Monday, April 2, 2012

severe insulin resistance and U 500 insulin

Endocrine Practice. 2012;18(1):56-61. © 2012 American Association of Clinical Endocrinologists
ClinicalExperience With U500 Insulin
Risks and Benefits
Angela Boldo, MD; Richard J. Comi, MD

The above article was posted in Medscape 3/9/2012

This is a good review article discussing the use of U500 insulin.  They reviewed 53 patients with severe insulin resistance requiring the use of U500 insulin.

Common conditions associated with this problem include Type 2 Diabetes, obesity and polycystic ovary syndrome. ( three patients in the study had Type 1 diabetes )

Defining severe insulin resistance  on paper is harder than it is to recognize it clinically. There are multiple written recommendation "whenever normal amounts of insulin elicit a less than normal biologic response" is a good one. Another is when insulin doses exceed 200 units /day .

 I recall many patients that would fit the above definitions that did not require U 500 insulin for control. I recall the clinical decision was easy and was made out of necessity because nothing else was working.
 I vividly recall 2 women , one lady was very obese  with type 2 diabetes who developed severe temporary insulin resistance a few days after coronary bypass surgery complicated by infection. She required over 100 u/hour of IV insulin infusion. Her insulin resistance improved over the next  few months and she was able to gradually decrease her insulin requirements  and eventually was controlled with oral agents. The other lady had polycystic ovary disease , was overweight ,with difficult to manage dyslipidemia and  Type 2 Diabetes . She  had to use a insulin pump  plus U 500 insulin for control.
 I mentioned these 2 cases because they demonstrate the challenges faced by patients and doctors when very large scary doses of insulin are required to obtain less than optimal glucose control.

 U 500  Regular  human insulin is a little different than  u100 insulin
   * It is for subcutaneous injection only. Do not use IV or intramuscularly
   * education and training is required for proper use of insulin syringes that are designed for U 100 insulin
   * onset of effect can be 30 to 45 minutes and the duration of the effect can be 13 or 14 hours or longer
   * the article suggest starting u 500 insulin  2 to 3 time daily and to consider a more rapid acting u 100   
     before meals

Don't expect perfect results
    The precent of people achieving an A1c of 7 was 8%
     Glucose control improved  (A1c decrease by about 1.5 %)
     Expect more frequent mild hypoglycemia
     There were no episodes of severe hypoglycemia reported
      Expect weight gain

This is a good article . I have attached a link below.

Have fun , Be smart and defeat Diabetes
David Calder, MD


  1. I am on 275 units of insulin a day and still my BS do not fall below 260. I am worried about taking so much insulin and not seeing any results. I would like to try this U500 insulin but I am also leary about taking something new. There is not much info on this insulin that I can read that is put into laymens terms. Is there a web sight that I can go to that will put it into words that I can understand?

    1. Please see my post from yesterday. Dr. Calder


Your comments and questions are appreciated. David Calder,MD