Lane Wendy S, Cochran Elaine K, Jackson Jeffrey A, Scism-Bacon Jamie L, Corey Ilene B, Hirsch Irl B, Skyler Jay S
Mountain Diabetes and Endocrine Center, Asheville, North Carolina 2880, USA.
Endocr Pract. 2009 Jan-Feb;15(1):71-9. doi: 10.4158/EP.15.1.71.
To provide an overview of U-500 regular insulin action, review published clinical studies with U-500 regular insulin, and offer guidance to practicing endocrinologists for identifying patients for whom U-500 regular insulin may be appropriate.
This review has been produced through a synthesis of relevant published literature compiled via a literature search (MEDLINE search of the English-language literature published between January 1969, and July 2008, related to U-500, insulin resistance, concentrated insulin, high-dose insulin, insulin pharmacokinetics, and diabetes management) and the authors' collective clinical experience.
The obesity epidemic is contributing to an increase in the prevalence of type 2 diabetes, as well as to increasing insulin requirements in insulin-treated patients. Many of these patients exhibit severe insulin resistance, manifested by daily insulin requirements of 200 units or greater or more than 2 units/kg. Delivering an appropriate insulin volume to these patients can be difficult and inconvenient and may be best accomplished with U-500 regular insulin by multiple daily injections or with continuous subcutaneous insulin infusion, rather than with standard U-100 insulin. Implementation of U-500 regular insulin in patients previously on other insulin formulations is described with a treatment algorithm covering dosage requirements ranging from 150 to more than 600 units per day on the basis of the authors' experience.
Regimen conversion of appropriately selected patients from high-dose, U-100 insulin to U-500 regular insulin therapy on the basis of the recommendations presented in this article may potentially result in improved glycemic control and lower cost.
概述U - 500常规胰岛素的作用，回顾已发表的关于U - 500常规胰岛素的临床研究，并为执业内分泌科医生提供指导，以确定哪些患者可能适合使用U - 500常规胰岛素。
本综述通过综合相关已发表文献得出，这些文献是通过文献检索（对1969年1月至2008年7月发表的与U - 500、胰岛素抵抗、浓缩胰岛素、高剂量胰岛素、胰岛素药代动力学和糖尿病管理相关的英文文献进行MEDLINE检索）以及作者的集体临床经验获得的。
肥胖流行导致2型糖尿病患病率增加，以及胰岛素治疗患者的胰岛素需求量增加。这些患者中的许多人表现出严重的胰岛素抵抗，表现为每日胰岛素需求量达200单位或更多，或超过2单位/千克。给这些患者提供合适的胰岛素剂量可能困难且不便，通过多次皮下注射或持续皮下胰岛素输注使用U - 500常规胰岛素可能是最佳方法，而非使用标准的U - 100胰岛素。根据作者经验，使用一种治疗算法描述了在先前使用其他胰岛素制剂的患者中实施U - 500常规胰岛素的情况，该算法涵盖了每天150至600单位以上的剂量需求。
根据本文提出的建议，将适当选择的患者从高剂量U - 100胰岛素转换为U - 500常规胰岛素治疗，可能会改善血糖控制并降低成本。
