661 U500 insulin for the management of severe insulin resistance in pregnancy

Abstract

Pregnancy exacerbates insulin resistance in diabetic women. In pregnant women with severe insulin resistance (SIR), administration of large amounts of insulin is often difficult and impractical. U500 insulin is five times more concentrated than regular insulin (U100) thus, it can be a valuable tool in the treatment of women with SIR. The objective of our study was to evaluate glycemic control and hypoglycemia in pregnant women treated with U500 insulin. A retrospective cohort study of pregnant women with SIR with a need for greater than 200 units of U100 insulin per day in a tertiary care center between the years of 2016 to 2020. Outcomes of interest were: 1) glycemic control, assessing mean fasting and postprandial blood sugars 2) hypoglycemia, defined as blood sugars less than 60. Outcomes were analyzed in two groups: 1) glycemic control and hypoglycemia prior to and following initiation of U500 2) glycemic control and hypoglycemia prior to admission for delivery in women on U100 compared to women on U500 insulin. Glucose values were collected by patients using a wireless blood glucometer which sends glucose values directly to the healthcare team. Twenty-nine women with SIR were treated with U500, 28 were treated with U100. Following initiation of U500, improvements in mean fasting sugars were noted (97.15 vs 123.72, p<.001). Compared to patients who received solely U100, women who received U500 had improvements in fasting (97.15 vs 112.98, p=0.07) and post-breakfast blood sugars (127.70 vs 140.50, p=0.04). There was no significant difference in maternal hypoglycemia in pre vs post U500 (12 vs 17, p=0.286) and in U100 vs U500 insulin (13 vs 17, p=0.399). The initiation of U500 as compared to U100 insulin improves glycemic control in fasting and post-breakfast blood sugars. Although women using U500 should be monitored closely for hypoglycemia, there was not an increased prevalence of hypoglycemia in patients on U500 as compared to U100 insulin. Due to improved glycemic control with U500, clinicians should consider offering this to their pregnant patients with SIR.View Large Image Figure ViewerDownload Hi-res image Download (PPT)