Concentrated Insulins: When a Little Goes a Long Way

Pharmacist Learning Objectives

At the conclusion of this continuing education activity, the participant will be able to:

1. Describe pathophysiology behind extreme (aka severe) insulin resistance

2. Identify the types of concentrated insulins

3. Describe key considerations of concentrated insulin prescribing and dispensing practices

Nurse / Pharmacy Technician Learning Objectives

At the conclusion of this continuing education activity, the participant will be able to:

1. Review the mechanism of insulin resistance

2. Identify the types of concentrated insulins

3. Recall patient considerations when dispensing concentrated insulins

The advancement of diabetes management has resulted in the development of concentrated insulins to treat the growing number of people with severe insulin resistance. Due to the various concentrations available of both old and novel insulins, there is a heightened risk for medication errors and negative outcomes at the points of prescribing, dispensing and administration. As patients transition between care models and insulin concentrations, pharmacists require the skills to effectively calculate equivalent doses, dispense accurate quantities, and provide thorough counseling to patients. Formulary restrictions within the healthcare system and/or limited exposure to these insulin delivery devices may lead to some pharmacists not having the opportunity to become adequately proficient in these skills. Furthermore, concentration insulins and their place in therapy is only minimally covered in national therapeutic guidelines, and often excluded from treatment algorithms. This activity will review the pathophysiology of severe insulin resistance to explain the rationale behind the development and increased utilization of concentrated insulins. The different classes of concentrated insulins will be covered, in addition to their delivery systems and device specifications. Cases will be used throughout the activity to apply knowledge obtained on dosing considerations and dispensing strategies, as well as patient counseling.