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Titrating Lantus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Insulin is secreted continuously by beta cells in a glucose-dependent manner throughout the day. It is also secreted in response to oral carbohydrate loads, including a large first-phase insulin release that suppresses hepatic glucose production followed by a slower second-phase insulin release that covers ingested carbohydrates 1 (Figure 12). Clinical recommendation Evidence rating References Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia. A 17–19 Fasting glucose readings should be used to titrate basal insul Continue reading >>

Selected Important Safety Information

Selected Important Safety Information

NovoLog® Mix 70/30 is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® Mix 70/30 or one of its excipients. Never Share a NovoLog® Mix 70/30 FlexPen® Between Patients, even if the needle is changed. Patients using NovoLog® Mix 70/30 vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens. Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia. Changes should be made cautiously under close medical supervision and the frequency of blood glucose monitoring should be increased. NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart injectable suspension) 100 U/mL Indications and Usage NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart injectable suspension) 100 U/mL is a mixture of insulin aspart protamine and insulin aspart indicated to improve glycemic control in patients with diabetes mellitus. NovoLog® Mix 70/30 is not recommended for the treatment of diabetic ketoacidosis. The proportions of rapid-acting and long-acting insulins are fixed and do not allow for basal versus prandial dose adjustments. NovoLog® Mix 70/30 is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® Mix 70/30 or one of its excipients. Never Share a NovoLog® Mix 70/30 FlexPen® Between Patients, even if the needle is changed. Patients using NovoLog® Mix 70/30 vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens. Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or Continue reading >>

Optimizing Glycemic Control Through Titration Of Insulin Glargine 100 U/ml: A Review Of Current And Future Approaches With A Focus On Asian Populations

Optimizing Glycemic Control Through Titration Of Insulin Glargine 100 U/ml: A Review Of Current And Future Approaches With A Focus On Asian Populations

, Volume 8, Issue6 , pp 11971214 | Cite as Optimizing Glycemic Control Through Titration of Insulin Glargine 100 U/mL: A Review of Current and Future Approaches with a Focus on Asian Populations Various data have demonstrated inadequate glycemic control amongst Asians with type 2 diabetes mellitus (T2DM), possibly on account of suboptimal titration of basal insulinan issue which needs to be further examined. Here we review the available global and Asia-specific data on titration of basal insulin, with a focus on the use of insulin glargine 100 U/mL (Gla-100). We also discuss clinical evidence on the efficacy and safety of titrating Gla-100, different approaches to titration, including some of the latest technological advancements, and guidance on the titration of basal insulin from international and local Asian guidelines. The authors also provide their recommendations for the initiation and titration of basal insulin for Asian populations. Discussion of the data included in this review and in relation to the authors clinical experience with treating T2DM in Asian patients is also included. Briefly, clinical studies demonstrate the achievement of adequate glycemic control in adults with T2DM through titration of Gla-100. However, studies investigating approaches to titration, specifically in Asian populations, are lacking and need to be conducted. Given that the management of insulin therapy is a multidisciplinary team effort involving endocrinologists, primary care physicians, nurse educators, and patients, greater resources and education targeted at these groups are needed regarding the optimal titration of basal insulin. Technological advancements in the form of mobile or web-based applications for automated dose adjustment can aid different stakeholders in optimizi Continue reading >>

7. Approaches To Glycemic Treatment

7. Approaches To Glycemic Treatment

Pharmacological Therapy for Type 1 Diabetes Most people with type 1 diabetes should be treated with multiple-dose insulin injections (three to four injections per day of basal and prandial insulin) or continuous subcutaneous insulin infusion. A Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. E Most individuals with type 1 diabetes should use insulin analogs to reduce hypoglycemia risk. A Individuals who have been successfully using continuous subcutaneous insulin infusion should have continued access after they turn 65 years of age. E Insulin Therapy Insulin is the mainstay of therapy for individuals with type 1 diabetes. There are excellent reviews to guide the initiation and management of insulin therapy to achieve desired glycemic goals (1). Although most studies of multiple-dose insulin versus pump therapy have been small and of short duration, a systematic review and meta-analysis concluded that there are minimal differences between the two forms of intensive insulin therapy in A1C (combined mean between-group difference favoring insulin pump therapy −0.30% [95% CI −0.58 to −0.02]) and severe hypoglycemia rates in children and adults (2). A large randomized trial in patients with type 1 diabetes with nocturnal hypoglycemia reported that sensor-augmented insulin pump therapy with the threshold suspend feature reduced nocturnal hypoglycemia, without increasing glycated hemoglobin values (3). Intensive management through pump therapy/continuous glucose monitoring and active patient/family participation should be strongly encouraged (4–6). Selected individuals who have mastered carbohydrate counting should be educated that fat increases glucose concent 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 >>

Patient-led Titration With Lantus Is Effective At Lowering Bloodglucose

Patient-led Titration With Lantus Is Effective At Lowering Bloodglucose

Patient-led Titration with Lantus is Effective at Lowering BloodGlucose - Self-empowerment for titration showed to be effective in ATLAS while education helps managing the slightly increased hypoglycemia risk in patient-led study arm - PARIS, France /PRNewswire/ -- Sanofi (EURONEXT : SAN and NYSE : SNY) announced today data from the Asian Treat to Target Lantus Study (ATLAS) showing that dosing of Lantus (insulin glargine) can be successfully self-adjusted by patients with type 2 diabetes to achieve glycemic control or administered in a physician-led program. Insulin therapy is widely established as an effective and well tolerated treatment for the management of type 2 diabetes[1] and patient self-management is key to optimizing treatment outcomes.[2] However, despite this, basal insulin is not as widely adopted in Asia. Initiation from diagnosis is often delayed[3] and target glucose lowering is rarely achieved due to insufficient dose titration. "Asian Treat to Target Lantus Study (ATLAS): A 24-Week Randomized, Multinational Study" [Poster number: 940-P] ATLAS, a randomized, multinational, 24-week study, compared the effectiveness of a patient- versus physician-led initiation (usual standard of care) of insulin glargine-based basal management. A total of 552 patients from Japan, China, Pakistan, India, the Philippines, and Russia with type 2 diabetes were randomly allocated to two titration arms: 275 patient-led, 277 physician-led. Both treatment groups adjusted their insulin dose using the same algorithm to achieve target fasting blood glucose levels of 110mg/dl. Results show that patients with uncontrolled glucose levels can effectively self-adjust their insulin glargine to lower their blood glucose to near target levels, without increased occurrence of severe hypo Continue reading >>

Lantus Titration

Lantus Titration

Member T2 since 1992, Lantus and Humalog since 2012 I was diagnosed with T2 about 10 years ago and have been on a variety of meds at different times since then (Metformin, Avandia, Actos, Prandin and Januvia). About 3 weeks ago my MD and I came to the conclusion that the oral meds were just not effective enough any more (consistent fasting glucose reading in the 170-190 range) and I started on Lantus (plus Metformin and Actos). My doctor decided to start me on 10 units of Lantus and then if the fbg was >150 after 5 days to bump it up to 12 units and if still >150 after 5 more days bump it up to 14 units. If still > 150 then contact her for further instructions. After 3-4 days it was obvious 10 units was doing nothing useful so I went to 12 units for a few days, but still nothing useful as far as my glucose levels are concerned. Being the adventurous sort, I modified the titration schedule to adjust by 4 units after 3 days until things started moving into the correct range. It is looking like the right dosage is probably going to be around 37-39 units based on the accelerated titration schedule I adopted. (going by the prescribed schedule it would have taken weeks to get here). I'll be contacting the doc at the end of next week to give her an update. I'm curious what sort of Lantus adjustment/titration schedule others have gone through to zero in on the correct dose. D.D. Family T1 since 1966, pumper since '03, transplant '08 Things may be different for type 2s, but as a type 1 I never adjusted my insulin by more than 2 units at a time. And then it was a minimum of 3 days between dosing changes to see if there was any effect. While it may take a bit more time, things are not always linear and you may find a tipping point and suddenly find yourself much too low with too 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 >>

Appendix H. Examples For Insulin Initiation And Titration

Appendix H. Examples For Insulin Initiation And Titration

STEP 2. START basal insulin 10 units bedtime (or morning) CONTINUE oral glucose-lowering medication Evening insulin dosing if fasting blood glucose (FBG) is high (pre-breakfast) Morning insulin dosing if FBG is on target but pre-dinner blood glucose level (BGL) is high STEP 3. TITRATION Adjust basal insulin dose to achieve target using either fasting glucose for bedtime insulin or pre-dinner glucose levels for morning dosages Practitioner-led titration (below left) can achieve target in a shorter time period than patient-led titration (below right) Practitioner-led titration OR Patient-led titration Mean FBG over previous two days (mmol/L)* Adjust insulin dose twice weekly until FBG target is achieved ↑ by 2 units every three days, until FBG target is achieved 10 ↑ by 4 units A. If FBG ≥6 mmol/L but ≤8 mmol/L for three consecutive days, no change 8-99 ↑ by 2–4 units B. If FBG is 4–6 mmol/L on any day, ↓ insulin dose by 2 units 7-7.9 No change or ↑ by 2 units C. If FBG <4 mmol/L on any day, ↓ insulin dose by 4 units 6-6.9 No change 4-5.9 ↓ by 2 units <4, or if severe hypoglycaemic episode ↓ by 2–4 units *Do not increase the insulin dose if FBG is <4 mmol/L at any time in the preceding week H.2. Guide to starting and adjusting premixed insulin ↓ Lowest blood glucose level (BGL) reading (mmol/L) of the previous three days – fasting or preprandial Insulin dosage adjustment >10 ↑ by 4 units 8–10 ↑ by 2 units 7–7.9 No change or ↑ by 2 units 6–6.9 No change 4–5.9 ↓ by 2 units <4.0 or severe hypoglycaemic event* ↓ by 4 units If a morning insulin dose is given, adjust the insulin dose according to evening preprandial BGL according to the same titration recommendations *Hypoglycaemia should prompt a review of other oral therapy. Whi Continue reading >>

Gradual Dose Titration | Soliqua 100/33 (insulin Glargine & Lixisenatide Injection) 100 Units/ml & 33 Mcg/ml

Gradual Dose Titration | Soliqua 100/33 (insulin Glargine & Lixisenatide Injection) 100 Units/ml & 33 Mcg/ml

for SOLIQUA 100/33 (insulin glargine and lixisenatide injection) 100Units/mL and 33 mcg/mL In patients with known hypersensitivity to the active substance(s) or to any of the product components. Anaphylaxis and Serious Hypersensitivity Reactions: In clinical trials of lixisenatide, there have been cases of anaphylaxis and other serious hypersensitivity reactions including angioedema. Severe, life-threatening, generalized allergic reactions, including anaphylaxis and angioedema, can occur with insulins, including insulin glargine. If hypersensitivity reactions occur, discontinue SOLIQUA100/33. Use caution in patients with a history of anaphylaxis or angioedema with another GLP-1 RA because it is unknown whether such patients will be predisposed to anaphylaxis. Pancreatitis: Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 RAs. Cases of pancreatitis were reported in clinical trials of lixisenatide. After initiation of SOLIQUA100/33, observe patients for signs and symptoms of pancreatitis (e.g., persistent severe abdominal pain, sometimes radiating to the back and which may be accompanied by vomiting). If pancreatitis is suspected, SOLIQUA100/33 should promptly be discontinued. If pancreatitis is confirmed, restarting SOLIQUA100/33 is not recommended and other antidiabetic therapies should be considered. Never Share a SOLIQUA100/33 SoloStar Pen between Patients: Pen-sharing poses a risk for transmission of blood-borne pathogens, even if the needle is changed. Do not withdraw SOLIQUA100/33 from the pen with a syringe. Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in SOLIQUA100/33 regimen may affect glycemic control and predispose to hypoglycemia or hyperglyce Continue reading >>

Treat-to-target Insulin Titration Algorithms When Initiating Long Or Intermediate Acting Insulin In Type 2 Diabetes

Treat-to-target Insulin Titration Algorithms When Initiating Long Or Intermediate Acting Insulin In Type 2 Diabetes

Go to: Abstract Until recently, titration of insulin in type 2 diabetes clinical trials was typically left up to the investigator's discretion with a simple statement of the target ranges for glucose. In type 2 diabetes trials the average glycemic control achieved was usually less than desirable. Since then a number of trials have been conducted and reported utilizing various algorithms under various conditions. The objective of this article is to provide a review of the evidence to date. In addition to studies already identified through work in the area, the literature was searched using PubMed with the search words “insulin and titration” and subsequently “insulin and algorithm” from which studies starting insulin therapy using insulin titration algorithms in type 2 diabetes were selected. The different algorithms and achieved results for glycemic control and hypoglycemia, as well as factors appearing to impact the results, are reviewed. The recent introduction of rigorously implemented insulin titration algorithms when adding on basal insulin to oral drugs in inadequately treated type 2 diabetes patients has led to better average glycemic control with little risk of severe hypoglycemia, as long as the morning fasting plasma glucose target is not lower than 100 mg/dl. Insulin titration algorithms have undergone and continue evolution in the direction of increased patient control. Keywords: algorithm, basal, detemir, fasting glucose, FPG, glargine, insulin, NPH, severe hypoglycemia, titration Insulin dose (a), FPG (b), and HbA1c (c) achieved as a function of morning FPG target. Squares: studies with a target range, but no specific prescribed insulin dose adjustments. X: studies with insulin dose algorithms, but left to the investigator's discretion to follow. T Continue reading >>

Aade In Practice // March 2014 // 35

Aade In Practice // March 2014 // 35

34 // AADE IN PRACTICE // March 2014 c CAPSULES | CLINICAL MATTERS AADE IN PRACTICE // March 2014 // 35 Over the past decade or two, insulin treatment options have come a long way. The development of so many new insulin preparations has made it easier for providers to successfully fine-tune regimens to meet each patient’s needs. Stud- ies have shown that for those on multiple daily injections, or even basal insulin alone, use of long-acting insulin preparations (ie, glargine and detemir) has yielded better glucose control throughout the entire day with fewer doses, less weight gain, and less hypoglycemia (Mavrogiannaki & Migdalis, 2012; Monami, Marchionni, & Mannucci, 2009). Using standardized treat-to-target algorithms, clinicians are able to ef- fectively titrate basal doses based on the fasting plasma glucose (FPG). If FPG values are consistently above target, then the daily basal dose is increased per protocol; if below target, the dose is decreased, and so on, until the FPG is consistently within target range. A sample treat-to-target algorithm, based on the AT.LANTUS trial (Davies, Storms, Shutler, Blanchi-Biscay, & Gomis, 2005) is provided in Figure 1. Basal Insulin Titration: Looking Beyond the Fasting Glucose TAMARA J. SWIGERT, MSN, RN, CDE Treat-to-Target Algorithm for Basal Insulin Titration Starting Dose: 10 units glargine daily at HS FPG goal: < 100 mg/dL Instructions: Review FPG patterns in-person or via telephone consultation. Calculate mean of last three FPG readings and adjust accordingly: Mean FPG for previous three days ≥ 100 mg/dL and < 120 mg/dL ≥ 120 mg/dL and < 140 mg/dL ≥ 140 mg/dL and < 180 mg/dL ≥ 180 mg/dL Increase daily basal dose by… 0 to 2 units (at provider’s discretion) 2 units 4 units 6 to 8 un Continue reading >>

Common Standards Of Basal Insulin Titration In T2dm

Common Standards Of Basal Insulin Titration In T2dm

Go to: Treatment of T2DM: What Do Diabetes Guidelines Recommend? Quite a number of national4–7 and international 8–10 guidelines on the treatment of T2DM exist. Apart from those published by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the International Diabetes Federation (IDF), which presumably represent the most influential guidelines within the diabetes community, other guidelines, e.g., those of the World Health Organization, the National Institute for Health and Clinical Excellence (NICE), or the Scottish Intercollegiate Guidelines Network (SIGN), are also well-known and respected. All guidelines give recommendations on glycemic targets for T2DM [hemoglobin A1c (HbA1c), blood glucose values], on blood glucose self-monitoring by the patients, and on therapeutic options, including specific treatment regimens. The aforementioned guidelines, however, vary considerably—not only in size and scope, but also with regard to time and mode of insulin initiation and with regard to targets (HbA1c). While the EASD, the IDF, and the German Diabetes Association in their evidence-based guidelines refer to a target HbA1c <6.5%, the ADA and the IDF recommend a target HbA1c <7.0%, and the SIGN recommends a cutoff of 7.0%. The NICE sets the highest glycemic target, with an HbA1c <7.5%. The latest ADA/EASD position statement on the management of hyperglycemia in T2DM8 emphasizes a flexible patient-centered treatment approach: “Ultimately, it is patients who make the final decisions regarding their lifestyle choices and, to some degree, the pharmaceutical interventions they use; their implementation occurs in the context of the patients’ real lives and relies on the consumption of resources (both public and private). Continue reading >>

How To Initiate, Titrate, And Intensify Insulin Treatment In Type 2 Diabetes

How To Initiate, Titrate, And Intensify Insulin Treatment In Type 2 Diabetes

US Pharm. 2007;32(10)(Diabetes suppl):10-16. Diabetes is a major public health problem that affects 7% of the United States population, or 20.8 million people.1 Type 2 diabetes accounts for 90% to 95% of the diabetes population and is diagnosed with increasing frequency, especially in adolescents and children. Nearly one third of individuals with diabetes are unaware of their illness, which delays the time to treatment and increases the risk of complications. Also, the cost of diabetes is staggering, with over $100 billion per year spent on the treatment of people with this disease. Diabetes is the leading cause of adult blindness, nontraumatic amputations, and end-stage renal disease. In addition, the death rates associated with heart disease and the risk of stroke are about two- to fourfold higher in adults with diabetes. These macrovascular complications account for 65% of deaths in people with the disease.1 Studies have documented that maintaining glycemic levels as close to normal as possible helps to reduce diabetes-specific complication risks.2-4 Each percentage point reduction in hemoglobin A1C (HbA1c)--equal to a drop in average plasma glucose of about 40 mg/dL--reduces the risk of microvascular disease by 37%.4 These observations have led to intensification of glycemic targets. The American Diabetes Association currently recommends that each patient maintains glycemic levels as close to normal as possible (HbA1c <6%) and minimally below 7%.5 Pathophysiology Normal physiological insulin secretion consists of a continuous basal secretion to control fasting and between-meal glucose and postprandial spikes in insulin to control meal-related hyperglycemia. Type 2 diabetes is characterized by insulin resistance and dysfunction in pancreatic beta- and alpha-cell func Continue reading >>

(insulin Glargine Injection) 300 Units/ml

(insulin Glargine Injection) 300 Units/ml

Toujeo® is a long-acting human insulin analog indicated to improve glycemic control in adults with diabetes mellitus. Limitations of Use: Toujeo® is not recommended for treating diabetic ketoacidosis. Contraindications Toujeo® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or any of its excipients. Warnings and Precautions Toujeo® contains the same active ingredient, insulin glargine, as Lantus®. The concentration of insulin glargine in Toujeo® is 300 Units per mL. Insulin pens and needles must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimens 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. Changes in insulin regimen may result in hyperglycemia or hypoglycemia. Unit for unit, patients started on, or changed to, Toujeo® required a higher dose than patients controlled with Lantus®. When changing from another basal insulin to Toujeo®, patients experienced higher average fasting plasma glucose levels in the first few weeks of therapy until titrated to their individualized fasting plasma glucose targets. Higher doses were required in titrate-to-target studies to achieve glucose control similar to Lantus®. Hypoglycemia is the most common adverse reaction of insulin therapy, including Toujeo®, 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 bef Continue reading >>

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