Managing the care of patients with diabetes who are highly insulin-resistant remains a challenge for many clinicians. Patients who require more than 200 units (U) per day of insulin face difficulties administering the amounts necessary for managing their blood glucose levels effectively. Besides the inconvenience and discomfort of multiple insulin injections to meet the needs for glycemic control, absorption of high volumes of insulin may be unpredictable, making diabetes management particularly challenging for clinicians and patients alike. Concentrated insulins provide a way for clinicians to tailor insulin regimens for patients who require large daily doses. To allay fears and misunderstandings that can lead to clinical inertia on the part of prescribers who are reluctant to intensify antihyperglycemic therapy with these agents, clarity is needed about the characteristics of available concentrated insulins, including their pharmacokinetic and pharmacodynamic (PK/PD) profiles, how bioequivalence plays a role in determining the activity of these agents when compared with their U-100–parent agents, and their modes of administration and dosing, which will lead to more appropriate use in clinical practice.
This case is the second of 2 companion case studies discussing the use of concentrated insulins and features a 55-year-old obese man with type 2 diabetes mellitus (T2DM) who presents to the endocrinology clinic with concerns about the frequency of his insulin injections.