Safety and Effectiveness of U‐500 Insulin Therapy in Patients with Insulin‐Resistant Type 2 Diabetes Mellitus

The use of U-500 regular insulin (U-500R) to treat diabetic patients with severe insulin resistance has increased. In this review, we performed a meta-analysis of PubMed studies reporting the use of U-500R to evaluate the effects of U-500R on hemoglobin A1c (HbA1c), body weight, and total daily insulin dose (TDD). These studies included 310 patients using U-500R as multiple daily injections (MDI) and 55 patients using U-500R via continuous subcutaneous insulin infusion (CSII). Overall, the use of U-500R as MDI resulted in a significant HbA1c reduction of 1.59%, a significant weight gain of 4.38 kg, and a significant increase in TDD by 51.9 units. The use of U-500R via CSII resulted in a similarly significant HbA1c reduction of 1.64% but a nonsignificant weight gain and a nonsignificant change in TDD. The use of U-500 regular insulin both as MDI and via CSII was not reported to be associated with severe hypoglycemia but was associated with an increase in patient satisfaction as well as in cost savings. Suggestions in initiating U-500R in the outpatient setting using U-500R in hospitalized patients are reviewed. In addition, precautions for avoiding prescription and patient errors are discussed.

show abstract

“…25 Two studies reported that the number of insulin injections significantly decreased. 25,26 In addition, there…”

Section: Use Of U-500r Via Multiple Daily Injectionsmentioning

confidence: 99%

Clinical Use of U-500 Regular Insulin: Review and Meta-Analysis

Reutrakul

Wroblewski

Brown

2012

J Diabetes Sci Technol

View full text Add to dashboard Cite

show abstract

“…1,2 In selected patients, U-500 regular insulin (U500) allows for administration of high TDD at volumes lower than that required with standard U-100 insulin (U100) preparations. 3 This higher insulin concentration alters the pharmacokinetic properties of regular insulin to that of an intermediate-or long-acting insulin (LAI) preparation.…”

Section: Introductionmentioning

confidence: 99%

“…[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. [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%

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

Lowery

Donihi²,

Korytkowski³

2012

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

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.

show abstract

“…Histologically, it creates a typical acute inflammatory reaction immediately, and within a few days macrophages engulf the pigment, migrate to the regional lymph nodes, and cause varying degrees of inflammatory reaction. 2,3 The presence of enlarged lymph nodes secondary to reaction to tattoo pigment recently has become significant in the malignant melanoma literature, where the presence of enlarged pigmented lymph nodes has led to the erroneous presumption of recurrence or metastasis. 4,5 Additionally, lymph node calcifications attributable to tattoo pigment have been mistaken for metastatic breast cancer on screening mammography.…”

Section: Casementioning

confidence: 99%

“…Typical insulin regimens for diabetic patients during pregnancy include combinations of intermediate-acting insulin and mealtime doses of short-acting insulin; however, for patients with increasingly high insulin requirements, these frequent, high-volume injections may lead to decreased insulin effect, compromised patient adherence, and inadequate glycemic control. 2 …”

mentioning

confidence: 99%