Kevin M Pantalone1, Charles Faiman. 1. Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio 44195, USA. pantalk@ccf.org
Abstract
BACKGROUND/ OBJECTIVE: We describe the effectiveness of liraglutide therapy in a severely insulin-resistant patient with type 2 diabetes mellitus (DM-2) requiring U-500 insulin. SUBJECT AND METHODS: A 65-year-old morbidly obese man (body mass index, 67.3 kg/m(2); weight, 156.2 kg) presented with a 20-year history of DM-2; the glycemic control deteriorated to U-500 insulin requirement. He was inadequately controlled (hemoglobin A1c [HbA1c], 9.1%) on metformin plus U-500 insulin titrated to 575 units daily. Liraglutide was added and titrated to 1.8 mg once daily over 3 weeks. RESULTS: Insulin requirements decreased markedly (>50%) to 250 units daily after 5 months of added liraglutide, with a concurrent improvement in HbA1c from 9.1% to 6.9% and weight loss of 22.6 kg. CONCLUSIONS: The addition of once-daily liraglutide to the regimen of patients with uncontrolled DM-2 requiring U-500 insulin should be considered as it may help to reduce insulin requirements, improve glycemic control, and assist with weight management.
BACKGROUND/ OBJECTIVE: We describe the effectiveness of liraglutide therapy in a severely insulin-resistant patient with type 2 diabetes mellitus (DM-2) requiring U-500 insulin. SUBJECT AND METHODS: A 65-year-old morbidly obeseman (body mass index, 67.3 kg/m(2); weight, 156.2 kg) presented with a 20-year history of DM-2; the glycemic control deteriorated to U-500 insulin requirement. He was inadequately controlled (hemoglobin A1c [HbA1c], 9.1%) on metformin plus U-500 insulin titrated to 575 units daily. Liraglutide was added and titrated to 1.8 mg once daily over 3 weeks. RESULTS:Insulin requirements decreased markedly (>50%) to 250 units daily after 5 months of added liraglutide, with a concurrent improvement in HbA1c from 9.1% to 6.9% and weight loss of 22.6 kg. CONCLUSIONS: The addition of once-daily liraglutide to the regimen of patients with uncontrolled DM-2 requiring U-500 insulin should be considered as it may help to reduce insulin requirements, improve glycemic control, and assist with weight management.
Authors: Elizabeth L Eby; Bradley H Curtis; Steven C Gelwicks; Robert C Hood; Iskandar Idris; Anne L Peters; Richard M Bergenstal; Jeffrey A Jackson Journal: BMJ Open Diabetes Res Care Date: 2015-04-30