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Lantus Long Or Short Acting

Not All Long-acting Insulins Are The Same

Not All Long-acting Insulins Are The Same

Glargine (Lantus) is an insulin analog recently available in the U.S. It is a long-acting insulin but differs from other long-acting insulins (such as NPH, Lente, and ultralente) because it is clear as opposed to cloudy. It also has an acidic pH and should not be mixed with other insulins. Because it is new and patients and physicians do not have a long history of using it, mistakes can occur. A number of our patients have mixed glargine and rapid-acting insulin, in spite of being instructed not to. Additionally, it is no longer possible to distinguish between short- and long-acting insulins by clear or cloudy, respectively. F.R. is a 55-year-old police officer with slowly progressive type 1 diabetes, diagnosed at age 53 years with positive anti-GAD antibodies. As oral agents lost their efficacy, an injection of evening NPH was added to his treatment. Due to his schedule, which involved working 3–4 nights a week, it was impossible to lower his fasting blood glucose levels on a bedtime NPH/daytime oral agents regimen. He was switched to twice-daily NPH and rapid-acting insulin. His HbA1c level remained elevated at 8.8%. When glargine became available he was switched from twice-daily NPH to evening glargine, plus premeal rapid-acting insulin. He was taught carbohydrate counting and was followed closely. His glargine did not seem to control his daytime blood glucose levels, so he was switched to twice-daily injections of glargine. In spite of the new treatment and close follow-up, F.R. seemed to have more erratic blood glucose levels and more unexplained lows and highs than would have been expected on glargine. Therefore, he was put on a continuous glucose sensor to better document his blood glucose levels. His sensor was picked up from his home on a Saturday by one of o Continue reading >>

Insulin A To Z: A Guide On Different Types Of Insulin

Insulin A To Z: A Guide On Different Types Of Insulin

Elizabeth Blair, A.N.P., at Joslin Diabetes Center, helps break down the different types of insulin and how they work for people with diabetes. Types of Insulin for People with Diabetes Rapid-acting: Usually taken before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin. Short-acting: Usually taken about 30 minutes before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin. Intermediate-acting: Covers the blood glucose elevations when rapid-acting insulins stop working. This type of insulin is often combined with rapid- or short-acting insulin and is usually taken twice a day. Long-acting: This type of insulin is often combined, when needed, with rapid- or short-acting insulin. It lowers blood glucose levels when rapid-acting insulins stop working. It is taken once or twice a day. A Guide on Insulin Types for People with Diabetes Type Brand Name Onset (length of time before insulin reaches bloodstream) Peak (time period when insulin is most effective) Duration (how long insulin works for) Rapid-acting Humalog Novolog Apidra 10 - 30 minutes 30 minutes - 3 hours 3 - 5 hours Short-acting Regular (R) 30 minutes - 1 hour 2 - 5 hours Up to 12 hours Intermediate- acting NPH (N) 1.5 - 4 hours 4 - 12 hours Up to 24 hours Long-acting Lantus Levemir 0.8 - 4 hours Minimal peak Up to 24 hours To make an appointment with a Joslin diabetes nurse educator, please call (617) 732-2400. Continue reading >>

Different Types Of Insulin: What To Use And When?

Different Types Of Insulin: What To Use And When?

What’s the difference between the different types of insulin? Long-acting, short-acting, premixed, learn more about all three. You may have a lot of questions as you begin insulin therapy. What are the different types of insulin available? Which should I be using and when? Insulins differ based on 3 key factors: 1 how quickly they work when they peak how long they last (duration) This table compares these factors in the types of insulin available:2 Type Onset (How quickly it starts working) Onset (What it is most effective) Duration (How long it works) Timing of injection (When should it be given) Bolus insulins Rapid acting analogues Apidra/Humalog/NovoRapid 10-15 min 1-2 hours 3-5 hours Given with 1 or more meals per day. To be given 0-15 minutes before or after meals. Short-acting Humulin-R/Toronto 30 min 2-3 hours 6.5 hours Given with one or more meals per day. Should be injected 30-45 minutes before the start of the meal. Basal insulins Intermediate-acting Humulin-N/NPH 1-3 hours 5-8 hours Up to 18 hours Often started once daily at bedtime. May be given once or twice daily. Not given at any time specific to meals. Long-acting analogues Lantus Levemir 90 min Not applicable Lantus: Up to 24 hours Levemir: 16-24 hours Often started once daily at bedtime. Insulin detemir (Levemir) may be given once or twice daily. Not given at any time specific to meals. Premixed insulins Premixed regular insulin Humulin 30/70 and Novolin ge 30/70, 40/60, 50/50 Varies according to types of insulin Contains a fixed ratio of insulin (% of rapid-acting or short-acting insulin to % of intermediate-acting insulin): See above for information about peak actions based on insulin contained Given with one or more meals per day. Should be injected 30-45 minutes before the start of the meal. Pre Continue reading >>

Rapid-acting Versus Long-acting Insulin: What’s The Difference?

Rapid-acting Versus Long-acting Insulin: What’s The Difference?

For people who need to take insulin, there are a couple of different types—long-acting, short-acting, rapid-acting, intermediate-acting, etc. That’s a lot of options! One question I see most often is the difference between rapid-acting and long-acting insulins. So, let’s get into it. What is rapid-acting insulin? Rapid-acting, or meal-time insulin, is a type of insulin that’s usually taken before, during, or after a meal to lower your blood sugar levels associated with meals. How long does it take rapid-acting insulin to begin working? The onset of action varies between rapid-acting insulin products, but can begin working in as little as 5 minutes, or could take as long as 30 minutes, depending on the insulin. The following are the typical onset of action times for each individual rapid-acting insulin products. What is long-acting insulin? Long-acting, or basal insulin, is a type of insulin that gives you a slow steady release of insulin that helps control your blood sugar between meals, and overnight. How long does long-acting insulin last? The duration of action varies between long-acting products but should last anywhere between 22-24 hours. The following are the typical duration of action times for each individual long-acting insulin product: Do I need more than one insulin? Maybe. It’s up to your doctor to determine the best medication regimen for you. Some type 2 diabetes patients may only need to use a long-acting insulin to get their blood sugar control on track; whereas others may need a combination of meal-time and long-acting insulin to best control their blood sugar. If you are using an insulin pump, you will only need to use a rapid or short-acting insulin. The pump is able to give you a slow and steady amount of insulin to cover you all day like Continue reading >>

Lantus, Toujeo (insulin Glargine) Dosing, Indications, Interactions, Adverse Effects, And More

Lantus, Toujeo (insulin Glargine) Dosing, Indications, Interactions, Adverse Effects, And More

100 units/mL (Lantus SoloSTAR; Basaglar KwikPen; 3 mL disposable prefilled pens) 300 units/mL (Toujeo; 1.5 mL SoloStar disposable prefilled pen) 300 units/mL (Toujeo Max; 3 mL SoloStar disposable prefilled pen) Note: Recent studies have suggested that glargine-300 extends blood glucose control well beyond 24 hr Long-acting basal insulin indicated to improve glycemic control in adults with type 1 diabetes mellitus Start ~1/3 of total daily insulin dose; use remaining 2/3 of daily insulin dose on short-acting, premeal insulin Usual initial dose range: 0.2-0.4 units/kg; optimal glucose lowering effect may take 5 days to fully manifest and the first insulin glargine dose may be insufficient to cover metabolic needs in the first 24 hr of use Titrate insulin glargine per instructions, and adjust coadministered glucose-lowering therapies per standard of care See Dosing Considerations and Administration Long-acting basal insulin indicated to improve glycemic control in adults with type 2 diabetes mellitus Start 0.2 units/kg qDay; if necessary, adjust dosage of other antidiabetic drugs when starting insulin glargine to minimize the risk of hypoglycemia See Dosing Considerations and Administration Dose must be individualized based on clinical response; blood glucose monitoring is essential in all patients receiving insulin therapy Patients adjusting the amount or timing of dosage should do so only under medical supervision with appropriate glucose monitoring Titrate Toujeo dose no more frequently than every 3-4 days Use with caution in patients with visual impairment who may rely on audible clicks to dial their dose If changing from a treatment regimen with an intermediate- or long-acting insulin to a regimen with insulin glargine, the amount and timing of shorter-acting insulin Continue reading >>

Types Of Insulin And Their Roles

Types Of Insulin And Their Roles

Do not take Lantus® during episodes of low blood sugar or if you are allergic to insulin or any of the inactive ingredients in Lantus®. Do not share needles, insulin pens, or syringes with others. Do NOT reuse needles. Before starting Lantus®, tell your doctor about all your medical conditions, including if you have liver or kidney problems, if you are pregnant or planning to become pregnant or if you are breast-feeding or planning to breast-feed. Heart failure can occur if you are taking insulin together with certain medicines called TZDs (thiazolidinediones), even if you have never had heart failure or other heart problems. If you already have heart failure, it may get worse while you take TZDs with Lantus®. Your treatment with TZDs and Lantus® may need to be changed or stopped by your doctor if you have new or worsening heart failure. Tell your doctor if you have any new or worsening symptoms of heart failure, including: Sudden weight gain Tell your doctor about all the medications you take, including OTC medicines, vitamins, and supplements, including herbal supplements. Lantus® should be taken once a day at the same time every day. Test your blood sugar levels while using insulin, such as Lantus®. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Do NOT dilute or mix Lantus® with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus® must only be used if the solution is clear and colorless with no particles visible. Always make sure you have the correct insulin before each injection. While using Lantus®, do not drive or operate heavy machinery until Continue reading >>

Basal Insulins (intermediate And Long-acting)

Basal Insulins (intermediate And Long-acting)

Who? Intermediate- and long-acting (basal) insulins are recommended for patients with type 1, type 2, or gestational diabetes. They may also be used in other types of diabetes (i.e. steroid-induced). Persons with type 1 diabetes generally use intermediate-acting insulin or long-acting insulin in conjunction with regular or rapid acting insulin. Persons with type 2 diabetes may use intermediate or long-acting insulins in conjunction with regular or rapid acting insulins or with oral medications. What? Injections given under the skin. Not suitable for insulin pumps. These medications can be injected with a traditional syringe and needle, or with a disposable pen that has been prefilled with insulin. Most patients tend to prefer pens though while convenient, they can be more expensive. The most common type of intermediate-acting insulin is: NPH (marketed as Humulin N and the Humulin N Pen) NPH (marketed as Novolin N and the Novolin N FlexPen) Long-acting insulins are marketed as different brands. The common ones are: Glargine (marketed as Lantus and the Solo Star Pen) Detemir (marketed as Levemir and the FlexPen) Degludec (marketed as Tresiba and the FlexTouch Pen) Where? These medicines are injected into the tissue under the skin and are slowly released into the body. These insulins allow glucose from the bloodstream to enter the cells in the body so that glucose can be used as energy. They also reduce glucose release into the bloodstream. When? NPH is usually injected twice a day. It begins working 1-3 hours after injection, and is most effective between 4-10 hours of injection. It generally keeps working for 10-16 hours. Detemir can be used once or twice a day. It begins working a few hours after injection and generally keeps working for anywhere from 20-24 hours. Glarg Continue reading >>

Types Of Insulin

Types Of Insulin

Topic Overview Insulin is used to treat people who have diabetes . Each type of insulin acts over a specific amount of time. The amount of time can be affected by exercise, diet, illness, some medicines, stress, the dose, how you take it, or where you inject it. The table below is a general guide. Your results may be different. Insulin strength is usually U-100 (or 100 units of insulin in one milliliter of fluid). Short-acting (regular) insulin is also available in U-500. This is five times more concentrated than U-100 regular insulin. Long-acting insulin (glargine) is also available in U-300. This is three times more concentrated than U-100 long-acting insulin. Be sure to check the concentration of your insulin so you take the right amount. Insulin is made by different companies. Make sure you use the same type of insulin consistently. Types of insulin Type Examples Appearance When it starts to work (onset) The time of greatest effect (peak) How long it lasts (duration) Rapid-acting insulins work over a narrow, more predictable range of time. Because they work quickly, they are used most often at the start of a meal. Rapid-acting insulin acts most like insulin that is produced by the human pancreas. It quickly drops the blood sugar level and works for a short time. If a rapid-acting insulin is used instead of a short-acting insulin at the start of dinner, it may prevent severe drops in blood sugar level in the middle of the night. Apidra (glulisine), Humalog (lispro), Novolog (aspart) Clear 5-30 minutes 30 minutes-3 hours 3-5 hours Rapid-acting insulin also comes in a form that can be inhaled through the mouth. Afrezza (insulin human, inhaled) Contained in a cartridge 10-15 minutes 30-90 minutes 2½-3 hours Short-acting insulins take effect and wear off more quickly th Continue reading >>

Insulin Types: Types Of Insulin

Insulin Types: Types Of Insulin

Usually taken before a meal to cover the blood glucose elevation from eating Used with longer-acting insulin Usually taken about 30 minutes before a meal to cover blood glucose elevation from eating Covers the blood glucoseelevations when rapid-acting insulins stop working Often combined with rapid- or short-acting insulin and usually taken twice a day Long acting: insulin glargine , ultralente insulin, insulin detemir Often combined, when needed, with rapid- or short-acting insulin Lowers blood glucose levels when rapid-acting insulins stop working American Diabetes Association. Insulin Basics. April 7, 2014. American Diabetes Association. Available at . Elizabeth Blair. Insulin A to Z: A Guide on Different Types of Insulin. 2015. [Full Text] . Usually taken before a meal to cover the blood glucose elevation from eating Used with longer-acting insulin Usually taken about 30 minutes before a meal to cover blood glucose elevation from eating Covers the blood glucoseelevations when rapid-acting insulins stop working Often combined with rapid- or short-acting insulin and usually taken twice a day Long acting: insulin glargine , ultralente insulin, insulin detemir Often combined, when needed, with rapid- or short-acting insulin Lowers blood glucose levels when rapid-acting insulins stop working Abimbola Farinde, PharmD, PhDFaculty, Columbia Southern University Francisco Talavera, PharmD, PhDAdjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. All material on this website is protected by copyright, Copyright 1994-2018 by WebMD LLC. This website also contains material copyrighted by 3rd parties. This website uses cookies to deli Continue reading >>

How To Use Long-acting Insulin: Types, Frequency, Peak Times, And Duration

How To Use Long-acting Insulin: Types, Frequency, Peak Times, And Duration

Long-acting insulin can help to stabilize blood sugar levels throughout the day, with only one or two shots. Fast-acting insulin replaces the surge of insulin that a healthy pancreas would release at mealtime. In contrast, long-acting insulin mimics the low-level flow of insulin normally released between meals and overnight. In this way, long-acting insulin works to establish a healthy baseline blood sugar level for the body to work around. Contents of this article: Using long-acting insulin Long-acting insulin cannot be delivered in pill form because it would be broken down in the stomach. Instead, it must be injected into the fatty tissue under the skin. From here, it can be gradually released into the bloodstream. Delivery methods According to the National Institute of Diabetes and Digestive and Kidney Diseases, there are a few ways to deliver long-acting insulin. These include: Needle and syringe: a dose of insulin is drawn from a vial into a syringe. Different types of insulin must not be mixed in the same syringe. Pen: this can be loaded with a cartridge containing a premeasured dose, or prefilled with insulin and discarded after use. Injection port: a short tube is inserted into the tissue beneath the skin. Insulin can be delivered using either a syringe or a pen. This only requires the skin to be punctured when the tube needs to be replaced. Injection sites Long-acting insulin can be injected into the abdomen, upper arms, or thighs. Abdomen injections deliver insulin into the blood most quickly. The process takes a little more time from the upper arms, and it is even slower from the thighs. It is important to stay consistent with the general injection area, but the exact injection site should be rotated frequently. Repeat injections at the same spot on the skin Continue reading >>

Effects Of Mixing Glargine And Short-acting Insulin Analogs On Glucose Control

Effects Of Mixing Glargine And Short-acting Insulin Analogs On Glucose Control

Intensive insulin management improves glycemic control and lowers the risks of long-term microvascular complications (1). Several new insulin analogs (2) are in use to improve glycemic control in type 1 diabetes. Glargine in particular is a “basal insulin” (3) and found to be relatively peakless. Glargine is thought to provide glucose profiles similar to insulin pumps (4). Although some clinical studies suggest that glargine lasts 24 h in children with diabetes (5), to date there have been no formal pharmacokinetic and pharmacodynamic data to make that claim in the pediatric population. In fact, clinical observations in pediatric type 1 diabetes suggest that glargine action may be <24 h. This would entail twice-daily glargine dosing and short-acting insulin analogs (SAIs), such as lispro and aspart, given separately three to four times per day, resulting in improved glycemic control but compromising compliance and increasing complexity of management (6). In this study, we tested the hypothesis that mixing glargine with SAIs and dividing the dose of glargine into twice- versus once-daily dosing would not adversely affect glycemic control as assessed by a continuous glucose monitoring system (CGMS). RESEARCH DESIGN AND METHODS The protocol was approved by the institutional review board of the Baylor College of Medicine, and consent was obtained before each study. Subjects were recruited from Texas Children’s Hospital Diabetes Care Center, Houston, Texas. Subjects had type 1 diabetes for at least 1 year with no other chronic illness and were on no additional medications (except for insulin and synthroid for hypothyroidism). All subjects were using insulin glargine as a once- daily injection at bedtime or before supper or breakfast, with three or more injections of SA 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 >>

Types Of Insulin

Types Of Insulin

Insulin analogs are now replacing human insulin in the US. Insulins are categorized by differences in onset, peak, duration, concentration, and route of delivery. Human Insulin and Insulin Analogs are available for insulin replacement therapy. Insulins also are classified by the timing of their action in your body – specifically, how quickly they start to act, when they have a maximal effect and how long they act.Insulin analogs have been developed because human insulins have limitations when injected under the skin. In high concentrations, such as in a vial or cartridge, human (and also animal insulin) clumps together. This clumping causes slow and unpredictable absorption from the subcutaneous tissue and a dose-dependent duration of action (i.e. the larger dose, the longer the effect or duration). In contrast, insulin analogs have a more predictable duration of action. The rapid acting insulin analogs work more quickly, and the long acting insulin analogs last longer and have a more even, “peakless” effect. Background Insulin has been available since 1925. It was initially extracted from beef and pork pancreases. In the early 1980’s, technology became available to produce human insulin synthetically. Synthetic human insulin has replaced beef and pork insulin in the US. And now, insulin analogs are replacing human insulin. Characteristics of Insulin Insulins are categorized by differences in: Onset (how quickly they act) Peak (how long it takes to achieve maximum impact) Duration (how long they last before they wear off) Concentration (Insulins sold in the U.S. have a concentration of 100 units per ml or U100. In other countries, additional concentrations are available. Note: If you purchase insulin abroad, be sure it is U100.) Route of delivery (whether they a Continue reading >>

Types Of Insulin And How They Work - Health

Types Of Insulin And How They Work - Health

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. What its called: Humulin N (NPH), Novolin N (NPH) Intermediate-acting insulin can control blood sugar levels for about 12 hours or longer, so it can be used overnight. It begins to work within one to four hours, and peaks between four and 12 hours, depending on the brand. Intermediate-acting insulin offer baseline insulin coverage and can be used with short-acting insulin or rapid-acting insulin, says Dr. Chandalia. What its called: Lantus (glargine), Levemir (detemir) Long-acting insulin has an onset of one hour, and lasts for 20 to 26 hours with no peak. This insulin type tends to cover your insulin needs for a full day. It is often taken at bedtime. These long-acting insulin provide 24-hour coverage, and have been helpful at achieving good blood sugar control in type 2 diabetes with just one shot, Dr. Chandalia says. What its called: Humulin 70/30, Novolin 70/30, NovoLog 70/30, Humulin 50/50, Humalog mix 75/25, Humalog mix 50/50 This type of insulin combines intermediate- and short-acting insulin. It is often taken twice a day before meals. It should be taken 10 minutes to 30 minutes before eating. Pre-mixed insulin takes effect in 5 to 60 minutes, and its peak times vary. Its effects last from 10 to 16 hours. Pre-mixed insulin was designed to be more con Continue reading >>

Types Of Insulin

Types Of Insulin

Topic Overview Insulin is used to treat people who have diabetes. Each type of insulin acts over a specific amount of time. The amount of time can be affected by exercise, diet, illness, some medicines, stress, the dose, how you take it, or where you inject it. Insulin strength is usually U-100 (or 100 units of insulin in one millilitre of fluid). Short-acting (regular) insulin is also available in U-500. This is five times more concentrated than U-100 regular insulin. Long-acting insulin (glargine) is also available in U-300. This is three times more concentrated than U-100 long-acting insulin. Be sure to check the concentration of your insulin so you take the right amount. Insulin is made by different companies. Make sure you use the same type of insulin consistently. Types of insulinfootnote 1 Type Examples Appearance When it starts to work (onset) The time of greatest effect (peak) How long it lasts (duration) Rapid-acting Apidra (insulin glulisine) Clear 10-15 minutes 1-1.5 hours 3-5 hours Humalog (insulin lispro) Clear 10-15 minutes 1-2 hours 3.5-4.75 hours NovoRapid (insulin aspart) Clear 10-15 minutes 1-1.5 hours 3-5 hours Short-acting Humulin R, Novolin ge Toronto (insulin regular) Clear 30 minutes 2-3 hours 6.5 hours Intermediate-acting Humulin N, Novolin ge NPH(insulin NPH) Cloudy 1-3 hours 5-8 hours Up to 18 hours Long-acting Lantus (insulin glargine) Clear 1.5 hours Does not apply Up to 24 hours Levemir (insulin detemir) Clear 1.5 hours Does not apply 16 to 24 hours Toujeo (insulin glargine U-300) Clear Up to 6 hours Does not apply Up to 30 hours Rapid-acting insulins work over a narrow, more predictable range of time. Because they work quickly, they are used most often at the start of a meal. Rapid-acting insulin acts most like insulin that is produced by Continue reading >>

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