MON-610 Use of Highly Concentrated U500 Insulin with Omnipod 5 in automated mode

Abstract Disclosure: P.K. Patel: None. A. Saif: None. P.R. Schroeder: None. P.A. Sack: None. Introduction: Concentrated regular U-500 insulin (U-500R) is typically prescribed for patients with Type 2 diabetes mellitus (T2DM) who are very insulin-resistant requiring more than 200 units of insulin per day. U-500R can reduce the number of daily injections, lower the volume of injections, and enhance cost-effectiveness. Clinical trials have demonstrated improvements in glycemic control without an increased risk of hypoglycemia with the use of U-500R for continuous subcutaneous insulin infusion (CSII). However, automated insulin delivery (AID) systems, including hybrid closed-loop systems, have not yet been formally studied in T2DM patients using U-500R.Case: We present the case of a 39-year-old female with very insulin resistant T2DM who was initially treated with insulin lispro U100, using 100 units/day via the pump, which resulted in frequent pod changes every 1 to 1.5 days. In addition to the insulin she received from her pump, she also required ∼140 units of subcutaneous Basaglar daily. Her U100 lispro insulin, used via the pump, was switched to U-500R while continuing to use the automated mode and her Basaglar was discontinued. We maintained a 24-hour blood glucose target of 110 mg/dL and increased her active insulin time from 3 hours to 6 hours to better reflect the kinetics of U-500R. After four weeks, her average glucose level was 164 mg/dL. The distribution of her blood glucose (BG) readings was 1% <54 mg/dL, 1% < 70 mg/dL, 61% 70-180 mg/dL, 29% >180 mg/dL, and 8% > 250 mg/dL. The pump remained in auto mode 100% of the time. She was getting ∼38 units x 5 per day, or a total of 190 units. Of her total insulin usage, 59% was basal insulin and 41% was bolus insulin. Her insulin pod now lasts for 3 days. The HgA1C improved to 7.3 from 8.8 after two-month use of U500R in the Omnipod 5 AID system. She did not report any overt symptoms of hypoglycemia throughout this period, despite setting the BG target at the lowest possible level of 110. The rare episodes of hypoglycemia seemed to be mostly overnight. Conclusion: U-500R proved to be safe and effective with Omnipod 5 AID. Further research is required to adapt the automated dosing algorithm to U-500R to reduce the risk of nocturnal hypoglycemia. Presentation: Monday, July 14, 2025