by Gary Scheiner MS, CDE
U2 May be one of the most successful bands of all time, but they haven’t done anything to improve the functionality of insulin pumps… at least not lately (Bono seems to have powers beyond those of mortal rockers). U200, On the other hand, just might.
Lilly recently began marketing their U200 Humalog Kwik-Pen. This pen contains rapid-acting lispro insulin that is twice as potent as ordinary lispro. In other words, every 1cc (cubic centimeter) of U200 has twice the blood-sugar-lowering-power as every 1cc of traditional U100 lispro.
So, what does this have to do with insulin pumps? If you use a large amount of insulin on a daily basis (100 units or more), you might run out of insulin within the first day or two of a fill-up. U200 Might allow you to get twice as much life out of each reservoir since you would only be using half the usual volume for basal and bolus delivery. 180 Units of U200 insulin would last as long as 360 units of traditional U100. 200 Would work like 400. 300 Acts like 600, and so on. Technically, U200 might not give you double the life of U100 since you would need equal amounts to fill the tubing and canula; only the insulin delivered into your body would require half the usual volume.
I’m not the type of type-1 to recommend anything without trying it myself first. I drew U200 lispro out of the pens and put it into a tubed pump (Medtronic) and a non-tubed pump (OmniPod). The pumps were left running in our office for three days delivering basal and periodic boluses. No clogs or other problems occurred. So then I wore one for three days, and it worked perfectly fine. The action profile of U200 lispro is similar to that of traditional U100… unlike U500 Regular which is much, much slower to act.
Of course, it is absolutely necessary to change your dosing parameters in your pump before trying this. All basal rates must be cut in half (if you have 0.50/hr then change to 0.25/hr). Correction factors must be doubled (if each unit normally lowers your BG 30mg/dl (1.6mmol), it will now lower it 60mg/dl (3.3mmol)). Insulin-to-carb ratios must be doubled (1:10 must be changed to 1:20, etc.). Since most pumpers will occasionally enter a bolus dose manually, it is also important to remember that the pump is delivering double-concentrated insulin, so half the usual amount should be taken (if you took 4 units for a meal usually, on U200 you’ll only need 2 units). I put a bright sticker on the front of my pump that says “U200” as a not-so-subtle reminder.
Understand that I’m not encouraging everyone to begin using U200 insulin in their pump. However, if you’re frustrated by the need for frequent reservoir/cartridge changes and you and your healthcare provider have discussed it and feel that you might benefit (and you’re careful about changing your delivery settings accordingly), there is no reason not to give U200 Humalog a try.
I currently use U200 Kwik pens in Omnipod, but the pod lasts 48=50 hours only (recently dx T 1.5/LADA/Autoimmune, on my way to T1D) Would love to have a real pump since I will get there eventually and the high/low monitoring of the pump would help me a lot since I can do both in 24 hours! And just found out Omnipod is EXCEPTION on my high pay Part D plan. UUGGHHH
Because omnipod is typically covered under pharmacy benefits (part D) and pumps are covered under Durable medical supply, you may be able to get a tubed Pump (I’d recommend the Tandem x1) without having to wait for your current pump warranty to expire. Medicare can make that more difficult but it’s worth a try.
Then you can also work with your prescriber to get a medical exemption to get out of your warranty is needed.
Finally you can also work with your doctor to add additional medications to your regimen to reduce blood sugars and reduce insulin needs
GLp1 agonists are incredibly helpful, as are SGLT2 inhibitors and even Metformin. These are not FDA approved for the treatment of type 1, but you clearly have some marked insulin resistance/hepatic glucose release issues as well that these medications can address
Alicia, I’ve checked with 2 pharmacies and my insurance pharmacist, they don’t sale the U200 except in the pens. Where do you get it.
in the US U 200 humalog is only available in pens. You can pull the insulin from the pens to fill a pump (which is what I do)
what is the Co-pay card from Humalog? I use a Flex Spending account to pay for my insulin (just got a U-200 quick pen rx) and get mine in 3 month lots. Would be great if could use both to pay for it.
Thanks for anyone with any info
here’s a link to the Lilly savings program
https://www.insulinaffordability.com/
has anyone tried u200 in tslim x2 with the IQ tecnology
Hi Mark, I have severe insulin resistance and I use 220 to 240 units of u100 Humalog via my Medtronic 670 G pump today but I am transitioning to the lily u200 via my pump soon. I am going to be following my doctors orders and I just wanted to see if there’s anybody else that is still successfully using the u200 quick pens via the 670g pump do you have any tips for filling the reservoir ? did you find any slick ways of transferring the insulin from the quick pen to the reservoir? And is it still working for you? Thanks for any tips you might have.
HI Dlynn,
I have not worked with patients using U200 insulin with automode, but have a number of patients who do pump using U200 insulin. It would likely require some investigation and possible adjustment of Duration of Insulin Action in automode.
You can actually place the reservoir needle straight through the needle membrane on the pen and draw the insulin straight out (Takes a little coordination as you will probably need to twist up the pen and push to deliver while also pulling back on the reservoir plunger, but’s it’s doable.)
I use the OmniPod too! I just shoot the U200 Kwikpen insulin directly into the filler syringe that’s supplied — through the needle hole! Easy peasy! Takes two times — once for 160 units (the max allowed with the pen), the second time is for the remaining 40 units needed for full 200 units. Do NOT overfill the filling syringe; it actually pulls back to about 210 and makes a mess & can screw up your math, so to speak! ADJUST YOUR BASALS BY 50%! This has made my pod use go up to 5 days! I was only getting 1-2 days with U100. It varied but never the full 3 days as told. But then, we’re all different, and when different things happen — too many carbs, too few, being ill, or just having ‘one of those bad hair days’ your insulin use can be radically different. I love my Pod and I love U200! I wonder what U500 would be like? Only worry about be … pump bumps.
First 90 days. Using OMNIPOD and U500 AC1 dropped from 6.5 to 6.1 and I still have a lot to learn with body reaction and differences over u100 .. These following are my learning curves for ME so far.
1) Fill pods with only enought insilin for pod life(3 days). No big deal to just use the omnipod supplied needle to just suck out any excess insulin through the fill hole and use for next pod..
2) read carbs and inject 30 minutes ahead of a meal instead of 15 minutes before a meal to avoid spike. My body seems to react slower to BOLUS.
3) had to LOWER my BASAL a small amount to avoid increased number of night/morning lows.
4) had to raise the CARB to insulin RATIO for BOLUS about 20% to match carb calculation to my body reactions to smooth out the highs and low when eating.
Just thoughts, I’m not a doctor and my body is different than yours so talk with one.
With me there were slight diferences btwn u100 and u500, mostly (I suspect) due to a much lower volume of insulin used and how fast my body can put it to work. It doesn’t apper to be a pure math problem as in divide by 5 to determ rates. Differences are slight.
I use the Omni Pod. Does u200 come on a vial because how would I get the Keillor pen into my pod? U500 not work well with me. A vial of u200 would be PERFECT.
U-200 is only int he Kwikpen in the US. You could draw the insulin from the pen into the syringe that comes with the omnipod for filling. Not the most ideal set up, but it’s a usable work around
I started using U200 about two weeks ago. Medtronic 670G, All is going well. It’s a little pain to fill the reservoir, But I only have to do it half the time.. Win! Also because of the copay card that Humalog offers it is actually cheaper then if I were using U100. Win-Win! :)
I currently use Humulin-R, a U500 in Animas pump with 200 unit capacity. I hope to use U200 as my doctor has been pushing for over a year or more. As my Animas pump reaches end of warranty and Animas is getting out of pump sales, now is time to consider U200 in a Tandem pump with 480 unit capacity. Any other pump users using U200?
Brilliant!