Clinical Experience with U-500 Regular Insulin by Multiple Daily Injections and Continuous Subcutaneous Insulin Infusion

Background: The effectiveness of U-500 regular insulin was assessed in patients with type 2 diabetes who were previously treated with U-100 insulin. Methods: A retrospective chart review was conducted on all patients who were prescribed U-500 insulin between January 2012 and December 2013. The primary outcome measure was change in glycosylated hemoglobin (A1C) 1 year after switching from U-100 insulin to U-500 regular insulin. Secondary outcomes included change in body weight, total daily insulin dose, number of daily injections, and episodes of hypoglycemia. Results: Sixty-six patients met inclusion criteria: U-500 regular insulin via multiple daily injections (MDI; n = 36) or continuous subcutaneous insulin infusion (CSII; n = 30). The A1C in patients using MDI decreased by 1.8%, whereas patients using CSII experienced an A1C decrease of 0.63% after 1 year of U-500 regular insulin use. There was an increase of 3.1 + 0.73 kg in body weight in both the MDI and CSII groups, which was significant (P < 0.001). Confirmed hypoglycemia with a blood glucose of 51-70 mg/dL occurred in 51 patients (77%), but there were no episodes of severe hypoglycemia requiring treatment assistance. Conclusion: The use of U-500 regular insulin in MDI and CSII patients can improve glycemic control, and it does not increase the frequency of hypoglycemia when compared with U-100 insulin hypoglycemic incidence reported in the literature.