Objective: Questions remain regarding the appropriate use of U-500 insulin particularly, in the hospital setting. The objective of this study was to evaluate the inpatient insulin dose requirements and glycemic control of patients using U-500 insulin prior to admission.

Methods: A retrospective chart review of adult patients using U-500 insulin prior to admission to Beaumont Hospitals between March 2012 and July 2017 was conducted. Inpatient insulin dose requirements and glycemic control were compared between those who were continued on U-500 insulin and those transitioned to a U-100 insulin regimen.

Results: A total of 95 patients were included in the study. Seventeen patients were continued on U-500 insulin while the remaining 78 received U-100 insulin during their inpatient stay. U-500 insulin group received significantly more units of insulin per day (181 units versus 99.65 units; p = 0.0048). However, the proportion of insulin administered inpatient relative to the prior to admission dose was similar between the two groups (59% in the U-500 group and 46% in U-100 group; p = 0.1344). Glycemic control was similar between the groups except for significantly more hypoglycemia events in the U-500 group compared to the U-100 group (p < 0.0001). When patients were further stratified by prior to admission dose or HbA1c, significantly more hypoglycemia was observed in the U-500 group with HbA1c < 8% and those with prior to admission dose between 300-600 units.

Conclusions: Our retrospective review demonstrated that only very few patients were continued on a U-500 insulin regimen during their hospitalization. Inpatient use of U-500 insulin posed higher risk of hypoglycemia even when used at much lower doses than the established home regimen. Continued use of U-500 insulin in the hospital requires careful assessment of the risks and further investigation is needed to determine the appropriate dosing.


P. Sanaty Zadeh: None. M.F. Lutz: None. A.A. Feleke: None.

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