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December 4, 2000

Insulin, Insulin Pumps

Question from Maplewood, New Jersey, USA:

I am on an insulin pump and very insulin resistant. I currently use Humalog and require about 130 to 150 units daily. I wish to become pregnant in the near future and know that I will require considerably more insulin before and during this time. I am seeking information about availability of U-400 insulin. My understanding is that it is available for implantable insulin pumps. Can it be used in external pumps? Where can my doctor and I find more information on the availability of this insulin? Is it fast-acting like Humalog?

Answer:

One of the things which is not clear from your question is whether you have type�1 or type�2 diabetes. I would assume that there is a degree of insulin resistance with your current insulin requirements. All individuals may have their insulin requirements decreased by exercise and maintenance of healthy weight. Above that, patients with type 2 diabetes may improve their insulin resistance with Glucophage [metformin] or a thiazolidinedione drug. However, these latter medicines are either controversial or contradicted with pregnancy. With regard to the availability of U-400 insulin (400 U per 1 ml volume), I would recommend you speak with a representative from the pharmaceutical industry. I have been told these insulins are available upon demand. You would have to work very close with your physician when implementing therapy with the insulin because of the risk of over-treatment with such a concentrated insulin.

JTL

[Editor’s comment: U-500 insulin is available from Lilly and can be used in external pumps. Your physician will need to contact the company directly. I believe, however, it is Regular and not Humalog.

SS]