Insulin Concentration and Types of Insulin

Regardless of the type of insulin used, the standard concentration of insulin is U-100.

• Most insulin syringes are calibrated to be U-100 syringes in which each 1 unit marking represents 1 unit of insulin.
  • It is important at discharge to ensure the correct types of insulin syringes (size and needle caliber) are supplied.
  • At Stead Family Children’s Hospital, this is done by the discharging endocrinologist or one of the diabetes educators. It is not usually the responsibility of the discharging resident team unless they are specifically asked to place these discharge orders.

When reconciling patient medications during inpatient admissions, it is important to verify that a patient is not using diluted (sometimes used in children < 1-2 years of age) or more concentrated insulins (often used in patients with significant insulin resistance, as seen in some teenagers or those with Type 2 diabetes).

The most common concentrated insulins include U-200, U-300, or U-500 insulins, which are 200, 300 or 500 units of insulin per mL of solution, respectively.

Verifying the insulin concentration is imperative for safety and the avoidance of medical error.

Delivery of U-100 insulin to a patient who usually takes concentrated insulin can lead to iatrogenic hyperglycemia due to underdosing.

Conversely, if a patient on dilute insulin (e.g., U-10, U-20, U-50) receives standard U-100 or more concentrated insulin, it can lead to iatrogenic and potentially deadly hypoglycemia.

There are many different types of exogenous insulin used in insulin-replacement therapy and each can be categorized by its duration of action.  These categories are broken down in Table 2 produced by the Centers for Disease Control and Prevention.

In the matching game below, drag the correct insulin class/types (found on the right) to their correct pharmacokinetic profile (the colored lines on the left). Then, drag the brand-name insulins (Lantus, NPH, Tresiba, Levemir, Humalog, Regular) to their corresponding pharmacokinetic profile and insulin type pairing.

Hint: You may need to read the remainder of Unit 2 to learn more about the brands of insulins.

The types of insulin chosen for the treatment of diabetes are dependent upon various factors, including:

• Goals of insulin therapy
• The method of insulin delivery
• Insurance coverage
• The individual needs of the patient

It is beyond the scope of this book to review each type of insulin; however, the most common types of insulin used in the inpatient setting at Stead Family Children’s Hospital will be reviewed along with the role each insulin plays in a basal/bolus insulin regimen.

1. Centers for Disease Control and Prevention. (2022, December 30). Types of insulin. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/type-1-types-of-insulin.html