Clinical Experience With U-500 Regular Insulin in Obese, Markedly Insulin-Resistant Type 2 Diabetic Patients

Ballani, Piya; Tran, Michael T.; Navar, Maria D.; Davidson, Mayer B.

doi:10.2337/dc06-1478

Cited by 54 publications

(56 citation statements)

References 10 publications

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“…3,6 Severe insulin resistance has been defined as the requirement for > 200 units of insulin/day. 1,4,7,8,10 The average insulin dose in patients in this report was 2.5 units/kg/day, similar to what has been reported in prior studies of U500 (range, 1.5-3.6 units/kg/day). 7,8 There are several limitations of this study.…”

Section: Discussionsupporting

confidence: 87%

“…1,4,7,8,10 The average insulin dose in patients in this report was 2.5 units/kg/day, similar to what has been reported in prior studies of U500 (range, 1.5-3.6 units/kg/day). 7,8 There are several limitations of this study. The most important is the small number of subjects, suggesting that U500 is used infrequently and may in fact be underutilized.…”

Section: Discussionsupporting

confidence: 87%

“…This weight gain has previously been attributed to increases in TDD with initiation of U500. [7][8][9] Increases in TDD observed in this and prior reports runs counter to the clinical expectation that administering similar insulin doses at reduced volume would allow reductions in insulin requirements. 3,6 Severe insulin resistance has been defined as the requirement for > 200 units of insulin/day.…”

Section: Discussioncontrasting

confidence: 83%

“…3 This higher insulin concentration alters the pharmacokinetic properties of regular insulin to that of an intermediate-or long-acting insulin (LAI) preparation. [4][5][6][7][8] Standard recommendations for U500 suggest that it be administered in divided doses of two or three injections per day as the sole insulin preparation to meet both basal and meal-related insulin requirements. 2,3 Others have suggested that it be administered as a component of a basal/bolus insulin (BBI) regimen in combination with either rapid-acting insulin (RAI) or LAI preparations.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Others have suggested that it be administered as a component of a basal/bolus insulin (BBI) regimen in combination with either rapid-acting insulin (RAI) or LAI preparations. [3][4][5][6][7] These suggestions result in uncertainty and variability among clinicians in how to optimally prescribe and implement U500.…”

Section: Introductionmentioning

confidence: 99%

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U-500 Insulin as a Component of Basal Bolus Insulin Therapy in Type 2 Diabetes

Lowery

Donihi²,

Korytkowski³

2012

Diabetes Technology & Therapeutics

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Background: Changes in hemoglobin A1c (A1C), weight, and total daily insulin dose (TDD) were investigated following initiation of insulin U-500 (U500) alone or as part of a basal/bolus insulin (BBI) regimen. Subjects and Methods: Records of patients with type 2 diabetes who were prescribed U500 were retrospectively reviewed. Logistic regression analysis was used to investigate relationships between changes in A1C and use of U500 alone or as BBI. Results: Twelve patients were identified as using U500 alone (n = 2) or in combination with long-acting (LAI) (n = 7) or rapidacting (RAI) (n = 3) insulin. Reductions in A1C (9.5% at baseline vs. 7.7% at 6-9 months, P < 0.0001) and increases in weight (128.8 -32.7 vs. 131.5 -31.3 kg, P < 0.014) and TDD (260 -111 to 333 -106 units/day, P < 0.0002) were observed. Concurrent use of LAI or RAI with U500 did not predict improvements in A1C. Conclusions: U500 resulted in improvements in A1C and weight gain and increased TDD when used alone or as part of combination insulin therapy. Further investigations to define the optimal use of U500 are recommended.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

U-500 Insulin as a Component of Basal Bolus Insulin Therapy in Type 2 Diabetes

Lowery

Donihi²,

Korytkowski³

2012

Diabetes Technology & Therapeutics

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Current literature in diabetes

2007

Diabetes Metabolism Res

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 26 sections: 1 Reviews; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Obesity; 7 Prediction and Prevention; 8 Intervention: a) General; b) Care; c) Drug Therapy; d)Economics; e) Gene therapy; f) Nursing; g) Nutrition; h) Surgery; i) Transplantation; 9 Pathology and Complications: a) General; b) Cardiovascular; c) Eye disease; d) Gestational and fetal; e) Neurological; f) Podiatrical; g) Renal; 10 Endocrinology & Metabolism; 11 Experimental Studies; 12 Diagnosis and Techniques. Within each section, articles are listed in alphabetical order with respect to author

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Long‐term follow up of patients on U‐500 insulin: a case series

et al. 2010

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The aim of this paper is to describe the long‐term effect of U‐500 insulin use on biomedical outcomes in a cohort of patients with diabetes mellitus.We carried out a case record review of 81 patients from a multicultural population who had received U‐500 insulin. We recorded data before the introduction of U‐500 and at data collection (February 2007) including: demographic information, weight, insulin dose, HbA1c, lipid profile and blood pressure.The results showed that the mean duration of treatment was 30±22.6 months (range 1–98). The median insulin dose was 292 vs 320 units/day (range 122–600 vs 120–760 units/day). Mean HbA1c at baseline improved from 10.0±1.8% to 8.7±2.0% (p<0.0001). Patients using U‐500 insulin for a longer period (>36 months) showed a greater reduction in HbA1c (1.8±1.5% vs 0.99±1.8%, p<0.05). An improvement in HbA1c was seen in all ethnic groups. Mean total cholesterol reduced from 4.9±1.4mmol/L to 4.3±1.0mmol/L (p<0.0001) and triglycerides from 4.3±4.5mmol/L to 3.0±3.0mmol/L (p<0.001). Significant weight gain was seen.It was concluded that long‐term glycaemic control improved with the use of U‐500 Human Actrapid in all ethnic groups (p<0.05) at the expense of weight gain.U‐500 Human Actrapid is a valuable treatment option in patients with diabetes and severe insulin resistance. Copyright © 2010 John Wiley & Sons.

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Clinical Experience With U-500 Regular Insulin in Obese, Markedly Insulin-Resistant Type 2 Diabetic Patients

Cited by 54 publications

References 10 publications

U-500 Insulin as a Component of Basal Bolus Insulin Therapy in Type 2 Diabetes

U-500 Insulin as a Component of Basal Bolus Insulin Therapy in Type 2 Diabetes

Current literature in diabetes

Long‐term follow up of patients on U‐500 insulin: a case series

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