New Insulin Preparations: Potential Benefits and Risk Assessments

• Two new products address safety concerns related to insulin pharmacology and delivery: insulin glargine (Toujeo U-300 [300 U/mL] delivered subcutaneously with a SoloSTAR insulin pen) and insulin lispro (Humalog U-200 [200 U/mL]) KwikPen).
• The increased incidence of insulin-resistant type 2 diabetes has created a need for more concentrated insulin with a flatter time action curve along with a safer means to administer these concentrated insulin preparations.
• The use of these insulin pens has the potential to decrease hospital-associated medication errors.
• However, the potential for patient off-label use of insulin pens is a risk that the nurse practitioner can mediate through patient assessment and education.

Concentrated insulins have been especially problematic high alert medications. On February 25, 2015 Federal Drug Administration (FDA) approval made available insulin glargine, Toujeo® U-300 (300 units/ml) in a SoloSTAR® pen. On May 27, 2015 the FDA approved insulin lispro, Humalog® U-200 (200 units/ml) KwikPen™. Increased incidence of insulin resistant type 2 diabetes has escalated the need for concentrated insulin. This paper discusses each insulin, appropriate patient selection, benefits of the new insulins for people with diabetes and providers, and suggestions for prevention of potential off-label use of insulin pens. Counseling and assessment are essential to avoid unintended harm.