EVALUATION OF TOTAL DAILY DOSE AND GLYCEMIC CONTROL FOR PATIENTS TAKING U-500 REGULAR INSULIN ADMITTED TO THE HOSPITAL
Patients using U-500 regular insulin are severely insulin resistant, requiring high doses of insulin. It has been observed that a patient's insulin requirements may dramatically decrease during hospitalization. This study sought to systematically investigate this phenomenon. We performed a retr...
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| Veröffentlicht in: | Endocrine practice 2016-10, Vol.22 (10), p.1187-1191 |
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| creator | Paulus, Andrew O Colburn, Jeffrey A True, Mark W Beckman, Darrick J Davis, Richard P Wardian, Jana L Graybill, Sky D Folaron, Irene Lewi, Jack E |
| description | Patients using U-500 regular insulin are severely insulin resistant, requiring high doses of insulin. It has been observed that a patient's insulin requirements may dramatically decrease during hospitalization. This study sought to systematically investigate this phenomenon.
We performed a retrospective chart review of patients with U-500 insulin outpatient regimens who were admitted to the San Antonio Military Medical Center over a 5-year period. Each patient's outpatient total daily dose (TDD) of insulin was compared to the average inpatient TDD. The outpatient estimated average glucose (eAG) was calculated from the glycated hemoglobin (HbA1c) and compared to the average inpatient glucose.
There were 27 patients with a total of 62 separate admissions. The average age was 64.4 years, with a mean body mass index of 38.9 kg/m
and eAG of 203 mg/dL (HbA1c, 8.7%, 71.6 mmol/mol). All patients were converted from U-500 to U-100 upon admission. The average inpatient TDD of insulin was 91 units, versus 337 units as outpatients (P |
| doi_str_mv | 10.4158/EP161355.OR |
| format | Article |
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We performed a retrospective chart review of patients with U-500 insulin outpatient regimens who were admitted to the San Antonio Military Medical Center over a 5-year period. Each patient's outpatient total daily dose (TDD) of insulin was compared to the average inpatient TDD. The outpatient estimated average glucose (eAG) was calculated from the glycated hemoglobin (HbA1c) and compared to the average inpatient glucose.
There were 27 patients with a total of 62 separate admissions. The average age was 64.4 years, with a mean body mass index of 38.9 kg/m
and eAG of 203 mg/dL (HbA1c, 8.7%, 71.6 mmol/mol). All patients were converted from U-500 to U-100 upon admission. The average inpatient TDD of insulin was 91 units, versus 337 units as outpatients (P<.001). Overall, 89% of patients received ≤50% of their outpatient TDD. The average inpatient glucose was slightly higher than the outpatient eAG, 234 mg/dL versus 203 mg/dL (P = .003).
U-500 insulin is prone to errors in the hospital setting, so conversion to U-100 insulin is a preferred option. Despite a significant reduction in insulin TDD, these patients had clinically similar glucose levels. Therefore, patients taking U-500 insulin as an outpatient can be converted to a U-100 basal-bolus regimen with at least a 50% reduction of their outpatient TDD.
BG = blood glucose eAG = estimated average glucose HbA1c = glycated hemoglobin NPO = nil per os SPSS = Statistical Package for the Social Sciences TDD = total daily dose.</description><identifier>ISSN: 1530-891X</identifier><identifier>EISSN: 1934-2403</identifier><identifier>DOI: 10.4158/EP161355.OR</identifier><identifier>PMID: 27359287</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Aged ; Aged, 80 and over ; Blood Glucose - drug effects ; Blood Glucose - metabolism ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - epidemiology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Glycated Hemoglobin A - drug effects ; Glycated Hemoglobin A - metabolism ; Humans ; Hyperglycemia - drug therapy ; Hyperglycemia - epidemiology ; Hypoglycemic Agents - administration & dosage ; Hypoglycemic Agents - adverse effects ; Insulin - administration & dosage ; Insulin - adverse effects ; Male ; Middle Aged ; Military Personnel ; Patient Admission - statistics & numerical data ; Retrospective Studies</subject><ispartof>Endocrine practice, 2016-10, Vol.22 (10), p.1187-1191</ispartof><rights>Copyright Allen Press Publishing Services Oct 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-467a425dbf33d20df772c79eea7f816da724aa371d520137cca3f337cdd8aa1b3</citedby><cites>FETCH-LOGICAL-c424t-467a425dbf33d20df772c79eea7f816da724aa371d520137cca3f337cdd8aa1b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27359287$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Paulus, Andrew O</creatorcontrib><creatorcontrib>Colburn, Jeffrey A</creatorcontrib><creatorcontrib>True, Mark W</creatorcontrib><creatorcontrib>Beckman, Darrick J</creatorcontrib><creatorcontrib>Davis, Richard P</creatorcontrib><creatorcontrib>Wardian, Jana L</creatorcontrib><creatorcontrib>Graybill, Sky D</creatorcontrib><creatorcontrib>Folaron, Irene</creatorcontrib><creatorcontrib>Lewi, Jack E</creatorcontrib><title>EVALUATION OF TOTAL DAILY DOSE AND GLYCEMIC CONTROL FOR PATIENTS TAKING U-500 REGULAR INSULIN ADMITTED TO THE HOSPITAL</title><title>Endocrine practice</title><addtitle>Endocr Pract</addtitle><description>Patients using U-500 regular insulin are severely insulin resistant, requiring high doses of insulin. It has been observed that a patient's insulin requirements may dramatically decrease during hospitalization. This study sought to systematically investigate this phenomenon.
We performed a retrospective chart review of patients with U-500 insulin outpatient regimens who were admitted to the San Antonio Military Medical Center over a 5-year period. Each patient's outpatient total daily dose (TDD) of insulin was compared to the average inpatient TDD. The outpatient estimated average glucose (eAG) was calculated from the glycated hemoglobin (HbA1c) and compared to the average inpatient glucose.
There were 27 patients with a total of 62 separate admissions. The average age was 64.4 years, with a mean body mass index of 38.9 kg/m
and eAG of 203 mg/dL (HbA1c, 8.7%, 71.6 mmol/mol). All patients were converted from U-500 to U-100 upon admission. The average inpatient TDD of insulin was 91 units, versus 337 units as outpatients (P<.001). Overall, 89% of patients received ≤50% of their outpatient TDD. The average inpatient glucose was slightly higher than the outpatient eAG, 234 mg/dL versus 203 mg/dL (P = .003).
U-500 insulin is prone to errors in the hospital setting, so conversion to U-100 insulin is a preferred option. Despite a significant reduction in insulin TDD, these patients had clinically similar glucose levels. Therefore, patients taking U-500 insulin as an outpatient can be converted to a U-100 basal-bolus regimen with at least a 50% reduction of their outpatient TDD.
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Colburn, Jeffrey A ; True, Mark W ; Beckman, Darrick J ; Davis, Richard P ; Wardian, Jana L ; Graybill, Sky D ; Folaron, Irene ; Lewi, Jack E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-467a425dbf33d20df772c79eea7f816da724aa371d520137cca3f337cdd8aa1b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Glucose - drug effects</topic><topic>Blood Glucose - metabolism</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Glycated Hemoglobin A - drug effects</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Humans</topic><topic>Hyperglycemia - drug therapy</topic><topic>Hyperglycemia - epidemiology</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Hypoglycemic Agents - adverse effects</topic><topic>Insulin - administration & dosage</topic><topic>Insulin - adverse effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Military Personnel</topic><topic>Patient Admission - statistics & numerical data</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Paulus, Andrew O</creatorcontrib><creatorcontrib>Colburn, Jeffrey A</creatorcontrib><creatorcontrib>True, Mark W</creatorcontrib><creatorcontrib>Beckman, Darrick J</creatorcontrib><creatorcontrib>Davis, Richard P</creatorcontrib><creatorcontrib>Wardian, Jana L</creatorcontrib><creatorcontrib>Graybill, Sky D</creatorcontrib><creatorcontrib>Folaron, Irene</creatorcontrib><creatorcontrib>Lewi, Jack E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Endocrine practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Paulus, Andrew O</au><au>Colburn, Jeffrey A</au><au>True, Mark W</au><au>Beckman, Darrick J</au><au>Davis, Richard P</au><au>Wardian, Jana L</au><au>Graybill, Sky D</au><au>Folaron, Irene</au><au>Lewi, Jack E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>EVALUATION OF TOTAL DAILY DOSE AND GLYCEMIC CONTROL FOR PATIENTS TAKING U-500 REGULAR INSULIN ADMITTED TO THE HOSPITAL</atitle><jtitle>Endocrine practice</jtitle><addtitle>Endocr Pract</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>22</volume><issue>10</issue><spage>1187</spage><epage>1191</epage><pages>1187-1191</pages><issn>1530-891X</issn><eissn>1934-2403</eissn><abstract>Patients using U-500 regular insulin are severely insulin resistant, requiring high doses of insulin. It has been observed that a patient's insulin requirements may dramatically decrease during hospitalization. This study sought to systematically investigate this phenomenon.
We performed a retrospective chart review of patients with U-500 insulin outpatient regimens who were admitted to the San Antonio Military Medical Center over a 5-year period. Each patient's outpatient total daily dose (TDD) of insulin was compared to the average inpatient TDD. The outpatient estimated average glucose (eAG) was calculated from the glycated hemoglobin (HbA1c) and compared to the average inpatient glucose.
There were 27 patients with a total of 62 separate admissions. The average age was 64.4 years, with a mean body mass index of 38.9 kg/m
and eAG of 203 mg/dL (HbA1c, 8.7%, 71.6 mmol/mol). All patients were converted from U-500 to U-100 upon admission. The average inpatient TDD of insulin was 91 units, versus 337 units as outpatients (P<.001). Overall, 89% of patients received ≤50% of their outpatient TDD. The average inpatient glucose was slightly higher than the outpatient eAG, 234 mg/dL versus 203 mg/dL (P = .003).
U-500 insulin is prone to errors in the hospital setting, so conversion to U-100 insulin is a preferred option. Despite a significant reduction in insulin TDD, these patients had clinically similar glucose levels. Therefore, patients taking U-500 insulin as an outpatient can be converted to a U-100 basal-bolus regimen with at least a 50% reduction of their outpatient TDD.
BG = blood glucose eAG = estimated average glucose HbA1c = glycated hemoglobin NPO = nil per os SPSS = Statistical Package for the Social Sciences TDD = total daily dose.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>27359287</pmid><doi>10.4158/EP161355.OR</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Endocrine practice, 2016-10, Vol.22 (10), p.1187-1191 |
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| language | eng |
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| subjects | Aged Aged, 80 and over Blood Glucose - drug effects Blood Glucose - metabolism Diabetes Mellitus - drug therapy Diabetes Mellitus - epidemiology Dose-Response Relationship, Drug Drug Administration Schedule Female Glycated Hemoglobin A - drug effects Glycated Hemoglobin A - metabolism Humans Hyperglycemia - drug therapy Hyperglycemia - epidemiology Hypoglycemic Agents - administration & dosage Hypoglycemic Agents - adverse effects Insulin - administration & dosage Insulin - adverse effects Male Middle Aged Military Personnel Patient Admission - statistics & numerical data Retrospective Studies |
| title | EVALUATION OF TOTAL DAILY DOSE AND GLYCEMIC CONTROL FOR PATIENTS TAKING U-500 REGULAR INSULIN ADMITTED TO THE HOSPITAL |
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