A retrospective review of insulin requirements in patients using U-500 insulin hospitalized to a Veterans Affairs Hospital

Aims 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 A1_c at the time of hospital admission was 8.3 ± 1.5% (n = 20). The average TDD of insulin during hospitalization (124 ± 67 units) was significantly less than prior to admission (295 ± 123 units) and at six week follow-up (310 ± 105 units). The average glucose during hospitalization was 180 ± 36 mg/dL. Hypoglycemia was less than 0.5%. Conclusion 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.