ArticleDiabetes therapy : research, treatment and education of diabetes and related disorders2026
Off-label Use of U-500 Regular Insulin with a Tubeless Automated Insulin Delivery System in Type 1 Diabetes and Severe Insulin Resistance: A Case Report.
Article in Diabetes therapy : research, treatment and education of diabetes and related disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionU-500 regular insulin (U-500R) can overcome reservoir-capacity constraints in people with severe insulin resistance, but its delayed and prolonged action is poorly matched to automated insulin delivery (AID) algorithms developed for rapid-acting U-100 insulin analogs. Experience in type 1 diabetes (T1D) is particularly limited.
methodsWe report the off-label transition to Omnipod 5 AID while continuing U-500R in a 46-year-old man with autoimmune T1D, obesity, severe insulin resistance, impaired hypoglycemia awareness (Gold score 6), and frequent isolated overnight work. Before transition, he was receiving approximately 245 units/day of U-500R through an Omnipod DASH patch pump. Initial adaptations included a 6-h active insulin duration, higher overnight glucose targets, semi-quantitative meal announcements, and proactive use of activity mode.
resultsBefore AID initiation, continuous glucose monitoring showed a mean glucose of 137 mg/dl, glucose management indicator of 6.6%, time in range of 75%, and time below range of 9%. After 12 months, time in range increased to 79.1% and time below range decreased to 5.7%, with 0.4% below 54 mg/dl. Automated mode was active for more than 95% of the time. The patient reported substantially fewer symptomatic hypoglycemic episodes, although occasional hypoglycemia persisted during overnight shifts.
conclusionsCarefully supervised use of U-500R in an AID system may preserve patch-pump therapy and reduce hypoglycemia exposure in selected people with T1D and very high insulin requirements. This off-label approach requires explicit dose-conversion procedures, conservative individualized settings, close follow-up, and recognition that residual hypoglycemia risk remains.
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