The use of U-500 in patients with extreme insulin resistance

Using the technology available today and available insulin preparations, it would appear that progress has been made in treating type 1 diabetes and that therapeutic targets are being approached with dose ranges of insulin from 0.3 to 0.6 units·kg-1 ·day-1. In "other specific types of diabetes" and in a subset of type 2 diabetes, this does not appear to be the case. It is clear that at least 40% of all diabetic patients will require insulin therapy to achieve therapeutic targets (7,8,26,27). In that the targets are not being met, it must mean an insufficient number of patients are treated with insulin and/or the doses of insulin are not sufficient. In patients who take insulin, one limitation may be the volume of insulin necessary to achieve a dose capable of reaching the therapeutic target. We have presented an algorithm from our experience in treating syndromic forms of insulin resistance. We believe the algorithm is relevant in an increasing number of patients with type 2 diabetes, who also demonstrate severe insulin resistance. The use of U-500 insulin may be another treatment option in helping severely insulin-resistant, type 2 diabetic patients reach their desired therapeutic targets. © 2005 by the American Diabetes Association.