Aw, thanks! Glad I am of some useful contribution here 
I appreciate you looking into it. Based on what I found and what my pharmacist friend found, I should be ok taking it in a 1:1 ratio. Just only can take even-numbered doses with the pen!
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@allison Here’s another article on U200 Tresiba: https://assets.publishing.service.gov.uk/media/547307fde5274a130300002b/con228797.pdf. I’m not sure it clarifies the “math” and admit to confusion in trying to wrap my head around this! I await instruction from someone that “knows” like the unflappable @Eric, @Sam, @ClaudnDaye or other expertise.
I thought, like you, U200 is twice the strength of U100 on a volume to volume basis (i.e. 1cc to 1cc), so 1cc of U200 is twice the insulin strength. That seems to be the case per the linked article. However, I’ve also read 1 unit = .01 ml, so that 100 units = 1ml and as most pens contain 3ml they contain 300 units of insulin. Following the logic, U200 pens with 3ml would equal 600 units of insulin, again it matches the linked page. I can only assume the 1 unit = .01 ml only applies to U100 products and that the “unit dialer” on the U200 Tresiba cuts the volume of material appropriately in half, ergo the 2 unit dosing limit.
OK, brilliant minds, educate us lowly neophytes!
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The whole “unit” thing is confusing. I know I have certainly considered a “unit” to be a measure of volume. How much of this "stuff " am I taking? Let me measure the volume in a syringe.
Just like we measure volume in a recipe, with things like “cups”, “teaspoons”, and “tablespoons”.
So the idea of volume is somewhat ingrained in our heads!
But thinking of units as “volume” is not the right way to think about it.
Not sure if this will help, but perhaps a non-math and non-insulin type of example will make it easier to understand…
When you have a headache, you take 1 aspirin. You only ever need 1 aspirin. Unfortunately, the aspirin in this story is really big, and hard to swallow!
A medical company has developed a new aspirin that is much more concentrated, and the pills are now much smaller. It is a tiny aspirin! It makes it so much easier to swallow. Yay!
You buy the new aspirin and you are surprised and delighted. The new pills are 1/2 the size of the old ones!
So…would you take 2 of the new aspirin, or still take 1 aspirin?
Of course you would still only take 1 aspirin…
I think the diabetes people made the whole U200 thing so much harder to understand than it needed to be.
But if you ever get confused, just remember the tiny aspirin example.
Rephrased, if you needed 5 units of U100, take 5 “units” of U200. It is the same amount of insulin, just in a smaller “aspirin”.
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That’s exactly what U100 means: 100 units per mL. That makes for nice arithmetic, because 0.01mL is 1 unit, 0.05mL is 5 units, and a 0.30mL U100 syringe holds 30 units.
U200 just means 200 units per mL. That matters if you are using it with a syringe that’s made for U100 insulin, but it doesn’t matter for pens, just set the dial to the number of units you want. With pens you don’t have to think about fractions of an mL.
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I use Humalog 200… injected by pen and in my pump. 1 unit by pen of Humalog 100 or 200 is the exact same dose. But the volume of the 200 is half and that is only pertinent if you draw it out by syringe from a pen to say… put in a pump. Which is why Humalog 200 will never be available for dosing by anything other than a pen where they can control the dose you actually are taking. Nor will it be approved by Eli Lilly for use in a pump. Because then you have to cut some calculations in half and double others in programming a pump. Lawsuits waiting to happen. My 1st endo originally prescribed it because when I started using Omnipods she thought I would go through pods too fast. It turns out that by switching to a pump I used quite a lot less insulin. But I liked it so I stayed with it. And my endo now has just kept up the scripts for me for it.
I am using about half my basal through my pod and half by MDI. And MDI for most of my bolus dosing. I’ve struggled to keep my pods because of DP, but also I still like some insulin when I exercise.
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Thanks for sharing your thoughts! Interesting to do pods + MDI - as they say, your diabetes may vary!
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The math would be very simple for the pump. All you would have to do is tell the pump if you are using U100 or U200. And the pump would then know if you need half the volume or normal volume, and deliver the correct amount.
The problem would be human error. If a person told the pump the wrong insulin, it would be pretty bad.
And either way - saying U200 when it’s U100, or the other way around. Making a mistake in either way would be significant.
And because people with 'betes can’t be trusted (sarcastic!), a pump company can never allow the possibility for us to make a mistake!
I can see them doing it where a pump is either U100 or U200. A prescription written for it, one way or the other. For example, if you get a U200 pump, that’s all it can ever do.
I admire you @Marie for using U200 in a U100 pump! Totally off-script! So cool.
I don’t think I could ever do that. The amounts are so ingrained in my head, that I don’t think I could ever “unlearn” how much insulin to take.
I just instinctively hit the number of units, don’t really think much about it. So using U200 would be a problem for me!
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@Marie The key point you make: Use extreme caution if using other than U100 in a pump!
I appreciate all the information provided!
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You are correct.
It’s exactly the same pen with u200 tresiba, except the one click of the u200 pen delivers 2 units of u200 (and each click is marked in 2 unit increments) —- which is exactly the same volume as 1 unit of u100, but contains 2x the medicine. The identical u200 pen contains 600 units of insulin, instead of 300.
It would be a problem if you were measuring it in a u100 syringe. In that case, for example, if you were measuring u200 insulin in a u100 syringe— the 10
Mark on the syringe would actually contain 20 units of insulin…… occupying the same amount of liquid volume as 10u of u100
A unit is a unit. How much volume that unit occupies is the only difference.
It’s easy to overthink but entirely unnecessary
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And here we all are, trying to make sense of it! Thank you!!
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This discussion makes me want to try a pump vacation–haven’t done so in a looooong time. I can’t even get Lantus anymore. My plan only covers Basaglar. I have perfect overnights on the Tandem, but I cannot for the life of me get any sites to work other than my stomach. It was the same with Omnipod, legs, butt, no hope I’d rip them off 100% of the time. Arms I could keep the site in, but it would hurt the entire time, and the absorption wasn’t great. I consistently run higher when I use my arms. My stomach is so overused it’s not even funny.
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It’s worth a try! Basaglar and Lantus are similar: Basaglar and Lantus - What is the difference between them?
I am currently using a sample pen of Tresiba but am going to switch back to Lantus soon. I think it’s easier to manage.
As long as you have a CGM, why not try it?! I am on month 5 of being unhooked and don’t plan on going back anytime soon. I do miss the perfectly flat overnight CGM graphs with ControlIQ, but I can put up with a little fluctuation using MDI.
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@PP777 Not sure if it might help, but I’ve also had some sites on my arms that are uncomfortable or even twinges of pain at times, if not painful. I’ve found trying to avoid muscle mass and using the space between muscle mass seems to be the key to avoiding it. I’ve developed a method to use the left abdomen a couple of times, then the right abdomen, then the left inner arm, and then the back left arm. The inside left arm area is where I tend to get the sensitive/twinge/painful areas and need to avoid the bicep/tricep area and aim for in between them. Hope you find another area to give your abdomen a break!
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