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[IP] A novel use of u-500 insulin for CSII

Endocr Pract. 2003 May-Jun;9(3):181-6.  

A novel use of u-500 insulin for continuous subcutaneous insulin infusion in 
patients with insulin resistance: a case series.

Knee TS, Seidensticker DF, Walton JL, Solberg LM, Lasseter DH.

Division of Endocrinology, Charette Health Care Center, Naval Medical Center 
Portsmouth, Portsmouth, Virginia.

OBJECTIVE: To report our experience with use of U-500 regular insulin (U-500) 
for continuous subcutaneous insulin infusion (CSII) in four patients with 
type 2 diabetes requiring high-dose insulin. METHODS: We performed a 
 retrospective review of medical records of four patients with type 2 diabetes
and insulin
resistance who were using U-500 in a CSII regimen for at least 6 months. 
 Before treatment conversion, two patients were receiving CSII with use of
lispro, and two were receiving multiple daily insulin injections. Clinical 
 assessment was monitored with glycosylated hemoglobin (HbA1c) levels. Changes
the insulin volume administered and associated cost savings are analyzed. 
RESULTS: Three months after conversion to U-500 therapy, the average HbA1c 
 decreased from 10.8% to 7.6%. By 6 months, it declined further to 7.3%. With
use of
U-500, the absolute volume of insulin infused per day decreased by at least 
 fourfold. This volume reduction led to potential cost savings for insulin of up
$2,600 per year per patient and a savings for pump supplies of up to $3,400 
per year per patient. All patients had subjective improvement in quality of 
life. CONCLUSION: We propose that smaller volumes of insulin with use of U-500 
 allow for more efficient absorption of large doses of insulin and yield
glycemic control. In our four patients, the use of U-500 for CSII resulted in 
improved quality of life, cost savings for treatment, and potential reduction 
in diabetes-related complications based on the decline in HbA1c. This 
 treatment method may be a novel alternative for patients with type 2 diabetes
 insulin resistance who have not met goal glycemic control with standard
regimens or who require insulin doses exceeding current insulin pump delivery 
capacity. (Endocr Pract. 2003;9:181-186)

PMID: 12917058 [PubMed - in process]    
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