

So many questions.

 

[Deleted Account]

Do they say why your pump can't use 200U insulin?

I think it has something to do with some of the algorithms that the pump uses.
However, as my doses are pretty low, i didn't pay much attention to the reason - sorry.

Regarding disconnection, this is possible with a tubey pump.
Regarding refill, yes you can unplug the cannula and refill the pump with a new cartridge and then "plug yourself back in".
(I have read about some people having a different schedule for their cannula replacements and cartridge replacements. I prefer to get mine done all at the same time.)

 

[Juicyj]

Tagging @tim2000s as he may have some knowledge of suitability of this with pumps.

I change sets every 2-3 days, both reservoir and cannula set, as I get lumps, insulin also starts to degrade after 3 days in the plastic reservoir so shouldn't be left any longer.

 

[Seacrow]

Hi
I use Humulin r500 in a Medtronic 640 pump. This is not approved by the NHS or the pump manufacturer and is not a generally offered option. I have been told that, officially, there is no-one in the UK using concentrated insulin in a pump, as it is too dangerous. Pumps don't have software to account for anything other than u100 insulin, which means the patient has to be able to translate from stated units to actual units and the NHS believes this is too difficult.

On mdi, I was at about 500u per day, and slowly increasing. Unsurprisingly, I was fed up with the number of injections this needed. I picked the Medtronic pump because it has the largest reservoir (3ml) of the pumps offered me. Now I'm on 200-300u per day, or 40-60u as the pump measures it.

I think I will have to contact some of them direct as this information is not always available on the websites.

Do they say why your pump can't use 200U insulin?
Is it a physical property of the insulin? Like, is it thicker or something?
Or is it to do with the pump software.
For example, unless the pump software has a particular setting for you to specify that you are using high strength insulin, then the pump will think it is normal insulin.
Therefore a calculation from the pump for 10 units would result in a dose of 20u.
This could be dangerous if you are not on the ball yourself.

This is one of the reasons I started this thread, to see whether it is possible.

It is possible. You need to find a consultant who can override NHS guidelines. You then need to convince him that you know how your body reacts to carbs and insulin, that you have a reasonable mathematical ability, you can cope with electronic gadgets, and if you're confused you will call for help.

There are at least two other posters using concentrated insulin in a pump, I'm sure they'll be along soon.

 

[Capt-Slog]

Hi
I use Humulin r500 in a Medtronic 640 pump. This is not approved by the NHS or the pump manufacturer and is not a generally offered option. I have been told that, officially, there is no-one in the UK using concentrated insulin in a pump, as it is too dangerous. Pumps don't have software to account for anything other than u100 insulin, which means the patient has to be able to translate from stated units to actual units and the NHS believes this is too difficult.

On mdi, I was at about 500u per day, and slowly increasing. Unsurprisingly, I was fed up with the number of injections this needed. I picked the Medtronic pump because it has the largest reservoir (3ml) of the pumps offered me. Now I'm on 200-300u per day, or 40-60u as the pump measures it.




It is possible. You need to find a consultant who can override NHS guidelines. You then need to convince him that you know how your body reacts to carbs and insulin, that you have a reasonable mathematical ability, you can cope with electronic gadgets, and if you're confused you will call for help.

There are at least two other posters using concentrated insulin in a pump, I'm sure they'll be along soon.

500...wow!
I didn't know that they even made insulin of that strength.
I find it absolutely amazing that they can expect a patient to do all the maths for MDI, but the pump companies can't write a TINY bit of code to set the insulin strength.

It sounds like I am unlikely to find a pump where the manufacturer approves the use of anything other than 100.

What does the "r" stand for in r500?

 

[Capt-Slog]

Just been on the Humulin website and they call it
Humulin R U-500

So, "U-500" means 5 times strength
And
500u means 500 units

I mean, REALLY?
They couldnt use S500 to denote Strength or something?

 

[Seacrow]

Just been on the Humulin website and they call it
Humulin R U-500

So, "U-500" means 5 times strength
And
500u means 500 units

I mean, REALLY?
They couldnt use S500 to denote Strength or something?

Oh it gets better. One unit of r500 insulin does not contain the same number of insulin molecules as one unit of u100 insulin. Instead, they rely on historical data, and set a 'unit' of a given insulin to be the amount that has the same effect as a 'unit' of a different insulin. So, all the insulins we use have their strength defined by comparison to other insulins.

The final test my consultant set me was:
"100u of u100 is the same as 100u of u500. What is the difference?"

R stands for recombinant human, or rDNA, or regular human. Never got a definitive answer on that, even from the manufacturer. As far as I know, Eli Lilly is the only manufacturer of this strength (worldwide) and in the UK it has to be ordered on a named patient basis by a consultant from the European distributor.

As far as the pump manufacturer goes, in my case (Medtronic), while they refuse to state that they approve (various legal reasons spring to mind), they also haven't stated that they disapprove of or forbid the use of concentrated insulin in their pumps. A bit like the NHS, really. I can't help but think everyone knows what's happening, but want, what's the phrase, plausible deniability. That would explain why a tiny bit of code didn't make it into the latest pump upgrades.

 

[Marie 2]

My endo who is is also a type 1 is the one that put me on the Humalog 200 for my pump. When I first switched to the pump it looked like I might have to worry about changing it sometime after 2 days instead of 3. (I have an Omnipod, it only holds 200 units). So hence she decided it would be better to use the stronger strength and not have to worry about it. I use about 25 units of it daily now, so that's equivalent to about 50 units of regular insulin a day. Before a pump I used about 75 units of regular insulin daily. It's just easier with a pump to deliver what you need when!

Just don't let the Humalog people know as they throw a fit if you say it to them!!!!

An Omnipod is tubeless which is why I picked it. But you have to change it at 3 days plus 8 hours. It will turn off and start shrieking at you if you forget. It does give you warnings prior that you set up. But my endo explained the insulin degrades next to the heat of your body and that you can even notice day 3 isn't as good as day 1. I haven't noticed but I'm not technical about watching that either.

 

[Marie 2]

Just a little more information in case it helps. An Omnipod is a tubeless pump so it isn't necessary to disconnect it at any time. You have a pod on your body and a separate reader. It also does well getting wet for up to 45 minutes? I know I go snorkeling for 60 minutes and it's always fine. You fill the pod with insulin, only fits 200 units, I usually fill it to about 100, it needs a min of 80 units in it. It is very versatile in where you can put it.

You completely reprogram it of almost everything when you are doing the double strength. My endo's office did that for me the first time as it can be a little confusing and they wanted to make sure my information in there was changed right. The IC ratio, correction factor and the basal rate get changed, so it's nice to have someone more used to it do it the first time.

 

[endocrinegremlin]

300 u in 3 days? yeah sure. not always but sometimes and not a problem

 

[megandlg]

Hi
I use Humulin r500 in a Medtronic 640 pump. This is not approved by the NHS or the pump manufacturer and is not a generally offered option. I have been told that, officially, there is no-one in the UK using concentrated insulin in a pump, as it is too dangerous. Pumps don't have software to account for anything other than u100 insulin, which means the patient has to be able to translate from stated units to actual units and the NHS believes this is too difficult.

On mdi, I was at about 500u per day, and slowly increasing. Unsurprisingly, I was fed up with the number of injections this needed. I picked the Medtronic pump because it has the largest reservoir (3ml) of the pumps offered me. Now I'm on 200-300u per day, or 40-60u as the pump measures it.




It is possible. You need to find a consultant who can override NHS guidelines. You then need to convince him that you know how your body reacts to carbs and insulin, that you have a reasonable mathematical ability, you can cope with electronic gadgets, and if you're confused you will call for help.

There are at least two other posters using concentrated insulin in a pump, I'm sure they'll be along soon.

My husband has been using Humulin R-U500 in his pump for about 4 years now. He was struggling to absorb the amount of insulin he was requiring and the pump struggled to cope with dispensing it. It’s a pain now though as they have stopped importing the vials into the UK, so he is prescribed the pens and then has to transfer the insulin from the pen to the pump cartridge,