title: Pregestational diabetes with extreme insulin resistance: use of U-500 insulin in pregnancy.
abstract: BACKGROUND
  Increased insulin requirements in pregnancy can hinder attainment of glycemic control in diabetic patients. U-500 insulin is a concentrated form of regular insulin that can be a valuable tool in the treatment of patients with severe insulin resistance.
  
  
  METHODS
  A 24-year-old woman with pregestational diabetes mellitus experienced increasing insulin requirements during pregnancy, peaking at 650 units daily. The frequent, large-volume injections of standard-concentration insulin were poorly tolerated by the patient and resulted in nonadherence. She subsequently achieved glycemic control on thrice-daily U-500 insulin.
  
  
  CONCLUSIONS
  Pregnancy exacerbates insulin resistance in diabetic patients, and these patients may require high doses of insulin. U-500 insulin is an effective alternative for patients with severe insulin resistance and should be considered for pregnant women with difficulty achieving glycemic control.
authors: From the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; the Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland; and the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Ohio State University School of Medicine, Columbus, Ohio.
authors: Lisa C
authors: LC
authors: Zuckerwise
authors: Erika F
authors: EF
authors: Werner
authors: Christian M
authors: CM
authors: Pettker
authors: Erin K
authors: EK
authors: McMahon-Brown
authors: Stephen F
authors: SF
authors: Thung
authors: Christina S
authors: CS
authors: Han
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007333:Insulin Resistance / Q000502:physiology*; D008687:Metformin / Q000008:administration & dosage; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000188:drug therapy / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin