Practical aspects in the usage of U‐500 insulin

Garg, Robin; Johnston, V.; McNally, PG; Davies, M. J.; Lawrence, IG

doi:10.1002/pdi.918

Cited by 5 publications

(8 citation statements)

References 8 publications

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“…[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. 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).…”

Section: Discussionmentioning

confidence: 99%

“…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: Discussionmentioning

confidence: 99%

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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“…Cost comparisons between insulin preparations with comparisons between the available U-100 formulations and U-500 have been described in the literature 15 21. (For most recent cost comparisons refer to table 2).…”

Section: Cost Implicationsmentioning

confidence: 99%

Insulin U-500 in severe insulin resistance in type 2 diabetes mellitus

Crasto

Jarvis

Hackett³

et al. 2009

Postgraduate Medical Journal

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Some patients with type 2 diabetes mellitus (T2DM) are profoundly insulin resistant and require large insulin doses to achieve optimal glycaemic control. However, large volumes of subcutaneous conventional U-100 insulin can cause discomfort at the injection site, resulting in poor concordance with insulin therapy. One therapeutic option is the use of U-500 insulin, thus reducing the insulin volume by 80%. This review will address the practical issues associated with the use of U-500, clinical efficacy and safety aspects of this concentrated insulin, which has an important role in a subgroup of patients with T2DM.

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“…NICE guidelines (published in 2003)9 were followed in 78% of patients for initiation of pump therapy. Although the NICE guidance is for T1DM and not T2DM, patients with T2DM were commenced on CSII as they were severely insulin resistant and using large doses of U‐500 Human Actrapid insulin 11. Thirty‐five patients had attended the Dose Adjustment For Normal Eating (DAFNE) education programme 12…”

Section: Methodsmentioning

confidence: 99%

Continuous subcutaneous insulin infusion: experience from a large specialist service

et al. 2009

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The National Institute for Health and Clinical Excellence issued guidelines on continuous subcutaneous insulin infusion (CSII) in 2003 and has recently updated them. We present the findings of a retrospective study on CSII in a tertiary teaching hospital. Data were analysed on 85 patients established on CSII. The mean follow up was 24 months, 70% were female and the mean age was 40 years. Eighty‐two patients (96.5%) had type 1 diabetes, the mean duration of diabetes being 23 years, and NICE guidelines were followed for initiation in 78%. Patient satisfaction was assessed by Likert scale (‐3 to + 3) questionnaire. On CSII there was an improvement in HbA1c (mean [SD] 9.4[1.9] vs 8.6[1.5]%; [p<0.01]), with no significant change in weight. Severe hypoglycaemia decreased from 0.85 episodes/patient‐year to 0.08/patient‐year without an increase in diabetic ketoacidosis (0.20/patient‐year vs 0.09/patient‐year). Mean basal insulin requirement fell from 31(25) to 22(16) units (p<0.01). Thirty‐five out of the 85 patients had undertaken a DAFNE (Dose Adjustment For Normal Eating) course. After DAFNE, mean HbA1c fell from 9.2 to 8.9% (p<0.05), and then to 8.5% (p<0.05) after pump therapy. The response rate to the satisfaction questionnaire was 92%. Patients were happier on the pump compared to their previous treatment (mean score 2.5[2.3‐2.7 95% CI]). In the cohort of patients established on pump therapy, there was a significant improvement in glycaemic control, with an accompanying reduction in severe hypoglycaemia. Insulin pump therapy improves glycaemic control further in DAFNE graduates with no increase in severe hypoglycaemia. Patients were satisfied with pump therapy. Copyright ©2009 John Wiley & Sons, Ltd.

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Practical aspects in the usage of U‐500 insulin

Cited by 5 publications

References 8 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

Insulin U-500 in severe insulin resistance in type 2 diabetes mellitus

Continuous subcutaneous insulin infusion: experience from a large specialist service

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