Humulin U-500 syringe with U-500 vial

[MIRPh]

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Hi everyone, I have a question about Humulin U-500
Is the U-500 syringe , the ONLY syringe that can be dispensed with a U-500 vial? is it mandatory ?
Or can we still dispense it with U-100 or tuberculin syringes? Of course I'm aware of the conversion required if this the case

Thanks

 

[Ackj]

Legally, you can dispense whatever the prescription says, or they can purchase whatever they want OTC (depending on local law). It's just not good practice to rely on the patient to accurately convert for themselves considering it's a high-risk med.

 

[MIRPh]

7/8/16] Today, the U.S. Food and Drug Administration approved a dedicated syringe for the administration of Humulin R U-500 insulin, which is now the only device approved for use with U-500 insulin vial.

Thanks, but my question was with regard to a FDA update (shown above)

The article says U-500 syringe is the only approved device with the vial
Is this mandatory or still upto the prescriber?
Thanks again

 

[Ackj]

FDA approval doesn't mean an rx is legal or not. Things are used off label all the time. See: gabapentin indications.

 

[Dred Pirate]

exactly- I love how they "approve it" when all it is was taking the same syringe and multiplying the numbers by 5.

But in honesty - I hate when they mix the doses up because a patients comes in all the time and say they take 20 unites of U-500- and I know that makes no sense, and after I talk t them, it is actually 100 -

 

[RxPreceptor]

Story time: Long time user of U500 drawing up insulin the traditional way with a unit scale insulin syringe for a 100u actually divides by 5 when switching to the U500 pens ending up rolling in the 5-600+ BG range. I thought this was a fairly creative fail as most would do the opposite messing up the U100 syringe

I swear to god people, just write the units out...nothing innovative about a syringe multiplying by 5

 

[CetiAlphaFive]

Yup, it's problematic.
For example:

I have a pt. who was doing "Humulin U 500, 16u QAM, 18u c lunch, 20u c dinner"

Physician was an old grouch who would just come onto the phone to repeat "That's how I've always done it ad nauseum"
I'd just send a fax "Rx will read 'units on syringe' and I will counsel patient on U-500 and how it's different from U-100."
Sure enough, when the patient was hospitalized a few months later, he told them "16, 20, and 18 units." I'm sure that was a ton of fun for them to figure out.

Now that he's discharged with a new Rx for U-500, he's been going super hypoglycemic every day.

 

[ldiot]

Why would you need a different syringe for it? Isn't one unit the same volume no matter what the concentration is? e.g. 30 units of 100 would be 3 units of 500... so just write 3 units in the SIG and give them the regular syringe...?

 

[Ackj]

Why would you need a different syringe for it? Isn't one unit the same volume no matter what the concentration is? e.g. 30 units of 100 would be 3 units of 500... so just write 3 units in the SIG and give them the regular syringe...?

No 1 unit is not the same volume. U500 is 500 units per mL, where typical U100 is 100 units per mL. Sure you can just say "fill it up to X line" but they will not truly be giving X units, they will be getting X*5 units. Then they end up with problems when the syringe changes, there is a dosage change, they get admitted, etc.

Also it's a factor of 5, not 10, so 30 units of U100 would be the same volume as 150 units of U500. If you wanted to administer 30 units (you wouldn't be on U500 in the first place, but anyway) you would only have to fill up to the 6 unit line on a standard syringe. Now to demonstrate the problem. Say they go and tell another doctor they are using 6 units, and their BGs look like they need to be increased. So the new prescriber says "go from 6 to 12" so the patient does, and now they are administering 60 units instead of 30, which is way too much of an increase.

 

[Sine Cura]

I would try to get people on the KwikPens (if they are even covered...at least Medicaid plan formularies are very strict) if the crappy prescriber is that stubborn.

"That's how I've always done it" a lot of times actually means "I've always been a freakin' idiot and can't admit I'm wrong"

 

[PumpkinSmasher]

Why would you need a different syringe for it? Isn't one unit the same volume no matter what the concentration is? e.g. 30 units of 100 would be 3 units of 500... so just write 3 units in the SIG and give them the regular syringe...?

Hopefully you are not involved in educating doctors or pts about insulin...check your math buddy

 

[ldiot]

Hopefully you are not involved in educating doctors or pts about insulin...check your math buddy

Can you educate me please?

 

[Sine Cura]

An insulin unit is the same regardless of concentration.

For 100 units/mL versus 500 units/mL, the concentration (units per volume) is different however. For a given volume, the amount of units of U-500 will be 5-fold greater compared to U-100. That is why you multiply the number of units on a U-100 syringe by 5 when drawing up U-500 insulin using the U-100 syringe.

ConsumerMedSafety.org - Prevent Medication Errors - Consumer Med Safety

 

[owlegrad]

Why would you need a different syringe for it? Isn't one unit the same volume no matter what the concentration is? e.g. 30 units of 100 would be 3 units of 500... so just write 3 units in the SIG and give them the regular syringe...?

30x100 =/= 3x500

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[CetiAlphaFive]

Why would you need a different syringe for it? Isn't one unit the same volume no matter what the concentration is? e.g. 30 units of 100 would be 3 units of 500... so just write 3 units in the SIG and give them the regular syringe...?

W... what?

No, dude.

Allow me to present what you just said in a different way:

Why would you need a different syringe for it? Isn't one milligram the same volume no matter what the concentration is? e.g. 30mg of amoxicillin 250/5 would be 30mg of amoxil 400/5 ... so just write 30mg in the SIG and give them the regular syringe...?

I think you understand this concept and you're just not understanding the word problem. I hope.

 

[ldiot]

Yeah it makes 100% sense now, not sure what I was thinking.