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How many units on a U-100 insulin syringe is a 20 mg dose at 5 mg/mL?

Asked 24 Aug 2024Modified 22 months agoViewed 13k times
17

The particulars: a U-100 insulin syringe · 20 mg · 5 mg/mL.

I would like the arithmetic checked rather than the conclusion asserted.

I have deliberately not used an online calculator because I want to be able to check the result.

What is the general form of this calculation?

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askedines_delacruz16k1724 Aug 2024
8Note that the label instructions differ between agents on precisely this point. – v_ramaswamy 31 days ago
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5 Answers

Accepted answer first, then by votes
99

Accepted answer

Write the units at every step, because units errors are the failure mode that catches everyone eventually.

Worked example, because the general form is easier to trust once you have seen it once. Take a 10 mg vial and add 2 mL of diluent: the concentration is 10 ÷ 2 = 5 mg/mL. A 0.5 mg dose is 0.5 ÷ 5 = 0.1 mL. On a U-100 syringe, where 1 unit = 0.01 mL, that is 0.1 ÷ 0.01 = 10 units. Change the diluent to 1 mL and the same dose becomes 5 units — same dose, half the resolution.

Concentration and unit conversion at a glance

VialDiluentConcentration0.25 mg0.5 mg1 mg2.5 mg
5 mg1 mL5 mg/mL5 u10 u20 u50 u
5 mg2 mL2.5 mg/mL10 u20 u40 u100 u
10 mg1 mL10 mg/mL2.5 u5 u10 u25 u
10 mg2 mL5 mg/mL5 u10 u20 u50 u
10 mg3 mL3.33 mg/mL7.5 u15 u30 u75 u

Units are U-100 insulin units, where 1 unit = 0.01 mL. Divide dose by concentration for millilitres, then multiply by 100.

The concentration you actually work with is label claim times content fraction divided by actual diluent volume, which is usually not the same as the nominal concentration because content is usually not 100 per cent and you rarely measure the diluent volume to 0.1 mL precision.

The insulin-unit standard U-100 means 100 units per millilitre, so one unit is 0.01 mL — this is the conversion that trips up more people here than any other single piece of arithmetic.

Write the arithmetic on the vial label. It costs nothing and removes the step where you reconstruct it from memory.

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SK
answered · accepteds_kalniete47k3829 Sept 2024
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85

The relevant detail is that the distinction that resolves most of these questions is understanding what concentration actually means and why it is not the same as label claim.

Room temperature before drawing is worth the ten minutes. Cold solution is more viscous, draws slower, and condensation on a cold barrel makes it harder to read the meniscus.

Air bubbles at these volumes are a measurement problem rather than a safety one. A 2 mm bubble in a 0.3 mL syringe is roughly 4 µL, which at 10 units drawn is a four per cent error.

The content assay results from major testing services show that nominal vial claim and measured content differ by one to ten per cent, making content a driver of dose error.

Worth noting: the concentration after reconstitution is not the same as the label claim, and most people do not account for the difference.

If in doubt, use more diluent and accept the shorter usable window.

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PH
answeredpetra_hovland42k3810 Oct 2024
41

The underlying point is that work in the order concentration, then volume, then units, and the arithmetic stops being confusing. Concentration is milligrams per millilitre and comes from the vial contents and the diluent volume. Volume per dose is dose divided by concentration. Units on a U-100 syringe are volume in millilitres multiplied by one hundred.

On filtration: a 0.22 µm syringe filter will remove particulates and organisms, and it will also adsorb a fraction of your peptide onto the membrane — with a low-binding PVDF or PES membrane the loss is typically a few per cent.

To be exact about it, number of stopper piercings matters less than the gauge doing the piercing. A 30G or 31G needle through a butyl stopper leaves a track that reseals; a 21G or 18G drawing needle punches a core and can drop it into the solution.

The Arrhenius relationship for drawing kinetics means that cold solution takes noticeably longer to draw than room-temperature solution.

One qualification: if your arithmetic and someone else's disagree by a factor of ten, one of you has made a unit error, and writing out the units at every step is the diagnostic.

Do the arithmetic twice, ideally with someone else doing it independently.

edited 10 Oct 2024 by meniscus_film — tightened the wording; no substantive change

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MF
answeredmeniscus_film34k3818 Sept 2024
Any reason this would differ for a longer peptide? – lyoph_cake 2 months ago
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34

The relevant detail is that two people working through the same arithmetic independently should get the same answer, and if they do not, someone has made a unit error.

Rotation of injection site is a tolerability measure, not a pharmacokinetic one, but if you are going to do it you might as well do it right.

Write the arithmetic on the vial label. It costs nothing and removes the step where you reconstruct it from memory.

edited 11 Sept 2024 by RP_C18 — updated for the 2026 guidance change

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RC
answeredRP_C1885k1587 Sept 2024
8For what it is worth, my own result was within half a per cent of this. – pk_curve 8 months ago
7Any reason this would differ for a longer peptide? – sian_llewellyn 6 months ago
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31

Concretely, the single most useful thing to do is write the arithmetic on the vial label, because you will reconstruct it from memory at an inconvenient moment if you do not.

Breaking it down further: if a 10 mg vial has 96.5 per cent content, you have 9.65 mg of peptide. Divide that by 2.00 mL and your concentration is 4.825 mg/mL, not 5.00 mg/mL, which is a 3.5 per cent systematic error in every dose calculation.

Published data on syringe dead space quantifies low-dead-space designs as retaining under 2 µL against 35 µL or more for conventional detachable-needle syringes.

The caveat is that this assumes the vial contains what the label says, and if the content assay has not been done, the arithmetic is precise about an unknown quantity.

If in doubt, use more diluent and accept the shorter usable window.

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EB
answeredelke_brunner14k1827 Aug 2024
3Any reason this would differ for a longer peptide? – b_delacroix 8 months ago
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