French clinicians reported a first detailed case where concentrated U-500 regular insulin was run safely for a year in a tubeless automated insulin delivery system. The report targets a high-need population—patients with type 1 diabetes and severe insulin resistance—where standard insulin volumes can complicate delivery. The case suggests feasibility for broader automation in insulin-resistant patients, where maintaining consistent dosing and minimizing interruptions can be especially important. It also highlights the engineering challenge of making concentrated insulin formulations compatible with automated dosing algorithms. While single-patient data does not establish generalizable efficacy, it provides an operational proof point for device makers and clinicians considering concentrated-insulin support in closed-loop platforms.