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Insulin

Contents

  1. 1 Insulin sliding scales
    1. 1.1 Standard: e.g. |  Delivery: e.g.
  2. 2 Inpatient Management
  3. 3 Insulin regimes
  4. 4 Bedtime basal insulin titration schedule (Glargine)
  5. 5 Insulin types and pharmakokinetics
  6. 6 Insulin available in the UK
  7. 7 Resources

Insulin sliding scales

Standard: e.g. |  Delivery: e.g.

 0< 4: 0.5    |  0< 4: 0.5    
 4< 7: 1=x-1c |  4< 6: 1=x-1c 
 7< 9: 2=x    |  6< 7: 2=x    
 9<11: 3=x+1c |  7< 9: 3=x+1c 
11<14: 4=x+2c |  9<10: 4=x+2c 
14<17: 5=x+3c | 10+  : 6=x+4c 
17+  : 6=x+4c |               

Inpatient Management

Insulin regimes

 Type Insulin Brand Onset Peak Duration Appearance

short-
acting

 Lispro (a) Humalog ~15min 60[30-90]min 4[3-5]h

Clear

Aspart (a) Novorapid 15[10-20]min 2[1-3]h 4[3-5]h
Glulisine (a) Apidra 15-30min 45[30-60]min 4h
Regular (h) Actrapid
Humulin S		 30-60min 2-4h 5-8h

long-
acting

 NPH (h) Insulatard
Humulin I		 1-2h 4-10h 14h+ Cloudy
Detemir (a) Levemir (NN) 3-4h 6-8h 14-23 Clear
Glargine (a) Lantus 1.5h flat 24h

bi-
phasic

 Lispro Mix 50 (a) HumalogMix50
(=50%protamine)		 15-30min 30min-3h 14-24h Cloudy
Lispro Mix 25 (a) HumalogMix25
(=75%protamine)		 15min-5h 30min-2.5h 14-24h
Aspart Mix 30 (a) Novomix30
(=70%protamine)		 5-10min 1-4h 18-24h

Bedtime basal insulin titration schedule (Glargine)

Src: Treat-To-Target Trial: Riddle(2003)DiabCare [free pdf]
Target FPG<=5.6mM/L: start with 10u/d bedtime basal insulin
and adjust weekly according to mean SMFPG from prececing 2 days:
  any single BM mean FPG of preceeding 2 days
BM 0-3.0 3.1-4.0 4.0-5.5 5.6-6.6 6.7-7.7 7.8-9.9 10.0+
change -4u -2u ±0u +2u +4u +6u +8u

Insulin types and pharmakokinetics

Insulin onset peak duration
analog <30' <2-4h <8h
human 30-60' 2-4h -8h
human(inh) <30-60' 2-4h -8h
intermediate 1-2h 4-12h 16-35h

Insulin available in the UK

 
 
 Insulin Brand Pen
short-
acting
 analog lispro Humalog®(L) Autopen®; HumaPen®; Humalog®-Pen
aspart NovoRapid®(NN) NovoPen®; FlexPen®
glulisine Apidra®(SA) OptiPen® Pro 1; Autopen®24; OptiClik®; Apidra® OptiSet®
human soluble Humulin S®(L) Autopen®; HumaPen®
soluble Actrapid®(NN) [10ml vial]
soluble Insuman® Rapid(AP) OptiPen® Pro 1; Insuman® Rapid OptiSet®
long-
acting
 analog glargine Lantus®(AP) OptiPen® Pro 1; Autopen®24; OptiClik®; Lantus® OptiSet®
detemir Levemir®(NN) NovoPen®; FlexPen®
human isophane Insulatard®(NN) Novopen®; Insulatard InnoLet®
isophane Humulin I®(L) Autopen® HumaPen® Humulin I-Pen®
isophane Insuman® Basal(AP) OptiPen® Pro 1; Insuman® Basal OptiSet®
bi-
phasic
 analog aspart+~prot. NovoMix®30(NN) NovoPen®; FlexPen®
lispro+~prot. Humalog®Mix25[/50](L) Autopen®; HumaPen®
human soluble+isoph. Mixtard®30(NN) Novopen®; Mixtard 30 InnoLet®

Legend: L=Lilly; NN=Novo Nordisk; SA=Sanofi-Aventis; AP=Aventis Pharma

Resources

Insulin wallchart: http://www.diabetes.org.uk/Documents/Magazines/Insulinwallchart.pdf

 
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