2026 Southeastern Residency Conference

Title:
An Observational Study of Patients Using U-200 Insulin in Insulin Pumps 

Authors:
Gabrielle E. Hall, Lauren Blumenfeld, Tavajay Campbell, Haley Pressley, Jonathan Hughes, Blake R. Johnson

Practice Site: 
Ascension Saint Thomas

Background: 
The use of concentrated insulin in insulin pumps has been described in a few small studies. These studies describe the use of human regular U-500 insulin via continuous subcutaneous insulin infusion versus multiple daily injections in adults with type 2 diabetes,1 the switch from rapid-acting U-100 insulin to U-500 regular insulin in patients with type 2 diabetes on insulin pump therapy,2 and the use of U-200 insulin in insulin pumps in adolescents and young adults with type 1 diabetes.3 The identified literature gap includes a lack of randomized controlled trials regarding the use of U-200 insulin in insulin pumps, a practice that has not been approved by the FDA.

Methods:
This is a retrospective, observational chart review of patients who used U-200 insulin via Omnipod® insulin pump. Patients were included if an order for Omnipod® and U-200 insulin were active at the same time from January 1, 2022 to November 30, 2025. To be included patients were further required to use the U-200 insulin in their insulin pump, wear a continuous glucose monitor, and complete at least two consecutive visits with their provider while using this regimen. Patients were excluded if they were pregnant or under age 18 at the start of the study period. Outcomes of interest include ambulatory glucose profile results, including time in range, time below range, and time above range, as well as A1c results and instances of stage 2 or 3 hypoglycemia. 

Results:
There were 315 patients using Omnipod® insulin pumps during the study period who were screened for inclusion. Fifteen patients met initial inclusion criteria. Of those fifteen, seven were excluded for not using U-200 insulin via insulin pump, one was excluded for not wearing a continuous glucose monitor, and three were excluded for not completing at least two consecutive visits with the managing provider while using this regimen. The four remaining patients were included in this retrospective chart review and described in a narrative which includes their care plan and associated outcomes. No patients experienced greater than 2% time below range or stage 2 or 3 hypoglycemia. One patient met the time in range goal of >70% after transitioning to using U-200 insulin via Omnipod® insulin pump. Though the other three patients did not meet time in range goals, they experienced improved time in range, time above range, and A1c after transitioning to using U-200 insulin via Omnipod® insulin pump. 

Conclusion:
In this case series of four patients using U-200 insulin via Omnipod® insulin pump, all patients made improvements towards reaching time in range goal >70%, time above range goal <25%, and A1c goal <7%. These findings add to the currently available evidence for this practice and reinforce the need for further study in this area.