EVALUATION OF TOTAL DAILY DOSE AND GLYCEMIC CONTROL FOR PATIENTS TAKING U-500 REGULAR INSULIN ADMITTED TO THE HOSPITAL.
Endocr Pract. 2016 Jun 30;
Authors: Paulus AO, Colburn JA, True MW, Beckman DJ, Davis RP, Wardian JL, Graybill SD, Folaron I, Lewi JE
OBJECTIVE: Patients using U-500 regular insulin are severely insulin resistant requiring high doses of insulin. It has been observed that a patient's insulin requirements may dramatically decrease during hospitalization. This study sought to systemically investigate this phenomenon.
METHODS: We performed a retrospective chart review of patients with U-500 insulin outpatient regimens who were admitted to the San Antonio Military Medical Center over a five-year period. Each patient's outpatient total daily dose (TDD) of insulin was compared to the average inpatient TDD. The outpatient estimated average glucose (eAG) was calculated from the HgbA1c and compared to the average inpatient glucose.
RESULTS: There were 27 patients with a total of 62 separate admissions. The average age was 64.4 years with a mean body mass index of 38.9 kg/m2 and eAG of 203mg/dl (HgbA1c of 8.7%). All patients were converted from U-500 to U-100 upon admission. The average inpatient TDD of insulin was 91 units vs. 337 units as outpatients (p < 0.001). Overall, 89% of patients received ≤ 50% of their outpatient TDD. The average inpatient glucose was slightly higher than the outpatient eAG, 234 mg/dl vs. 203 mg/dl (p = 0.003).
CONCLUSION: U-500 insulin is prone to errors in the hospital setting, so conversion to U-100 insulin is a preferred option. Despite a significant reduction in insulin TDD, these patients had clinically similar glucose levels. Therefore, patients taking U-500 insulin as an outpatient can be converted to a U-100 basal-bolus regimen with at least a 50% reduction of their outpatient TDD.
PMID: 27359287 [PubMed - as supplied by publisher]