Abstract

Objective: To describe the clinical experience and the pharmacokinetics of U-500 regular insulin in severely insulin resistant obese type 2 diabetic patients.

Research design and methods: Patients requiring >200 units of insulin with A1C levels >8.0% were switched to U-500 regular insulin. For the pharmacokinetic study, fasting subjects received 100 units of U-500 regular insulin subcutaneously and samples drawn before and every 30-60 minutes for glucose, insulin and C-peptides until glucose fell below 100 mg/dl.

Results: U-500 regular insulin doses were adjusted using the same approach as for adjusting NPH insulin doses. Mean values at baseline and at minimum A1C levels, respectively, were, respectively: A1C (%) — 9.9, 7.1; units/kg — 3.2, 3.3; weight (kg) — 98.6, 102.8. Pharmacokinetically, insulin concentrations rose briskly by 30 minutes and remained elevated for at least 7 hours.

Conclusions: Uncontrolled severely insulin resistant obese type 2 diabetic patients can be satisfactorily controlled with U-500 regular insulin.