PERSPECTIVE article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1692589
This article is part of the Research TopicTechnologies for Diabetes, volume IIIView all 7 articles
Practical Considerations for Using Concentrated U200 Insulin in Automated Insulin Delivery Systems
Provisionally accepted
- 1Children's Hospital of Philadelphia, Philadelphia, United States
- 2University of Pennsylvania Perelman School of Medicine, Philadelphia, United States
- 3The Children's Hospital of Philadelphia, Philadelphia, United States
- 4Johns Hopkins University, Baltimore, United States
- 5Children's National Hospital, Washington, United States
- 6University of Colorado Denver Barbara Davis Center for Childhood Diabetes, Denver, United States
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The use of automated insulin delivery systems (AID) is standard of care for people with type 1 diabetes. However, the limited capacity of insulin pump cartridges, which can hold 1.6-3.0mL or the equivalent of 160-300 units of U100 insulin, can be a barrier to AID use for individuals with high total daily insulin (TDI) requirements. With the rising prevalence of obesity, expansion of AID use to type 2 diabetes, and trends towards smaller cartridge volumes to decrease the size of devices, practical solutions to reduce barriers to AID use for those with high TDI requirements are needed. U200 concentrated rapid-acting insulin (U200) has a similar pharmacokinetic and pharmacodynamic profile to U100 insulin, provides the same dose of U100 insulin in half of the volume, and has been used off-label to facilitate AID use for those with high TDI needs. In this perspective piece we provide practical considerations for clinical implementation of U200 use in AID systems, including identification of candidates, unique considerations in filling pumps with U200 insulin, guidance on programming appropriate AID settings for the different algorithms, concepts to address in patient education, and recommendations for standardized documentation in the electronic health record.
Keywords: Diabetes Mellitus, Type 1, Insulin Infusion Systems, automated insulin delivery, concentrated insulin, Patient Safety, Clinical Protocols
Received: 25 Aug 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Marks, Chu, Parimi, Wolf, Tran and Berget. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Brynn E Marks, marksb@chop.edu
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