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Bob, A 55-Year-Old Obese African American Man With T2DM

Bob, A 55-Year-Old Obese African American Man With T2DM


Patient Case Study

Time to Complete

30 minutes


September 30, 2016


December 31, 2017
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Maximum Credits

0.50 / AMA PRA Category 1 Credit(s)TM

Accredited Provider

This educational activity is provided by Haymarket Medical Education.

Commercial Supporter

Supported by an educational grant from Lilly USA, LLC.

Program Description

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.

Intended Audience

Endocrinologists, diabetologists, primary care physicians, nurse practitioners (NPs) and physician assistants (PAs)

Educational Objectives

At the conclusion of this activity, participants should be better able to:

  • Identify patients with diabetes who may be severely insulin-resistant to develop an appropriate antihyperglycemic treatment regimen that may include concentrated insulins
  • Recognize the differences between available concentrated insulins and their related U-100 formulations and among each other based on clinically relevant characteristics, such as PK/PD profiles and bioavailability
  • Evaluate clinical trial data on concentrated insulins to individualize treatment plans for patients with high-dose insulin requirements
  • Implement effective strategies for minimizing risk of error and avoiding confusion when developing treatment plans that include concentrated insulins
  • Counsel patients with high-dose insulin requirements to ensure safe and proper use of concentrated insulins as a part of their treatment regimen

Conflict Of Interest Disclosure Policy

In accordance with the ACCME Standards for Commercial Support, HME requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. HME resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.


Wendy Lane, MD
Mountain Diabetes and Endocrine Center
Asheville, NC

Dr. Lane has received consulting fees from Insulet Corp., Novo Nordisk, and Thermalin Diabetes, LLC.

Accredited Provider Disclosure

The Haymarket Medical Education staff involved in the planning and content review of this activity have no relevant financial relationships to disclose.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

Haymarket Medical Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement

Haymarket Medical Education designates this enduring material for a maximum of 0.50 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Unlabeled Use

This educational activity may contain discussion of approved and/or investigational uses of agents that are not indicated by the FDA. Haymarket Medical Education and Lilly USA, LLC, do not recommend the use of any agent outside of the labeled indications.


The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of Haymarket Medical Education and Lilly USA, LLC. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

If you have any questions relating to the accreditation of this activity, please contact


To obtain credit, a score of 70% or better on the post-test is required. This activity is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the post-test and evaluation, and have received a digital copy of your credit certificate. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

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