The high-dose large-volume insulin injections that may become necessary during pregnancy due to marked pregnancy-induced insulin resistance may result in suboptimal therapeutic effectiveness. Use of U-500 insulin, a concentrated insulin formulation, has been suggested during pregnancy. However, the pharmacokinetic properties of U-500 insulin monotherapy can impede achievement of strict pregnancy glycemic targets. We propose a novel regimen for treatment of severe pregnancy-induced insulin resistance that enables precise delivery of U-500 basal insulin therapy through continuous subcutaneous insulin infusion (CSII) while maintaining the desired kinetics of prandial rapid-acting U-100 insulin therapy. This combination approach, guided by continuous glucose monitoring data, enabled achievement of pregnancy glycemic targets while reducing basal insulin requirements by approximately one-third. We report our method for (1) conversion to U-500 insulin delivery through CSII during pregnancy and (2) conversion from U-500 basal insulin delivery through CSII to U-100 intravenous insulin infusion therapy at delivery, to offer clinicians who encounter similar challenging scenarios a novel approach to diabetes management during pregnancy in the setting of marked insulin resistance.
This article was originally published in Diabetes Technology & Therapeutics on June 6, 2022.
Emily D. Szmuilowicz, MD, associate professor of Medicine in the Division of Endocrinology at Northwestern Medicine. Program Director, Endocrinology Fellowship, Northwestern University Feinberg School of Medicine. Peer Coach, Department of Medicine, Northwestern University Feinberg School of Medicine.
Grazia Aleppo, MD, is a professor of Medicine in the Division of Endocrinology, director of the Northwestern Medicine Diabetes Training and Education Program and an expert in diabetes research and clinical care.
Northwestern Medicine welcomes the opportunity to partner with you in caring for your patients.