Abstract #1184998: A Case of using U-500 During Pregnancy for Optimal Glycemic Control

Abstract

Insulin resistance is a common and challenging complication faced by many women during pregnancy. Due to severe resistance, patients can have very high insulin requirements making its management challenging for physicians. This has been a well-established phenomenon due to the human placental lactogen which decreases insulin sensitivity in pregnant women. U-500 regular insulin is a concentrated insulin used in patients with high insulin requirements however its use during pregnancy has not been fully established. We present a case of a pregnant female who was insulin naive prior to pregnancy, who was successfully managed with U-500 to achieve optimal glycemic control. A 24 year old woman with history of Type 2 diabetes (controlled by diet alone) presented to her endocrinologist at 8 weeks gestation. Her last Hemoglobin A1c prior to pregnancy was 7.1%. Due to elevated fasting blood sugars, she was initially started on Metformin 1 gram twice a day along with Glargine 10 units daily. Due to persistently elevated fasting and post prandial blood sugars, meal time insulin was also initiated using Lispro. Patient’s insulin had to be gradually up titrated to 100 units daily in her first trimester using the traditional basal bolus regimen. She continued to have increasing insulin requirements, peaking at 300 units in the third trimester with the abovementioned basal bolus regimen. The decision was made to switch patient to U-500 to assist with glucose optimization. With the use of U-500, patient was able to maintain the required tight pregnancy blood glucose goals. For the remainder of her pregnancy, she stayed on U-500 100 units thrice daily. Patient eventually delivered a 6 pound healthy baby without any complications. Post-partum, patient’s insulin requirements improved significantly within the first two weeks and was taken off all insulin. She continues to remain well controlled on only Metformin 1g twice a day. The use of U-500 is typically for patients requiring more than 200 units of insulin daily. There have not been enough studies with the use of U-500 in the pregnant population. We present a case where U-500 was safely used in a pregnant woman in the setting of extreme insulin resistance for a safe and healthy pregnancy. Furthermore, to our knowledge there have been no cases showing the use of U-500 during pregnancy with complete resolution of insulin requirement post-partum. Our case demonstrates that U-500 can be considered in clinical trials for further assessment of its safety and efficacy in pregnant subjects with severe insulin resistance.