title: Treatment of severe insulin resistance in pregnancy with 500 units per milliliter of concentrated insulin.
abstract: OBJECTIVE
  To evaluate glycemic control and pregnancy outcomes among pregnant women with severe insulin resistance treated with 500 units/mL concentrated insulin.
  
  
  METHODS
  Retrospective analysis of gravid women with severe insulin resistance (need for greater than 100 units of insulin per injection or greater than 200 units/d) treated with either 500 units/mL concentrated insulin or conventional insulin therapy. We performed a two-part analysis: 1) between gravid women treated with and without 500 units/mL concentrated insulin; and 2) among gravid women treated with 500 units/mL concentrated insulin, comparing glycemic control before and after its initiation.
  
  
  RESULTS
  Seventy-three pregnant women with severe insulin resistance were treated with 500 units/mL concentrated insulin and 78 with conventional insulin regimens. Patients treated with 500 units/mL concentrated insulin were older and more likely to have type 2 diabetes mellitus. Average body mass index was comparable between both groups (38.6 compared with 40.4, P=.11) as were obstetric and perinatal outcomes and glycemic control during the last week of gestation. Within the 500 units/mL concentrated insulin cohort, after initiation of this medication, fasting and postprandial blood glucose concentrations improved. However, the rates of blood glucose values less than 60 mg/dL and less than 50 mg/dL were higher in the 500 units/mL concentrated insulin group after initiation than before, 4.8% compared with 2.0% (P<.01) and 2.0% compared with 0.7% (P<.01), respectively.
  
  
  CONCLUSIONS
  The use of 500 units/mL concentrated insulin in severely obese insulin-resistant pregnant women confers similar glycemic control compared with traditional insulin regimens but may increase the risk of hypoglycemia.
  
  
  METHODS
  II.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Hector
authors.initials: H
authors.lastname: Mendez-Figueroa
authors.forename: Lindsay
authors.initials: L
authors.lastname: Maggio
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Dahlke
authors.forename: Julie
authors.initials: J
authors.lastname: Daley
authors.forename: Vrishali V
authors.initials: VV
authors.lastname: Lopes
authors.forename: Donald R
authors.initials: DR
authors.lastname: Coustan
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007333:Insulin Resistance; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012237:Rhode Island; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin