High-dose insulin therapy: is it time for U-500 insulin?

Wendy S. Lane, Elaine K. Cochran, Jeffrey A. Jackson, Jamie L. Scism-Bacon, Ilene B. Corey, Irl B. Hirsch, Jay S Skyler

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

OBJECTIVE: To provide an overview of U-500 regular insulin action, review published clinical studies with U-500 regular insulin, and offer guidance to practicing endocrinologists for identifying patients for whom U-500 regular insulin may be appropriate. METHODS: This review has been produced through a synthesis of relevant published literature compiled via a literature search (MEDLINE search of the English-language literature published between January 1969, and July 2008, related to U-500, insulin resistance, concentrated insulin, high-dose insulin, insulin pharmacokinetics, and diabetes management) and the authors' collective clinical experience. RESULTS: The obesity epidemic is contributing to an increase in the prevalence of type 2 diabetes, as well as to increasing insulin requirements in insulin-treated patients. Many of these patients exhibit severe insulin resistance, manifested by daily insulin requirements of 200 units or greater or more than 2 units/kg. Delivering an appropriate insulin volume to these patients can be difficult and inconvenient and may be best accomplished with U-500 regular insulin by multiple daily injections or with continuous subcutaneous insulin infusion, rather than with standard U-100 insulin. Implementation of U-500 regular insulin in patients previously on other insulin formulations is described with a treatment algorithm covering dosage requirements ranging from 150 to more than 600 units per day on the basis of the authors' experience. CONCLUSIONS: Regimen conversion of appropriately selected patients from high-dose, U-100 insulin to U-500 regular insulin therapy on the basis of the recommendations presented in this article may potentially result in improved glycemic control and lower cost.

Original languageEnglish
Pages (from-to)71-79
Number of pages9
JournalEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
Volume15
Issue number1
StatePublished - Jan 1 2009
Externally publishedYes

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Insulin
Therapeutics
Insulin Resistance
Subcutaneous Infusions
Cost Control
MEDLINE
Type 2 Diabetes Mellitus
Language
Pharmacokinetics
Obesity
Injections

ASJC Scopus subject areas

  • Medicine(all)

Cite this

High-dose insulin therapy : is it time for U-500 insulin? / Lane, Wendy S.; Cochran, Elaine K.; Jackson, Jeffrey A.; Scism-Bacon, Jamie L.; Corey, Ilene B.; Hirsch, Irl B.; Skyler, Jay S.

In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, Vol. 15, No. 1, 01.01.2009, p. 71-79.

Research output: Contribution to journalArticle

Lane, Wendy S. ; Cochran, Elaine K. ; Jackson, Jeffrey A. ; Scism-Bacon, Jamie L. ; Corey, Ilene B. ; Hirsch, Irl B. ; Skyler, Jay S. / High-dose insulin therapy : is it time for U-500 insulin?. In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2009 ; Vol. 15, No. 1. pp. 71-79.
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