Management of U-500 insulin users during inpatient admissions within a Veterans Affairs Medical Center

Aims: 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.