Delivery of U‐500 insulin by CSII in a patient with type 2 diabetes and extreme insulin resistance

A subset of patients with type 2 diabetes have a more extreme form of insulin resistance. Such patients require in excess of 200 units/day of insulin. The large volume of insulin required can cause problems with absorption and is often painful, affecting patient concordance. These patients often have poor glycaemic control. U‐500 insulin in equivalent doses delivers one‐fifth of the volume of regular U‐100 insulin and can potentially improve glycaemic control. Use of insulin pumps allows continuous infusion of U‐500 insulin resulting in better absorption and ability to deliver larger volumes over a 24‐hour period. There are a few case reports of U‐500 insulin delivered via pump, which have shown improvement in glycaemic control and patients' quality of life.

We present a case of extreme insulin resistance in a female patient whose glycaemic control improved remarkably using insulin pump. She also reported subjective improvement in her quality of life. Copyright © 2009 John Wiley & Sons.