Humulin R (U-500) and effects on HbA1c and weight in patients with severe insulin resistance in Tasmania.  — ASN Events
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Humulin R (U-500) and effects on HbA1c and weight in patients with severe insulin resistance in Tasmania.  (#314)

Jessica Beechey 1 , Rory Gilmour 2 , Roland McCallum 3 4
  1. School of Medicine (medical student), University of Tasmania, Hobart, TAS, Australia
  2. Pharmacy Department, Royal Hobart Hospital, Hobart, TAS, Australia
  3. Department of Endocrinology, Royal Hobart Hospital, Hobart, TAS, Australia
  4. School of Medicine (Senior Lecturer), University of Tasmania, Hobart, TAS, Australia

Introduction: Insulin resistance in obese patients with type 2 diabetes mellitus is difficult to manage. These patients may require large doses of insulin, requiring large volume injections. Concentrated insulin Humulin R (500 units/mL) is one way to address this issue.

Objectives: To determine the number of patients prescribed Humulin R (U-500) in Tasmania and the effect of starting this medication on their HbA1c and weight through a retrospective case series. 

Methods: Pharmacy dispensing data identified the number of patients who had been dispensed Humulin R from January 2009 to April 2015 in Tasmania. The patient’s Digital Medical Record (DMR) was reviewed to determine duration of diabetes, insulin dose prior to starting Humulin R, HbA1c at baseline, 6 months, 1, 2 and 3 years, and weight at baseline and 1 year where available. 

Results: A total of 20 patients had used Humulin R (10 males, 10 females). The mean age at starting Humulin R was 56 years (SD 9, range 41-69). The 10 patients whose pre-Humulin R insulin dose was available were on total daily doses ranging from 110 to over 300 units. The mean pre-Humulin R HbA1c was 10.6% (SD 2.5, range 8.0-17.2), and at 1 year was 10.0% (SD 2.2, range 8.0-17.2). Seven patients had both pre and 1 year HbA1c recorded. One patient had an increase in HbA1c (0.1 increase), the remaining had a decrease (mean change of -0.9 (SD 0.9, range -2.3-0.1)). The mean pre-Humulin R weight was 108.8 kg (SD 19.8, range 80.1-132.5). Six patients had both pre and 1 year post Humulin R weight recorded. Four patients gained weight. The mean weight change was +2.8kg (SD 4.6, range loss of 3 to gain of 10.7kg).

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Conclusions: Although sample size prevents any conclusive findings, mean HbA1c decreased after 1 year of Humulin R use. At one year most patients had gained weight. Humulin R (U-500) may be an effective option for some patients requiring very large doses of insulin but worsening patient metabolic features may make this is a less attractive one. Further strategies for combatting severe insulin resistance are required.