U-500 regular insulin use in hospitalized patients
Abstract
Objective U-500 is a potent insulin used in patients with severe insulin resistance. This study aimed to describe the inpatient insulin requirements, insulin regimens, and glycemic control of hospitalized patients using U-500. Methods A retrospective chart review of adult patients using U-500 insulin at home who were admitted to Cleveland Clinic hospitals between 2001 and 2011 was performed. Two groups were compared: those who were given U-500 while hospitalized (Group A) and those who were switched to a different insulin regimen (Group B). The percentages of hypoglycemia days and hyperglycemia days were calculated as the number of days with the respective event divided by the length of stay (LOS) in days for each patient. Results There were 61 patients, 59% of which were male, with a median body mass index (BMI) 38.4, age 60.8 years, hemoglobin A1c 8.9% or 74 mmol/mol, and LOS 5.0 days. The majority (66%) remained on a U-500-based insulin regimen, while the rest were switched to a combination of long-, intermediate-, short- and/or fast-acting insulin. The endocrinology service was consulted for 61% of patients. Glucose levels were not significantly different between the 2 groups. Group B was given less insulin in the hospital compared to their home regimen. Group A had more frequent hypoglycemia days (mean ± SD: 15.3 ± 21.3 vs. 2.8 ± 6.4%) and more frequent severe hyperglycemia days (16.8 ± 21.8 % vs. 6.3 ± 9.8%) than Group B. Conclusion This study suggests that there is a s…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Data on the use of concentrated insulins such as glargine U-300, degludec U-200, and U-500 regular insulin in the inpatient and perioperative settings are limited and have shown variable results.
“Data on the use of concentrated insulins such as glargine U-300, degludec U-200, and U-500 regular insulin in the inpatient and perioperative settings are limited and have shown variable results (78-81).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [81]
Cited by
Sorted by citations
Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers
Riddle, M., & Holl, R. (2019) · Clinical Diabetes · doi:10.2337/cd20-as01 · Cited by 616 · see citing works
16. Diabetes Care in the Hospital: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s016 · Cited by 440 · see citing works
15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2020
American Diabetes Association (2019) · Diabetes Care · doi:10.2337/dc20-s015 · Cited by 272 · see citing works
“patient and by meticulous supervision of the dose administered (55,56).”
Background15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019
American Diabetes Association (2018) · Diabetes Care · doi:10.2337/dc19-s015 · Cited by 238 · see citing works
“For patients continuing regimens with concentrated insulin (U-200, U-300, or U-500) in the inpatient setting, it is important to ensure the correct dosing by utilizing an individual pen and cartridge for each patient, meticulous pharmacist supervision of the dose administered, or other means (44,45).”
15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2021
American Diabetes Association (2020) · Diabetes Care · doi:10.2337/dc21-s015 · Cited by 199 · see citing works
“For patients transitioning to regimens with concentrated insulin (U-200, U-300, or U-500) in the inpatient setting, it is important to ensure correct dosing by utilizing an individual pen and cartridge for each patient and by meticulous supervision of the dose administered (55,56).”
BackgroundMethod16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D. M., Johnson, E. L., et al. (2022) · Diabetes Care · doi:10.2337/dc23-s016 · Cited by 226 · see citing works
16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2024
ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Galindo, R. J., Hilliard, M. E., Johnson, E. L., Khunti, K. K., et al. (2023) · Diabetes Care · doi:10.2337/dc24-s016 · Cited by 185 · see citing works
16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2025
ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Early, K. B., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., Galindo, R. J., et al. (2024) · Diabetes Care · doi:10.2337/dc25-s016 · Cited by 225 · see citing works
14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018
American Diabetes Association (2017) · Diabetes Care · doi:10.2337/dc18-s014 · Cited by 182 · see citing works
“meticulous pharmacist supervision of the dose administered, or other means (37,38).”
Background16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s016 · Cited by 80 · see citing works
Concentrated insulins: Clinical update of therapeutic options
Umpierrez, G. E., Holt, E. H., Einhorn, D., & McGill, J. B. (2020) · Endocrine Practice · doi:10.4158/ep-2019-0607 · Cited by 44 · see citing works
Inpatient hyperglycemia management: A practical review for primary medical and surgical teams
Lansang, M. C., & Umpierrez, G. E. (2016) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.83.s1.06 · Cited by 45 · see citing works
Self-citation14. Diabetes Care in the Hospital
American Diabetes Association (2016) · Diabetes Care · doi:10.2337/dc17-s017 · Cited by 91 · see citing works
Paulus, A. O., Colburn, J. A., True, M. W., Beckman, D., Davis, R. P., Wardian, J., Graybill, S. D., Folaron, I., & Lewi, J. E. (2016) · Endocrine Practice · doi:10.4158/ep161355.or · Cited by 10 · see citing works
Inpatient hyperglycemia and transitions of care: A systematic review
Lansang, M. C., Zhou, K., & Korytkowski, M. T. (2021) · Endocrine Practice · doi:10.1016/j.eprac.2021.01.016 · Cited by 9 · see citing works
Self-citationMorey-Vargas, O. L., Aminian, A., Steckner, K., Zhou, K.-R., Kashyap, S., Cetin, D., Pantalone, K., Daigle, C. R., Griebeler, M. L., Butsch, W. S., et al. (2022) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2022.05.008 · Cited by 9 · see citing works
Self-citationPalladino, C. E., Eberly, M. E., Emmons, J. T., & Tannock, L. R. (2016) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2016.02.004 · Cited by 8 · see citing works
Hypoglycemia Reduction Strategies in the ICU
Braithwaite, S. S., Bavda, D. B., Idrees, T., Qureshi, F. M., & Soetan, O. T. (2017) · Current Diabetes Reports · doi:10.1007/s11892-017-0963-3 · Cited by 9 · see citing works
A primer on concentrated insulins: what an internist should know
Barnosky, A., Shah, L., Meah, F. A., Emanuele, N., Emanuele, M. A., & Mazhari, A. (2016) · Postgraduate Medicine · doi:10.1080/00325481.2016.1159909 · Cited by 7 · see citing works
Kedia, R., Desouza, C., Smith, L., & Shivaswamy, V. (2017) · Journal of diabetes and its complications · doi:10.1016/j.jdiacomp.2017.02.008 · Cited by 6 · see citing works
Erukulapati, R. S., Manikandan, R. M., Jakkidi, L. R., Sathyanarayana, S. O., Ayyagari, U., Aswathiah, S., Nalla, S., Sampath, S. K., Manohar, S. P., Shah, S. C., et al. (2024) · Clinical Diabetology · doi:10.5603/cd.98136 · Cited by 4 · see citing works
“The insulin dosage is best determined based on the insulin infusion rate during the last 6 hours when stable glycemic objectives were met [72].”
BackgroundGlycemic Outcomes of Hospitalized Patients on Ambulatory Humulin-R U-500 Insulin
Kanbour, S., Yenokyan, G., Snyder, R. A., Abusamaan, M. S., & Mathioudakis, N. N. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.09.005 · Cited by 3 · see citing works
Passarella, P., & Gosmanov, A. (2025) · The Medical clinics of North America · doi:10.1016/j.mcna.2025.11.001
- Authors
- Tripathy, P. R., & Lansang, M. C.
- Affiliations
- Memorial Hospital of Carbondale (US)
- Cleveland Clinic (US)
- Corresponding author
- Lansang, M. Cecilia
- ORCID
- Lansang, M. Cecilia
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2015
- Volume
- 21
- Issue
- 1
- Pages
- 54-58
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W2158137933
- Cited by
- 23
- References
- 10
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 4 · 2016: 5
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- U-500 insulin, insulin resistance, hospitalized patients, insulin regimens, glycemic control, hypoglycemia, hyperglycemia, insulin requirement, insulin switching, long-acting insulin, inpatient management
- MeSH terms
- Aged, Female, Hospitalization, Humans, Hypoglycemic Agents, Insulin, Length of Stay, Male, Middle Aged, Retrospective Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
