A Case Report of Continuous Subcutaneous U-500 Insulin Administration in a Patient with Insulin Resistant Lipodystrophy

Objective: To report the clinical outcome of a patient with lipodystrophy complicated by insulin-resistant diabetes mellitus who was changed from traditional multiple daily injection U-500 dosing to off-label continuous subcutaneous insulin infusion (CSII) of U-500 insulin in a V-Go® Disposable Insulin Delivery device (V-Go®). Methods: Case report with literature review. Results: After initiation of V-Go® the patient was able to reduce her total daily insulin dose from 415 U to 280 U with a concomitant reduction in glycated hemoglobin (HbA1c) from 9.3 to 6.8% over a 3-month period. The reported frequency of hypoglycemia was also significantly reduced. The patient reported increased satisfaction and improved insulin administration compliance. Conclusion: U-500 delivered via CSII in patients with highly resistant type 2 diabetes, as can be seen in lipodystrophy, may be beneficial when patient becomes difficult to manage on insulin administered by multiple daily injections. The use of a V-Go® insulin delivery device can facilitate continuous insulin delivery in patients who are not able to use an insulin pump.