Original ArticleU500 Regular Insulin use in Insulin-Resistant type 2 Diabetic Veteran Patients
Section snippets
INTRODUCTION
Insulin resistance is a major component of type 2 diabetes mellitus often aggravated by obesity, which may necessitate the injection of large amounts of insulin to control hyperglycemia. In patients with severe insulin resistance, U500 regular insulin has been effectively used to improve glycemic control (1., 2., 3., 4., 5., 6., 7.). Generally fewer injections are required with U500 regular insulin, potentially resulting in improved regimen adherence. The decreased volume of concentrated
PATIENTS AND METHODS
The diabetes service at the VA North Texas Health Care System-Dallas developed a protocol for starting U500 insulin in patients on more than 200-300 units a day of U100 insulin regimens (Box 1). Key components of our protocol were (a) patients were followed up by the diabetes clinic and kept their regularly scheduled appointments; (b) patients met with a diabetes educator before starting U500 insulin and understood the difference between U100 and U500 insulin; and (c) U500 insulin was
RESULTS
Sixty-six type 2 diabetic patients were identified from pharmacy records as having received treatment with U500 insulin. Six patients were excluded because they had been taking U500 insulin less than 6 months. One patient was excluded because he was already taking U500 insulin before being referred to the diabetes clinic and thus no baseline data were available. One patient was excluded because of incorrectly taking U500 insulin, which meant it was difficult to estimate how much insulin the
DISCUSSION
Treatment of insulin resistance in obese type 2 diabetic patients remains a therapeutic challenge. Insulin sensitizers such as metformin or thiazolidinediones often cannot be used because of concomitant medical conditions. U500 regular insulin is an effective treatment option because the increased concentration results in reduced volume, which may make it more predictably absorbed than U100 insulin in insulin-resistant patients. Our data suggest that U500 regular insulin can be safely used in a
CONCLUSION
The results of this study show that U500 regular insulin can be safely and effectively used in a large academic VA medical center using a protocol that ensures patient safety. Patients taking U500 insulin for 6 months or longer had a reduction in A1C level of 1 percentage point. Unlike findings from other published studies, the patients included in this study did not have a significant increase in weight gain or require more units of insulin per day (1., 2., 3., 4., 5., 6., 7., 14). Episodes of
DISCLOSURE
The authors have no multiplicity of interest to disclose.
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Cited by (20)
The switch from rapid-acting to concentrated regular insulin improves glucose control in type 2 diabetes patients on pump therapy: A cohort survey
2022, Diabetes and MetabolismCitation Excerpt :The use of a more concentrated insulin may be offered to patients with T2DM in the context of high insulin requirements and/or suboptimal glucose control. Small retrospective series have shown an improvement of glucose control with the use of 500 U/ml (U-500) regular insulin administered by MDI [3–7] or by CSII using a pump device [8–11]. Only one retrospective uncontrolled study has examined the long-term efficacy of concentrated insulin use in pumps for treating T2DM [12].
Treatment patterns and outcomes before and after human regular U-500 insulin initiation via KwikPen® among US veterans with type 2 diabetes mellitus
2021, Journal of Diabetes and its ComplicationsCitation Excerpt :Many studies have evaluated the effectiveness and safety of U-500R multiple daily injection (MDI) via syringe,9,10,15,22,26,36 including one randomized clinical trial (Hood et al),19 one large retrospective study,26 and several studies meta-analyzed by Reutrakul et al.37–46 Although this U-500R MDI via KwikPen real-world study shared the same trends as previous studies of U-500R MDI via syringe some differences exist. For effectiveness, the 0.7% reduction in HbA1c observed in the present study was less than that seen in Hood et al. (1.1%–1.2%)19 and in the meta-analyzed studies (overall reduction 1.59% (CI: 1.26–1.92)37–46) but aligned with a 0.7% reduction observed in another retrospective study by Eby et al.26 We note that except of biguanides, the use of concomitant anti-diabetes treatments were infrequent and sulfonylureas and biguanides decreased after U500-KP initiation with a modest, 3.9% increase in GLP-1 receptor agonist use. We therefore feel that concomitant use of other diabetes medications is unlikely to confound the observed HbA1c reduction due to U500-KP initiation.
A retrospective review of insulin requirements in patients using U-500 insulin hospitalized to a Veterans Affairs Hospital
2017, Journal of Diabetes and its ComplicationsCitation Excerpt :This potent insulin is given to patients with highly resistant diabetes mellitus that require greater than 200 units per day of U-100 insulin or require greater than 2 units/kg.1–4 Previous retrospective and prospective studies have shown the safety and efficacy in improving glycemic control long term in patients receiving U-500 insulin.5–10 The potency and concentration of U-500 insulin raise safety issues such as protracted hypoglycemia and administration errors and physicians, pharmacists and patients should be aware of these.11
A simplified straightforward protocol for the use of U-500 regular insulin
2023, Diabetes, Obesity and Metabolism