Related Experiment Video
Updated: May 30, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Clinical experience with U500 insulin: risks and benefits.
1Department of Medicine, Section of Endocrinology and Metabolism, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 06756, USA. angela.t.boldo@hitchcock.org
Summary
High-dose U500 insulin effectively improves glycemic control in severely insulin-resistant diabetes patients. While it can increase body weight and non-severe hypoglycemia, it offers a valuable treatment option.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Pharmacology
Background:
- Severely insulin-resistant diabetes mellitus (SIRDM) presents significant treatment challenges.
- Traditional insulin regimens may be insufficient for patients with extreme insulin resistance.
Purpose of the Study:
- To evaluate the clinical outcomes of using U500 insulin in patients with severe insulin resistance.
- To assess changes in glycemic control, body weight, insulin dosage, and hypoglycemia.
Main Methods:
- Retrospective chart review of 53 patients treated with U500 insulin.
- Data collected included glycosylated hemoglobin (A1C), body weight, and insulin dosage at baseline, 6 months, and last follow-up.
- Recorded hypoglycemic episodes and daily injection frequency.
Main Results:
- Mean A1C decreased from 10.1% to 8.6% over a mean follow-up of 36.6 months.
- Body weight increased by a mean of 6.8 kg; insulin dosage increased by 0.44 units/kg.
- A rise in non-severe hypoglycemic episodes and a decrease in daily injections were noted.
Conclusions:
- U500 insulin can effectively manage uncontrolled, severely insulin-resistant diabetes.
- Treatment with U500 insulin shows potential for improving glycemic control.
- Observed side effects include weight gain, increased insulin dosage, and more non-severe hypoglycemic events.
Related Concept Videos
01:16Insulin: Dosing Regimen and Adverse Effects
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:27Insulin Formulations: Types and Delivery
Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into rapid-acting...
Short-acting insulins are divided into rapid-acting...
01:06Oral Hypoglycemic Agents: Glinides
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
01:25Insulin: Biosynthesis, Chemistry, and Preparation
The endoplasmic reticulum (ER) of pancreatic β-cells synthesizes preproinsulin, which consists of a signal peptide, A and B chains, and a C-peptide. Preproinsulin is then cleaved and folded into proinsulin, which translocates to the Golgi apparatus for sorting and packaging into secretory granules. In these granules, enzymatic clipping generates insulin and C-peptide.
Damage or functional impairment of β-cells inhibits insulin production, leading to diabetes. Diabetes treatment primarily uses...
Damage or functional impairment of β-cells inhibits insulin production, leading to diabetes. Diabetes treatment primarily uses...
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood glucose levels...
01:12Type I Diabetes I: Introduction
Type 1 diabetes mellitus is a chronic metabolic disorder characterized by an absolute deficiency of insulin resulting from the autoimmune destruction of pancreatic β-cells. Although it can occur at any age, it is most commonly diagnosed in childhood, adolescence, or early adulthood. The loss of insulin production impairs cellular glucose uptake, resulting in persistent hyperglycemia and necessitating lifelong insulin therapy.Autoimmune Destruction of β-CellsThe hallmark of type 1 diabetes is an...