Short answer first, then the reasoning. Concentration choice is a precision decision, not a preference. Reconstitute high and every dose is a tiny volume where one unit of syringe error is a large fraction of the dose. Reconstitute low and you get more graduations per dose, so the same hand tremor costs proportionally less. Against that, more diluent means more benzyl alcohol and a shorter comfortable in-use window.

BenResearch_OR said:

Concentration choice is a precision decision, not a preference.

BenResearch_OR has the substance of this right. The condition it depends on is worth stating. The arithmetic is right and one caveat matters: a U-40 syringe changes the markings, not the volumes. If someone hands you U-40 and you read it as U-100 you will be 2.5 times out, and that error has a direction — it is always an overdose.

FranDenver said:

Two of us with identical vials and identical diluent arrived at different unit counts, which means one of us has a conceptual error rather than a…

Same position here, arrived at the long way round. Dead space is the answer to the missing dose. A fixed-needle insulin syringe holds a few microlitres in the hub and needle after the plunger bottoms out, and on small draws that is a measurable percentage of every dose. Across ten draws it adds up to most of an eleventh, which is exactly the "nine draws from a ten-dose vial" complaint. Luer-lock syringes are worse; low-dead-space fixed-needle designs are better.

Adding the clinical framing, because it changes how the question reads.

Bacteriostatic water quality matters for dosing arithmetic reconstitution. Not all BAC water is created equal:

• Should contain 0.9% benzyl alcohol as preservative
• Must be sterile and pyrogen-free
• Should come in a sealed, intact vial
• Check expiration date — yes, BAC water expires
• Store at room temperature, protected from light

I buy from a reputable medical supply company, not Amazon marketplace sellers. The $3 savings isn't worth the infection risk from unverified BAC water.