title: A retrospective review of insulin requirements in patients using U-500 insulin hospitalized to a Veterans Affairs Hospital.
abstract: OBJECTIVE
  The aim of this study was to compare the changes in the total daily dose (TDD) of insulin of patients on U-500 insulin; before hospitalization, during hospitalization and six weeks after discharge.
  
  
  METHODS
  A retrospective chart review of veterans with type 2 diabetes receiving U-500 insulin in the ambulatory setting and who were admitted between 2012 and 2015 was performed. During hospitalization, patients were transitioned to receive U-100 insulin (detemir or glargine for basal and aspart for bolus). Paired t-tests were conducted to compare TDD of insulin during hospitalization to prior to admission and at six week of follow-up.
  
  
  RESULTS
  The average hemoglobin A1cat the time of hospital admission was 8.3±1.5% (n=20). The average TDD of insulin during hospitalization (124±67units) was significantly less than prior to admission (295±123units) and at six week follow-up (310±105units). The average glucose during hospitalization was 180±36mg/dL. Hypoglycemia was less than 0.5%.
  
  
  CONCLUSIONS
  We showed that patients received significantly less total daily insulin while hospitalized compared to their insulin doses in the ambulatory setting, and we demonstrate that patients receiving U-500 insulin can be safely transitioned to U-100 insulin while hospitalized, with minimal hypoglycemia.
authors.affiliation: Department of Internal Medicine, Omaha, NE, United States. Electronic address: rkedia@facey.com.
authors.forename: Rohit
authors.initials: R
authors.lastname: Kedia
authors.affiliation: VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; Department of Internal Medicine, Omaha, NE, United States. Electronic address: cdesouza@unmc.edu.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Desouza
authors.affiliation: Department of Biostatistics, College of Public Health, 984375, University of Nebraska Medical Center, Omaha, NE 68198-4375, United States. Electronic address: lmsmith@unmc.edu.
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Smith
authors.affiliation: VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; Department of Internal Medicine, Omaha, NE, United States. Electronic address: vshivaswamy@unmc.edu.
authors.forename: Vijay
authors.initials: V
authors.lastname: Shivaswamy
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D016903:Drug Monitoring; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006787:Hospitals, Veterans; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D061386:Insulin, Regular, Human / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009329:Nebraska / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D061386:Insulin, Regular, Human; C517652:hemoglobin A1c protein, human
keywords: Hospitalization; Hypoglycemia; Insulin resistance; U-500 insulin; Veteran