Management of U-500 insulin users during inpatient admissions within a Veterans Affairs Medical Center.
OBJECTIVE
The purpose of this study was to compare inpatient insulin needs with usual home insulin needs for severely insulin resistant individuals using U-500 insulin.


METHODS
This was a retrospective review of patients using U-500 insulin at one institution. Subjects were divided into 3 groups according to their pre-admission HbA1c [<8%, 8-8.99%, ≥9%] as glycemic control could impact inpatient insulin requirements. The primary outcome was the average total daily insulin dose during hospitalization. Secondary outcomes included the degree of blood sugar control during hospitalizations and insulin doses 6 months after discharge.


RESULTS
Sixty-three patients with a total of 116 admissions were included. The average inpatient insulin dose was only 22.6% of the usual home insulin dose. There were no differences in the frequency of low blood sugars between glycemic control groups. By 6-months post-discharge the majority of subjects were back on their pre-admission dosing.


CONCLUSIONS
Inpatient insulin needs were strikingly reduced (by average 75%) compared to home dosing regardless of pre-admission glycemic control. The results of this study should encourage institutions to assess their inpatient insulin protocols for U-500 using individuals.
Department of Pharmacy, Lexington VA Medical Center, Lexington, KY, United States.
Catherine E
CE
Palladino
Department of Pharmacy, Lexington VA Medical Center, Lexington, KY, United States.
Mary E
ME
Eberly
Department of Pharmacy, Lexington VA Medical Center, Lexington, KY, United States.
John T
JT
Emmons
Department of Medicine, Lexington VA Medical Center, Lexington, KY, United States; Department of Internal Medicine, Division of Endocrinology and Molecular Medicine, University of Kentucky HealthCare, Lexington, KY, United States. Electronic address: Lisa.tannock@uky.edu.
Lisa R
LR
Tannock
D000328:Adult; D000368:Aged; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D011498:Protein Precursors / Q000032:analysis; D012189:Retrospective Studies; D014728:Veterans
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D011498:Protein Precursors; C040839:pre-hemoglobin A, glycosylated
Diabetes mellitus; Glycemic control; HbA1c; Inpatient insulin; U-500 insulin