title: Liraglutide effective in the severely insulin-resistant patient with type 2 diabetes requiring U-500 insulin: a case report.
abstract: OBJECTIVE
  We describe the effectiveness of liraglutide therapy in a severely insulin-resistant patient with type 2 diabetes mellitus (DM-2) requiring U-500 insulin.
  
  
  METHODS
  A 65-year-old morbidly obese man (body mass index, 67.3 kg/m(2); weight, 156.2 kg) presented with a 20-year history of DM-2; the glycemic control deteriorated to U-500 insulin requirement. He was inadequately controlled (hemoglobin A1c [HbA1c], 9.1%) on metformin plus U-500 insulin titrated to 575 units daily. Liraglutide was added and titrated to 1.8 mg once daily over 3 weeks.
  
  
  RESULTS
  Insulin requirements decreased markedly (>50%) to 250 units daily after 5 months of added liraglutide, with a concurrent improvement in HbA1c from 9.1% to 6.9% and weight loss of 22.6 kg.
  
  
  CONCLUSIONS
  The addition of once-daily liraglutide to the regimen of patients with uncontrolled DM-2 requiring U-500 insulin should be considered as it may help to reduce insulin requirements, improve glycemic control, and assist with weight management.
authors: Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio 44195, USA. pantalk@ccf.org
authors: Kevin M
authors: KM
authors: Pantalone
authors: Charles
authors: C
authors: Faiman
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D000069450:Liraglutide; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069450:Liraglutide; C517652:hemoglobin A1c protein, human