Elsevier

Endocrine Practice

Volume 18, Issue 1, January–February 2012, Pages 34-38
Endocrine Practice

Original Article
U500 Regular Insulin use in Insulin-Resistant type 2 Diabetic Veteran Patients

https://doi.org/10.4158/EP11043.ORGet rights and content

ABSTRACT

Objective

To evaluate the use of U500 regular insulin therapy in insulin-resistant patients with type 2 diabetes mellitus who were previously treated with high-dosage U100 insulin regimens.

Methods:

At a large Veterans Affairs medical center, a retrospective chart review was performed of all patients whose U100 insulin regimens were converted to U500 regular insulin regimens using a protocol to ensure patient safety. Patients were followed up for longer than 6 months. Data reviewed included total daily dosage of insulin before and after regimen conversion and changes in hemoglobin A1c, body weight, lipids, and episodes of severe hypoglycemia.

Results

Fifty-three patients met inclusion criteria. Average hemoglobin A1c level on U100 insulin regimens was 9.1 ± 1.7%, which decreased to 8.1 ± 1.3% (P < .001) after an average of 20 months (range, 6-52 months) on U500 insulin. The total daily insulin dosage at study end was not significantly greater on U500 (415 ± 166 units/day) than on U100 insulin (391 ± 120 units/day) (P = .34). Body weight did not change significantly (134 ± 29 kg vs 136 ± 30 kg, P = .18). There was a 20-mg/dL decrease in total cholesterol (P = .014). Triglyceride values decreased by 97 mg/dL (P = .005). Eight episodes of severe hypoglycemia were documented in patients treated with U500 insulin, but this was similar to the incidence in these same patients while treated with U100 insulin.

Conclusion

We conclude that U500 insulin can be safely and effectively used in insulin-resistant patients with type 2 diabetes followed up at a large Veterans Affairs medical center using a protocol that ensures patients are thoroughly educated and carefully monitored. (Endocr Pract. 2012;18:34-38)

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.

REFERENCES (14)

There are more references available in the full text version of this article.

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