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J Perinatol. 2013 Mar;33(3):235-8. doi: 10.1038/jp.2012.70.

U-500R and aspart insulin for the treatment of severe insulin resistance in pregnancy associated with pregestational diabetes.

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Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco and San Francisco General Hospital, San Francisco, CA 94110, USA.


Severe insulin resistance as a complication of diabetes in pregnancy is seen with increasing frequency. Treatment with large doses of insulin (>300 units perday) can be practically difficult. A woman with preexisting Type 2 diabetes mellitus and poor glycemic control presented in early pregnancy requiring over 1000 units of insulin daily. She was transitioned to subcutaneous U-500 (concentrated regular insulin) in combination with a rapid-acting insulin analog achieving good glycemic control and good maternal and fetal outcomes. U-500R insulin in conjunction with a rapid-acting insulin analog can be used safely in early pregnancy to improve glycemic control in severe insulin resistance due to pregestational diabetes.

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