Lisa C Zuckerwise1, Erika F Werner, Christian M Pettker, Erin K McMahon-Brown, Stephen F Thung, Christina S Han. 1. From the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; the Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland; and the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Ohio State University School of Medicine, Columbus, Ohio.
Abstract
BACKGROUND: Increased insulin requirements in pregnancy can hinder attainment of glycemic control in diabetic patients. U-500 insulin is a concentrated form of regular insulin that can be a valuable tool in the treatment of patients with severe insulin resistance. CASE: A 24-year-old woman with pregestational diabetes mellitus experienced increasing insulin requirements during pregnancy, peaking at 650 units daily. The frequent, large-volume injections of standard-concentration insulin were poorly tolerated by the patient and resulted in nonadherence. She subsequently achieved glycemic control on thrice-daily U-500 insulin. CONCLUSION: Pregnancy exacerbates insulin resistance in diabetic patients, and these patients may require high doses of insulin. U-500 insulin is an effective alternative for patients with severe insulin resistance and should be considered for pregnant women with difficulty achieving glycemic control.
BACKGROUND: Increased insulin requirements in pregnancy can hinder attainment of glycemic control in diabeticpatients. U-500 insulin is a concentrated form of regular insulin that can be a valuable tool in the treatment of patients with severe insulin resistance. CASE: A 24-year-old woman with pregestational diabetes mellitus experienced increasing insulin requirements during pregnancy, peaking at 650 units daily. The frequent, large-volume injections of standard-concentration insulin were poorly tolerated by the patient and resulted in nonadherence. She subsequently achieved glycemic control on thrice-daily U-500 insulin. CONCLUSION: Pregnancy exacerbates insulin resistance in diabeticpatients, and these patients may require high doses of insulin. U-500 insulin is an effective alternative for patients with severe insulin resistance and should be considered for pregnant women with difficulty achieving glycemic control.