We are evaluating an insurance plan that only covers HumuLIN® R, HumuLIN® R U-500 and NovoLIN® R.
I know there’s some folks around who have used Humulin R U-500 (5x the concentration of U-100) on TuDiabetes, but has anyone around ever used Humulin R (U-100) on an insulin pump before? Can you please share your experience?
Thanks,
Manny,
I am using Humalin R in my pump right now. My numbers aren’t great but they are not bad. You will also have to be careful to set the DIA to longer.
Thanks, Wendy! What do you mean with DIA?
I don’t have a pump, but use Humulin R. In case this helps anyone changing to R, here’s my experience.
My endo recommended R for gastroparesis. I need the slower onset & the longer duration of R with delayed stomach emptying. R takes about 40-45 to begin working & stays around longer than rapid acting. Lows are still possible, of course, but it’s not the awful feeling of rapid descent experienced with faster insulin. Compared to rapid acting, it’s smoother because it’s slower. Not an insulin to quickly correct highs. I use Apidra to correct highs & for faster digesting meals. For some meals, I use both Apidra & R.
I have different insulin:carb ratios for Humulin R than for Apidra. R doesn’t cover as many carbs for me & I don’t know if that’s typical.
I also find that R works better than Apidra when I’m sick. Perhaps this is because it lasts longer.
Duration of Insulin Activity
Gary Scheiner has a good explanation of DIA.
I have only used Humulin R (U100) in my pump. 10+ years. So can’t compare it to anything else but as far as I can tell, it works fine for me. I have a good A1c. Why would you think it would not work for you?
Thanks, bsc and Kristin! 
Thanks Nell and Gerri for sharing your experiences with Humulin R… goes to show how diabetes and diabetes therapies can operate in such different ways for different people.
Doris uses regular in her pump too I think (because she had reactions to the fast-acting insulins).
These are all regular insulins thus they will have a significantly slower reaction. The duration will be 4 to 6 hours instead of 3 to 4 with an analog insulin. This means physical activity could more likely lead to lows (if you have a normal / fast absorbtion of carbs). I have heard of a study with an insulin called VIAject that was based on regular but is equal or even quicker as analog insulins. This worked by changing the concentration of the insulin to something like U20 (I do not know the exact number) and using a different substance for dilusion. Insulin is produced in a form that is not functional from the start. The individual strains need to separate from each other to get active. With the lower concentration this separation process is faster and this is responsible for the quicker onset. Thus regular insulin in U100 concentration must have a slower onset than the U40 I have used in my first years after diagnosis - at least this would be the logical conclusion from the information at hand. Not much you can do about that. The manufacturers decided to switch to U100 and we have to get along with this. If it is not fast enough they can point to their faster but more expensive analog insulins. I have no idea how much speed was wasted by changing from U40 to U100. Maybe it is not much but it remains to me that the slower the concentration the faster even good old regular can act.
Well, this is backed up by the observation that U-500 insulin actually has a duration of action that is more like 24 hours. What I am not clear about is whether you could dilute U-100 in a 5:1 ratio down to U-20 and speed up it’s action. It may be something related to the actual formulation that is different. There is “stuff” in the insulin formulations.
Hi. I would worry about corrections, since you really do need a fast acting insulin for them. Pens are a little less expensive than vials (I think), but for safety’s sake you should probably always have something fast acting on hand.
Most pump users moved from “Regular” (that’s what the “R” means) to a fast acting analog (e.g. Humalog or Novolog) a decade ago.
Not that long ago the fast-acting analogs weren’t available and all of us who have been at it for a while started off on Regular. Ooh, let me try to remember, Humalog came out in the late 90’s, and pharmacies began regularly carrying it (as opposed to “special order”) by 2000.
There’s nothing wrong with using Regular in a pump (that’s what was used before the fast acting analogs were available recently) but it’s not as “quick” at corrections etc as that fast acting analogs and it may require more dosing-in-advance-of-a-meal and a different setting on the pump. It also has activity going a lot later (up to 6 hours) than the fast-acting analogs.
If you have a younger endo or recently-minted CDE, he/she may not be familiar with using Regular in a pump.
I’m sure there are some folks who started using a pump before Humalog was widely available and are still using Regular because they have all their timings etc. set up for Regular. But… most pump newbies are started out on Humalog or Novolog these days.
Regular is a LOT cheaper than humalog.
You had mentioned in an earlier post, Manny, you were considering Kaiser. Is this Kaiser that told you they only used Regular? I have heard of a type 2 friend at Kaiser who was put on NPH, but also have several women in my Type 1 group who are on Kaiser with pumps and I assume use one of the Rapids. Just wondering.
Vials & syringes are cheaper than pens.
And intramuscular injections are faster still!
I have used both U-100 and U-500 Regular.
U-100 is slower than the rapids, so pre-bolusing for meals is not optional, it’s required, and it often can’t match some foods as well as a rapid insulin can, but other than that it’s pretty similar.
Pumping U-500 for me was horrible… I tried it because I have an allergy to one of the preservatives in all insulin, so I wanted to see if injecting 80% less volume made a difference… and it did, but my #'s were just horrible… I would have had to go beyond “low carb” to basically no carb to make it work for me… there was no way I could make boluses have any effect, and it was pretty typical to not see a change from a correction or bolus for at least 8-10 hours. That’s asking a bit much in terms of pre-bolusing, even extending it out to an hour or 90 minutes before a meal seemed to make little difference.
The main change between u-40 and u-100 insulins is that almost all u-40 insulins were/area animal based (bovine or porcine), and the u-100 are synthetic and created with the aid of genetically engineered bacteria or yeast.
That could also have a little to do with the change in “speed”… I don’t know if animal insulins are faster, as I’ve never used any.
Yep. The Kaiser plan we received a quote for only covers HumuLIN® R, HumuLIN® R U-500 and NovoLIN® R.
I got a call form my endo today and he strongly advised against the use of HumuLIN’s on a pump… so back to shopping for insurance options! :S