diabetestalk.net

How To Switch Between Insulin Products

Should My Insulin Dose Be Lower? Toujeo Vs Lantus

Should My Insulin Dose Be Lower? Toujeo Vs Lantus

Early in 2015 the FDA approved the first concentrated long-acting insulin known as Toujeo (insulin glargine), and it’s now available in pharmacies. While Toujeo is the first of its kind, the key word is “concentrated.” It actually contains the same active ingredient (insulin glargine) as Lantus—which is currently the #1 prescribed insulin in the US. To make things even more confusing: Toujeo comes in a 300 mg/mL dosage, while Lantus is 100 mg/mL. Knowing that Toujeo is concentrated, you might think that you can take a much smaller amount of Toujeo for a similar dose compared to Lantus. Believe it or not though, that isn’t the case. Lantus and Toujeo doses are converted 1:1. This means that if you are injecting 50 units of Lantus, you can essentially be switched over to Toujeo and instructed to inject the exact same amount, 50 units. In reality, some dose adjustments can be expected (according to clinical trial data), but it isn’t a matter of converting to a three times smaller dose. Surprisingly, patients who switch over to Toujeo are actually injecting higher doses compared to what they were using for Lantus. I see a lot of confusion around the different dosages, and a few common questions: Is it normal for my dose of Toujeo to be more than my Lantus dose? Yes. Although Toujeo has three times the concentration of insulin glargine, patients treated with Toujeo during clinical trials used more insulin than patients treated with Lantus in order to maintain the same level of blood sugar control. According to the manufacturer, Sanofi-Aventis, a higher dose can be expected with Toujeo and is completely normal. Why would Sanofi-Aventis make Toujeo if Lantus is the most-prescribed insulin? There is speculation that Sanofi-Aventis came up with Toujeo due to the upco Continue reading >>

Product Important Safety Information

Product Important Safety Information

Selected Important Safety Information WARNING: RISK OF THYROID C-CELL TUMORS Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined. Victoza® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Victoza® and inform them of symptoms of thyroid tumors (eg, a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Victoza®. Selected Important Safety Information Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients NovoLog® and NovoLog® Mix 70/30 are contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin aspart or any of the excipients Warnings and Precautions Never Share a Tresiba® FlexTouch®; Levemir® FlexTouch®, NovoLog® FlexPen, NovoLog®FlexTouch®, PenFill® Cartridge, or PenFill® Cartridge Device; or NovoLog®Mix 70/30 FlexPen® Between Patients, even if the needle is changed. Patients using vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens Hypoglyc Continue reading >>

Interactive Dosing Calculator

Interactive Dosing Calculator

Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>

When You Can't Afford The Insulin That You Need To Survive | How To Use The Cheap

When You Can't Afford The Insulin That You Need To Survive | How To Use The Cheap "old-school" Insulin

Note: BootCamp for Betics is not a medical center. Anything you read on this site should not be considered medical advice, and is for educational purposes only. Always consult with a physician or a diabetes nurse educator before starting or changing insulin doses. Did you know that all type 1 diabetics and some type 2 diabetics need injectable insulin in order to live? Put another way, if a diabetic needs insulin in order to live, and the diabetic does not get insulin, the diabetic will die. Diabetic death from Diabetic Ketoacidosis is a grisly process, during which acid starts running through your bloodstream, searing your vessels and organs while your body shrivels up in dehydration as it tries to push the acid out of your body through your urine and lungs, and, left untreated, the condition shuts down your organs one by one until you are dead. If you're lucky, your brain will be the first thing to swell itself into a coma and you'll be unconscious for the remainder of the organ failures. In some cases, this grisly diabetic death can take a few days or weeks to complete its process. Or, if you're one of the luckier less-resistant insulin-dependent type 2 diabetics, you may actually get away with staying alive for quite a few years and suffer only some heart disease, stroke, kidney damage/failure, neuropathy, limb amputations and blindness. (my intent in describing how lack of insulin leads to death is not to cause fear in people with diabetes or their loved ones; rather, my intent is to make clear the reality that injectable insulin is absolutely vital to diabetics who depend on injectable insulin to live) While I'd love to go off on a political rant about how insulin should be a basic human right for all insulin-dependent diabetics (and why the hell isn't it?), that' Continue reading >>

Types Of Insulin And How They Work

Types Of Insulin And How They Work

Insulin is a hormone the body makes to control the level of glucose (sugar) in the blood. It lowers blood sugar by allowing glucose to leave the bloodstream and enter body cells. Without enough insulin, the level of glucose in the bloodstream can become too high. Everyone needs insulin to use food properly. People without diabetes make enough of their own insulin to keep their blood sugar at healthy levels all the time. People with type 1 diabetes no longer make insulin of their own. Instead, they need to take shots of one or more types of insulin to keep their blood sugars close to normal. Between 75 and 90 percent of people with type 2 diabetes need to take insulin shots to help them get the best control of their blood sugar levels. Deciding How Much Insulin to Take The amount of insulin a person needs depends on: Body weight Percentage of body fat Activity level Diet Other medicines Emotions and stress General health Type of insulin When you first start taking insulin shots, your doctor might ask you to change the amount you take or the time you take it several times. You and your doctor will base these changes on the results of your blood sugar tests. You'll need to make adjustments until you find the dose and schedule that work best for you. Each person's need for insulin is different: Some people can control their blood sugar with one shot of insulin a day. Most people need more than three shots every day. Many people need more than one type of insulin. If you take several insulin shots a day or use more than one type of insulin, it doesn't mean your diabetes isn't in good control. Your blood sugar, not the amount or type of insulin you take, is the best way to judge how well you are doing. If you take three shots a day and your blood sugar is near normal, that's Continue reading >>

5 Types Of Insulin And How They Work

5 Types Of Insulin And How They Work

What you need to know If you have to take insulin to treat diabetes, there’s good news: You have choices. There are five types of insulin. They vary by onset (how soon they start to work), peak (how long they take to kick into full effect) and duration (how long they stay in your body). You may have to take more than one type of insulin, and these needs may change over time (and can vary depending on your type of diabetes). Find out more about the insulin types best for you. Rapid-acting insulin What it’s called: Humalog (lispro), NovoLog (aspart), Apidra (glulisine) Rapid-acting insulin is taken just before or after meals, to control spikes in blood sugar. This type is typically used in addition to a longer-acting insulin. It often works in 15 minutes, peaks between 30 and 90 minutes, and lasts 3 to 5 hours. “You can take it a few minutes before eating or as you sit down to eat, and it starts to work very quickly,” says Manisha Chandalia, MD, director of the Stark Diabetes Center at the University of Texas Medical Branch, in Galveston. Short-acting insulin What it’s called: Humulin R, Novolin R Short-acting insulin covers your insulin needs during meals. It is taken about 30 minutes to an hour before a meal to help control blood sugar levels. This type of insulin takes effect in about 30 minutes to one hour, and peaks after two to four hours. Its effects tend to last about five to eight hours. “The biggest advantage of short-acting insulin is that you don't have to take it at each meal. You can take it at breakfast and supper and still have good control because it lasts a little longer,” Dr. Chandalia says. Intermediate-acting insulin What it’s called: Humulin N (NPH), Novolin N (NPH) Intermediate-acting insulin can control blood sugar levels for about Continue reading >>

B130. Biosimilars - Insulin Analogues 2.1

B130. Biosimilars - Insulin Analogues 2.1

1 of 8This document is for use within the NHS and is not for commercial or marketing purposes Community Interest Company Biosimilar - Insulin glargine Across the globe diabetes mellitus is recognised as one of the leading causes of death and disability. It is estimated that 371 million adults have diabetes worldwide. This number is predicted to increase to 552 million by 2030.1 Diabetes mellitus is a chronic disease that occurs for one of two reasons: • The pancreas does not produce enough insulin (type 1 diabetes mellitus - T1DM). • The body cannot effectively utilise the insulin it produces (type 2 diabetes mellitus -T2DM). In either scenario hyperglycaemia will ensue. With both forms of diabetes, close glycaemic control is recommended as this has been shown to reduce the risks of long term complications due to high circulating blood glucose levels. The role of insulin in achieving the required control is well recognised.2 Long acting insulin analogues, such as insulin glargine, provide smooth, peakless basal insulin profiles, resulting in a glycaemic profile similar to normal physiology, potentially enabling people to achieve normal blood glucose levels. Long acting insulin analogues, such as insulin glargine, may provide benefits such as less hypoglycaemia over intermediate and long acting insulin, e.g. isophane insulin (Neutral Protamine Hagedorn (NPH)).3-7 These benefits are more pronounced in T1DM and include reduced frequency of nocturnal hypoglycaemia, better fasting blood glucose control and improved quality of life. The benefits in T2DM are less distinct and insulin glargine should be used only in selected patients as per National Institute of Clinical Excellence (NICE) guidance.8 Insulin glargine was first authorised in the EU on 9 June 2000 unde Continue reading >>

Insulin Therapy In Type 2 Diabetes Mellitus

Insulin Therapy In Type 2 Diabetes Mellitus

INTRODUCTION Type 2 diabetes is by far the most common type of diabetes in adults and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance. It is a common disorder whose prevalence rises markedly with increasing degrees of obesity. Treatment of patients with type 2 diabetes mellitus includes education, evaluation for microvascular and macrovascular complications, normalization of glycemia, minimization of cardiovascular and other long-term risk factors, and avoidance of drugs that can aggravate abnormalities of insulin or lipid metabolism. Weight reduction, diet, and oral medication (typically metformin) can all be used to improve glycemic control, although the majority of patients with type 2 diabetes fail to maintain glycemic targets after a successful initial response to therapy. The therapeutic options for such patients include adding a second or third oral agent or an injectable agent, including insulin, or switching to insulin. The role of insulin in achieving optimal glycemic control in patients with type 2 diabetes will be reviewed here. Options for initial therapy, options for the management of persistent hyperglycemia, and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. Continue reading >>

Levemir® (insulin Detemir [rdna Origin] Injection) Indications And Usage

Levemir® (insulin Detemir [rdna Origin] Injection) Indications And Usage

Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients. Never Share a Levemir® FlexTouch® Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens. Dosage adjustment and monitoring: Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment of concomitant anti-diabetic treatment. Administration: Do not dilute or mix with any other insulin or solution. Do not administer subcutaneously via an insulin pump, intramuscularly, or intravenously because severe hypoglycemia can occur. Levemir® (insulin detemir [rDNA origin] injection) is indicated to improve glycemic control in adults and children with diabetes mellitus. Levemir® is not recommended for the treatment of diabetic ketoacidosis. Intravenous rapid-acting or short-acting insulin is the preferred treatment for this condition. Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients. Never Share a Levemir® FlexTouch® Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens. Dosage adjustment and monitoring: Monitor blood glucose in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in the insulin dose or an adjustment of concomitant anti-diabetic treatment. Administration: Do not dilute or mix with any other insulin Continue reading >>

Types Of Insulin For Diabetes Treatment

Types Of Insulin For Diabetes Treatment

Many forms of insulin treat diabetes. They're grouped by how fast they start to work and how long their effects last. The types of insulin include: Rapid-acting Short-acting Intermediate-acting Long-acting Pre-mixed What Type of Insulin Is Best for My Diabetes? Your doctor will work with you to prescribe the type of insulin that's best for you and your diabetes. Making that choice will depend on many things, including: How you respond to insulin. (How long it takes the body to absorb it and how long it remains active varies from person to person.) Lifestyle choices. The type of food you eat, how much alcohol you drink, or how much exercise you get will all affect how your body uses insulin. Your willingness to give yourself multiple injections per day Your age Your goals for managing your blood sugar Afrezza, a rapid-acting inhaled insulin, is FDA-approved for use before meals for both type 1 and type 2 diabetes. The drug peaks in your blood in about 15-20 minutes and it clears your body in 2-3 hours. It must be used along with long-acting insulin in people with type 1 diabetes. The chart below lists the types of injectable insulin with details about onset (the length of time before insulin reaches the bloodstream and begins to lower blood sugar), peak (the time period when it best lowers blood sugar) and duration (how long insulin continues to work). These three things may vary. The final column offers some insight into the "coverage" provided by the different insulin types in relation to mealtime. Type of Insulin & Brand Names Onset Peak Duration Role in Blood Sugar Management Rapid-Acting Lispro (Humalog) 15-30 min. 30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with Continue reading >>

Lantus Vs Tresiba: The Better Long Acting Insulin For Diabetes

Lantus Vs Tresiba: The Better Long Acting Insulin For Diabetes

The judges have declared the winner, and it wasn’t even close! First, some back story in order to understand the importance of this epic fight. Why would Tresiba want to take on Lantus? Lantus has been the champion of long-acting insulin for over fifteen years. That’s right! Lantus was an amazing discovery for diabetes management: the first long-acting basal insulin. Before the year 2000, doctors did not have many types of insulin to choose from. Lantus is actually an analogue of natural human insulin. The insulin molecule was changed slightly in the lab, creating differences in the way it is absorbed. In the case of U-100 glargine (the generic name of Lantus), there is an amino acid substitution and a slight lengthening of one of the two chains that make up the insulin molecule. When Lantus is injected, this alteration increases the time over which the insulin is absorbed, giving it a longer half-life than all the insulins available previously. Fast-forward sixteen years, and Tresiba is now an excellent alternative for what doctors call basal insulin. Basal insulin is a type of insulin that lasts long periods of time and helps control blood sugars between meals and overnight. Several changes were made to slow the absorption of Tresiba, making its effect on lower blood sugar more predictable. As compared to regular insulin, Tresiba contains an amino acid deletion and a special bond with a fatty acid. When combined with zinc and phenol, degludec (the generic name of Tresiba) forms multihexamers under the skin. Once absorbed, it reversibly binds to the main protein in the blood, called albumin. The end result of these modifications is a new class of insulin referred to as “ultra-long-acting basal insulin”. Just recently, in June 2017, the results from the DEVOTE s Continue reading >>

Levemir Vs. Lantus: Similarities And Differences

Levemir Vs. Lantus: Similarities And Differences

Levemir and Lantus are both long-acting injectable insulins that can be used for long-term management of diabetes. Insulin is a hormone that is naturally produced in the body by the pancreas. It helps convert the glucose (sugar) in your bloodstream into energy. This energy is then distributed to cells throughout your body. With diabetes, your pancreas produces little or no insulin or your body is unable to use the insulin correctly. Without insulin, your body can’t use the sugars in your blood and can become starved for energy. The excess sugar in your blood can also damage different parts of your body, including your blood vessels and kidneys. Everyone with type 1 diabetes and many people with type 2 diabetes must use insulin to maintain healthy blood sugar levels. Levemir is a solution of insulin detemir, and Lantus is a solution of insulin glargine. Both are basal insulin formulas. That means that they work slowly to lower your blood sugar levels. They’re both absorbed into your body over a 24-hour period. They keep blood sugar levels lowered for longer than short-acting insulins do. Although the formulations are slightly different, Levemir and Lantus are very similar drugs. There are only a few differences between them. Children and adults can use both Levemir and Lantus. Specifically, Levemir can be used by people who are 2 years or older. Lantus can be used by people who are 6 years or older. Levemir or Lantus can help with daily management of diabetes. However, you may still need to use short-acting insulin to treat spikes in your blood sugar levels and diabetic ketoacidosis (a dangerous buildup of acids in your blood). Learn more: All about diabetic ketoacidosis » Administration Both Levemir and Lantus are given through injection in the same way. You can gi Continue reading >>

Changing Insulin

Changing Insulin

Insulin may be changed due to side effects, allergies or it simply being unavailable If you are on insulin, you may at time needs to switch onto a different type or make of insulin. There can be a number of reasons why you may need to change. There are a number of reasons why you may need to switch insulin: To move to an insulin with a different peak action To move to an insulin with a different duration You are experiencing allergies or side effects with your insulin Your current insulin no longer being produced When you are put onto a new type of insulin, the insulin you are switched may have different properties that you may need to consider. Allergic reactions to insulin or side effects Whilst relatively rare, people may experience signs of allergic reactions or side effects on different types of insulin. This is slightly more likely if switching from an animal insulin to a synthetic insulin, or vice versa. However, a switch between different types of brands of insulin can also have this effect. Allergic reactions or side effects may include redness, swelling or itching at the site of the injection. If the effect happens regularly or for a significant period of time, it is important to mention to your doctor or health team. More advanced allergies, which are more rare, include nausea and vomiting. Speak to your health team if these symptoms occur. Different insulins tend to have different speeds of action. Sometimes the speeds of action will be similar, Read our reference table on quickly different types of insulin tend to start, have there peak action and their duration. How quickly does the insulin begin to act? How quickly the insulin starts to act is a consideration that usually applies to short and rapid acting insulin and may dictate when you take your insuli Continue reading >>

Information Regarding Insulin Storage And Switching Between Products In An Emergency

Information Regarding Insulin Storage And Switching Between Products In An Emergency

en Español Insulin Storage and Effectiveness Insulin for Injection Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. After a disaster, patients in the affected area may not have access to refrigeration. According to the product labels from all three U.S. insulin manufacturers, it is recommended that insulin be stored in a refrigerator at approximately 36°F to 46°F. Unopened and stored in this manner, these products maintain potency until the expiration date on the package. Insulin products contained in vials or cartridges supplied by the manufacturers (opened or unopened) may be left unrefrigerated at a temperature between 59°F and 86°F for up to 28 days and continue to work. However, an insulin product that has been altered for the purpose of dilution or by removal from the manufacturer’s original vial should be discarded within two weeks. Note: Insulin loses some effectiveness when exposed to extreme temperatures. The longer the exposure to extreme temperatures, the less effective the insulin becomes. This can result in loss of blood glucose control over time. Under emergency conditions, you might still need to use insulin that has been stored above 86°F. You should try to keep insulin as cool as possible. If you are using ice, avoid freezing the insulin. Do not use insulin that has been frozen. Keep insulin away from direct heat and out of direct sunlight. When properly stored insulin becomes available again, the insulin vials that have been exposed to these extreme conditions should be discarded and replaced as soon as possible. If patients or healthcare providers have specific questions about the suitability of their insulin, they may call the respective manufacturer a Continue reading >>

Clinical Use Of Insulin Degludec - Sciencedirect

Clinical Use Of Insulin Degludec - Sciencedirect

Volume 109, Issue 1 , July 2015, Pages 19-31 Author links open overlay panel JitenVoraa Insulin degludec (IDeg) is a novel basal insulin with improved PK and PD properties. IDeg improves glycaemic control and significantly reduces the risk of hypoglycaemia. When switching to IDeg, this can be done unit-to-unit or may require dose reduction. Dose adjustment with IDeg can be carried out once-weekly in steps of 2units. The ultra-long duration of action of IDeg allows for dose flexibility, if needed. The limitations of current basal insulin preparations include concerns related to their pharmacokinetic and pharmacodynamic properties, hypoglycaemia, weight gain, and perception of management complexity, including rigid dosing schedules. Insulin degludec (IDeg) is a novel basal insulin with improved pharmacokinetic and pharmacodynamic properties compared to insulin glargine (IGlar) including a long half-life of 25h and a duration of action >42h at steady state, providing a flat and stable blood glucose-lowering effect when injected once daily. Evidence from phase 3a clinical trials with a treat-to-target design in patients with type 1 and type 2 diabetes has shown that IDeg has similar efficacy to IGlar, with a 9% and 26% reduction in risk of overall and nocturnal hypoglycaemia, respectively (in the pooled population) during the entire treatment period, and a 16% and 32% reduction during the maintenance period, respectively. Given its pharmacodynamic properties, IDeg offers a broad dosing window, allowing for flexible dose administration, if required. Two different formulations of IDeg are available (100units/mL [U100] and 200units/mL), the latter providing the same IDeg dose as the U100 formulation in half the injection volume. The unique pharmacokinetic profile of IDeg faci Continue reading >>

More in diabetes