Introduction and Objective: Insulin pump-based Automated Insulin Delivery (AID) therapy has significantly improved glucose control and reduced hypoglycemic risk in patients with Type 1 Diabetes (T1D), but is currently only approved to use with U-100 insulin, which can be problematic in patients with severe insulin resistance, due to frequent cartridge volume exhaustion, infusion site saturation, less reliable insulin delivery. We present a case of successful off-label use of U-500 insulin in a Tandem Mobi pump in a patient with insulin resistant T1D.Methods: The patient is a 28-year-old female with T1D diagnosed at age 6 on insulin pump therapy since age 12. She has Class III obesity (Body Mass Index of 52). She chose to upgrade her pump AID to Tandem Mobi system integrated with Dexcom G7 continuous glucose monitor 2 years ago for use as a small patch pump with 5-inch tubing, but her glucose control was slightly worse afterwards. Hemoglobin A1c (HbA1c) increased from 6.8% to 7.5%, and she needed to use ~150 units of U-100 insulin daily, requiring changing the pump cartridge and infusion site on an almost daily basis, with occasional infusion site failure due to large insulin volumes, which became burdensome. After shared decision making, the patient was switched to U-500 regular insulin to optimize diabetes care and reduce pump burden.Results: Eighteen months after initiating U-500 therapy, the patient remains comfortable and satisfied with using U-500 in her Mobi pump. HbA1c remained at 7.3% but she did not have any significant hypoglycemia, with much less pump burden and improved quality of life. Postprandial glucose control improved with low carbohydrate (around 30 grams) meals throughout the day due to the longer duration nature of U-500 insulin.Conclusion: While requiring careful setting adjustment and close supervision, the off-label use of U-500 insulin in a Tandem Mobi pump is a safe and viable option for patients with insulin resistant T1D. More studies are needed to assess the efficacy and safety of using concentrated insulin in pumps.
A. Poniatowski: None. S. Bao: None.
Source link
Leave a Reply