Using insulin pump for glycemic control in patients with severe insulin resistance.

BACKGROUND:Patients with type 2 diabetes using a continuous subcutaneous insulin infusion (CSII) often require large doses of insulin and need to change their insulin administration sets frequently. A proposed solution to this problem is to use concentrated insulin in their insulin pump; however, insulin pumps are programmed to administer U-100 insulin. Therefore, these patients are at greater risk of hypoglycemia and are responsible for adjusting daily doses. CASE SUMMARY:The solution for our patient encountering this problem was to administer half of his daily basal insulin via subcutaneous injection and allow the CSII to administer the remainder through automated insulin delivery (AID). When this strategy was initiated, the patient's A1C was > 14%. After 5 months of follow-up, the patient's A1C was 8.3% and he reported improved quality of life. PRACTICE IMPLICATIONS:This technique allows patients with high insulin requirements to benefit from AID without the safety risks associated with using concentrated insulin.