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.