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Aims The prevalence of highly insulin-resistant diabetes is increasing and treatment requires the use of very high doses of insulin. This study was performed to analyze efficacy and patient satisfaction with use of U-500 concentrated insulin. Methods The medical records of 40 patients using U-500 insulin for at least 3 months were reviewed. A quality of life questionnaire was administered 6 or more months after U-500 was initiated. Effects of U-500 use on HbA1c, weight, total daily insulin use, hypoglycemia, and patient satisfaction were measured. Results Patients had uncontrolled diabetes for 3 years prior to U-500 initiation despite insulin titration. Subjects required continued insulin titration to attain glycemic control even after U-500 initiation, but HbA1c decreased by 1.5% within 3 months. Subjects gained weight with insulin titration. Hypoglycemic symptoms increased early after transition to U-500 insulin, but patients reported fewer hypoglycemic episodes on the quality of life questionnaire. Patient satisfaction with diabetes care and control was significantly improved following transition to U-500 insulin. Conclusions Use of U-500 insulin assists with attaining glycemic control in highly insulin-resistant subjects, but at the cost of weight gain and increased insulin doses. However, patient satisfaction is improved with U-500 insulin use.

The purpose of this study was to compare inpatient insulin needs with usual home insulin needs for severely insulin resistant individuals using U-500 insulin.This was a retrospective review of patients using U-500 insulin at one institution. Subjects were divided into 3 groups according to their pre-admission HbA1c [8%, 8-8.99%, ≥9%] as glycemic control could impact inpatient insulin requirements. The primary outcome was the average total daily insulin dose during hospitalization. Secondary outcomes included the degree of blood sugar control during hospitalizations and insulin doses 6 months after discharge.Sixty-three patients with a total of 116 admissions were included. The average inpatient insulin dose was only 22.6% of the usual home insulin dose. There were no differences in the frequency of low blood sugars between glycemic control groups. By 6-months post-discharge the majority of subjects were back on their pre-admission dosing.Inpatient insulin needs were strikingly reduced (by average 75%) compared to home dosing regardless of pre-admission glycemic control. The results of this study should encourage institutions to assess their inpatient insulin protocols for U-500 using individuals.

Previous short-term studies evaluating U-500 insulin have reported improvements in glycemic control but with significant weight gain. This study was performed to examine the glycemic durability of U-500 insulin in highly insulin resistant subjects, and to determine if weight gain was continuous with use. Patients using U-500 insulin provided consent for chart reviews for up to 3 years prior to and 3 years after use of U-500 insulin. Charts were reviewed for physical and metabolic data from 53 subjects using U-500 insulin of which 20 used U-500 insulin for 3 years. Use of U-500 insulin led to an approximate 1% decrease in HbA1c within 3–6 months of use which was sustained for up to 3 years. Patients required increased insulin doses (by ∼80%) over the first 6–12 months with a corresponding weight gain (∼10 lbs) and a spike in hypoglycemia symptoms, but then insulin doses and body weight, as well as glycemic control and hypoglycemic symptoms, stabilized over subsequent follow up. Use of U-500 insulin in a clinical diabetes practice leads to sustained improvements in glycemic control following a period of insulin titration and weight gain. Despite the weight gain, glycemic control was sustained for up to 3 years.