The use of U-500 insulin for patients with severe insulin resistance

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One of the most significant challenges in the management of type 2 diabetes mellitus (T2DM) is the titration of insulin in patients with severe insulin resistance. This is particularly true of obese, sedentary patients whose severe insulin resistance may require daily amounts of 200 units of insulin or more to obtain target A1C levels.1 This volume of insulin, injected subcutaneously, often leads to inadequate absorption, poor adherence, and increased drug and supply costs.2
U-500 regular concentrated insulin offers insulin treatment without large volumes of insulin. It is a viable alternative to U-100 insulin formulations in select patients and may result in improved A1C control, enhanced adherence, and increased patient satisfaction.3,4 However, some primary care providers may be unaware or clinically uncomfortable with the use of U-500 insulin.
The purpose of this article is to describe the evaluation and management of a patient with T2DM with severe insulin resistance who is a candidate for U-500 regular concentrated insulin. This case-based approach will highlight important considerations, describe the dosing of U-500 insulin, and review potential challenges.
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