7374 U-200 Lispro In An Automated Insulin Delivery System To Treat Patients With Type 1 Diabetes: Case Series
Authors: Bacha Dania Salih , Malloy Kevin , Isaacs Diana , Cecilia Lansang M 
Published: October 2024

Abstract
Disclosure: D. Salih Bacha: None. K. Malloy: None. D. Isaacs: Consulting Fee; Self; Abbott Laboratories, Medtronic Diabetes, Insulet Corporation, Novo Nordisk, Lilly USA, LLC, Dexcom. M. Lansang: Consulting Fee; Self; Glooko. Research Investigator; Self; Abbott Laboratories, Xeris, Dexcom.
Background: Automated insulin delivery (AID) pumps enable continuous delivery of insulin that more closely reflects a person’s physiologic insulin needs compared to multiple daily insulin injections (MDI) or open-loop insulin pumps. Omnipod-5 is a tubeless AID pump compatible with U-100 (i.e. 100 units/mL) rapid-acting insulins. For higher dose requirements, the more concentrated U-200 (i.e. 200 units/mL) insulin offers the advantage of similar kinetics to U-100 rapid-acting insulin with less frequent pod changes. However, using U-200 insulin in AIDs is not routinely done in clinical practice due to pump setting parameters and algorithms engineered for U-100 insulin. We present 2 patients with type 1 diabetes mellitus (T1DM) in whom we used U-200 insulin in Omnipod-5 to promote their care. Case 1: A 57-year-old male with T1DM and kidney transplant history (on daily prednisone) was on MDI of aspart and degludec. Despite carbohydrate counting and adjusting insulin doses correctly, his glycemic control was suboptimal with continuous glucose monitor (CGM) time in range (TIR) consistently around 50%. He opted for Omnipod-5. His total daily insulin (TDI) dose was &gt;100 units/day, necessitating daily pod exchanges with U100. Therefore, the pump was initiated using U-200 lispro with adjustment of insulin delivery setting parameters (basal rates, insulin-to-carb ratios, insulin sensitivity factors) to reflect a 2-fold increase in insulin delivery per volume. One month later, his TIR increased to 70% with minimal hypoglycemia episodes (&lt;1%). Case 2: A 25-year-old pregnant female with T1DM and PCOS was using U-100 lispro in Omnipod-5. Her pregnancy-specific TIR (63-140 mg/dL) was 36%, with TDI dose &gt;100 units/day, requiring daily pod exchanges. To match the increasing insulin requirements associated with pregnancy progression, her insulin was changed to U-200 lispro, with commensurate adjustment of insulin delivery settings as in Case 1. She was initially placed on manual mode to allow the algorithm time to adapt to the new TDI dose. One month later, she continued to have similar glycemic control (TIR 34%; non-adherence was a factor) with minimal hypoglycemia episodes (1%), but she was exchanging her pod every other day instead of daily. Both patients were informed that the pump’s algorithm was not studied with U-200 insulin and to monitor for hypoglycemia. Conclusion: These two cases highlight the use of U-200 lispro in Omnipod-5 AID system. The first case describes the transition from MDI to initiation of Omnipod 5 with U-200 lispro, whereas the second shows the conversion from U-100 to U-200 lispro in a patient already using an AID system. The use of U-200 insulin in Omnipod-5 facilitated the administration of higher insulin doses in a more manageable volume requiring less frequent pod exchanges without an increase in hypoglycemia. In case 1, using U-200 was also associated with improved glucose control.
Presentation: 6/1/2024