Insulin Mgmt in DM

Question 1

INSULIN CAUSES

Answer 1

WEIGHT GAIN
HYPOGLYCEMIA
REDUCTION IN A1C by 1.5-3.5%

Question 2

Rapid Insulin

Answer 2

lispro (Humalog)
aspart (Novolog)
glulisine (Apridral)

Onset of Action: 5-15min
Peak: 1-2 Hours
Duration: 3 to FOUR hours
Clear

Bolus with snacks and meals

Question 3

Regular Insulin

Answer 3

Humulin R and Novolin R

Onset of Action: 30 min
Peak: 2-4 hrs
Duration: 6-8 hrs

Question 4

Intermediate Insulin (NPH)

Answer 4

Humulin N and Novolin N

Onset of Action: 1-4 hrs
Peak: 6-10 hrs
Duration: 10-16 hrs

Question 5

Long-Acting Insulin

Answer 5

detemir (Levemir)

Onset of Action: 3-4 hrs
Peak: 3-9 hrs
Duration: 10-16 hrs

glargine (Lantus) (100U/ml)

Onset of Action: 3-4 hrs
Peak: No Peak
Duration: 22-24 hrs

Question 6

Toujeo

Answer 6

glargine 300U/ml
Long-Acting

Onset of Action: 6 hours
Peak: No peak
Duration: 24-36hrs

• Usually 33-50% of pts total daily insulin requirement
• Rec’d to increase no more frequently than q 3-4 days
• Toujeo Max Solostar: 900U with 160U max/inj
• Toujeo Solostar: 450U with 80U max/inj
• IT MAY take at least 5 days to see the max glucose-lowering effect which means it should ideally be titrated no more than q 3-5 DAYS
  > THIS IS a distinct difference from Lantus (glargine
  100U) which can be titrated 1 day after injection

Question 7

Tresiba

Answer 7

degludec (Tresiba)
Ultra long acting

Onset of Action: 30-90 min
Peak: No peak
Duration: 24-42 hrs

• 100U and 200U doses bioequivalent
• No insulin stack (excess accumulation)
• Can be dose anytime of day
  > as long as its at least 8 hours from last dose and
  not more than 40 hours since last dose
• Nocturnal hypoglycemia not increased when compared to glargine
• Dose once daily (does necessarily be given at same time)
• Steady state is reached after 3-5 days
• Adjust no more often than q 3 days