Insulin

• 1. Lispro (Humalog)
• 2. Aspart (NovoLog)
• 3. Glulisine (Apidra)
• Onset: 15 - 30 mins
• Peak: 2 - 3 hours
• Duration: 4 - 6 hours

• 1. Humulin R
• 2. Novolin R
• 3. Humulin R (U-500)
• Onset: 30 mins - 1 hour
• Peak: 2 - 3 hours
• Duration: 6 - 8 hours

• 1. NPH - Humulin N
• 2. Novolin N
• Onset: 2 - 4 hours
• Peak: 6 - 9 hours
• Duration: 14 - 18 hours

• 1. Glargine (Lantus) Onset 4 - 5 hours, no peak, 22 - 24 hour duration
• 2. Detemir (Levemir) Onset 2 hours, peak 6 - 9 hours, 14 - 24 hour duration

• - hypoglycemia (more common in DMI)
• - weight gain
• - lipohypertophy (not good, changes kinetics of absorption)

• 0.5 - 0.6 units/kg for DMI
• 0.1 - 0.15 units/kg for DMII?
• DMII may need as much as 2 U/kg (titrate to this amount) ? OR a set dose of 10 units?

• 1. Intermediate OR long-acting insulin (basal insulin)
• AND
• 2. rapid OR short-acting insulin with meals
• *Pramlintide may be used in combo with insulin (only non-insulin product allowed for DMI)

Lifestyle modifications + metformin

*If FPG > 250 mg/dL, random BG > 300 mg/dL consistenly, A1C > 10 %, ketonuria, sig. weight loss with polyuria polydipsia and polyphagai --> bring BG back to near normal levels with insulin first and then d/c insulin and initiate oral therapy.

[long-acting?] insulin

• Intermediate or long-acting insulin ac dinner OR at bedtime
• - 0.1 - 0.15 units/kg?
• OR
• - a set dose of 10 units?

• *A rapid or shot-acting insulin may be used with largest meal
• ** Eventually a pt with DMII will transition to typical insulin therapy
• *** STOP SU Tx when combination of basal-bolus insulin is initiated