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Can Glargine Be Mixed With Other Insulins?

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 >>

Can Lantus And Regular Insulin Be Taken Together?

Can Lantus And Regular Insulin Be Taken Together?

Community Answers Lantus is a sterile solution of insulin glargine that is used in injection form. The main thing that makes Lantus stand out from other insulins is that is long-acting with a duration of up to 24 hours. Regular insulin tends to be more short lived and is better used for controlling spikes in your blood sugar levels. While you are taking Lantus it is perfectly safe to use regular insulin to control spikes in your blood sugar. However as with any other medication be sure to consult your doctor before mixing drugs. Too much insulin can cause an unsafe drop in BG levels. It is important to follow your prescribed dosing schedule to ensure you maintain the proper insulin levels. I want to add to that last part , although insulin may be taken " together," as in you may take the long lasting Lantus Insulin and then LATER, when your blood sugar spikes, (usually after meals) you may take Regular insulin and Inject the insulin in a different area. Ex: If giving a subcutaneous injection in the stomach works for you, give the second injection in another part of the stomach. The reason for this is because different parts of your body will absorb the insulin differently.For instance the absorption rate injected in to your arm would be different the the absorption rate in your thigh. So, you may take Insulin Lantus and Regular Insulin "together," However, you can not put Insulin regular and insulin Lantus in the same syringe and give it in one dose. Simplified: You will have 2 insulin's and 2 injections. Continue reading >>

Insulin Analogs

Insulin Analogs

Insulin analogs mimic the body’s natural pattern of insulin release. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. An analog refers to something that is “analogous” or similar to something else. Therefore, “insulin” analogs are analogs that have been designed to mimic the body’s natural pattern of insulin release. These synthetic-made insulins are called analogs of human insulin. However, they have minor structural or amino acid changes that give them special desirable characteristics when injected under the skin. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably. In this section, you will find information about: Rapid-acting injected insulin analog The fastest working insulins are referred to as rapid-acting insulin. They include: These insulin analogs enter the bloodstream within minutes, so it is important to inject them within 5 to 10 minutes of eating. They have a peak action period of 60-120 minutes, and fade completely after about four hours. Higher doses may last slightly longer, but will last no more than five or six hours. Rapid acting insulin analogs are ideal for bolus insulin replacement. They are given at mealtimes and for high blood sugar correction. Rapid-acting insulins are used in insulin pumps, also known as continuous subcutaneous insulin infusion (CSII) devices. When delivered through a CSII pump, the rapid-acting insulins provide the basal insulin replacement, as well as the mealtime and high blood sugar correction insulin replacement. The insulins that work for the longest period of time are referred to as long-acting insulin. They provide relatively constant insulin levels that plateau for many hours after injection. Some Continue reading >>

Early Pharmacokinetic And Pharmacodynamic Effects Of Mixing Lispro With Glargine Insulin

Early Pharmacokinetic And Pharmacodynamic Effects Of Mixing Lispro With Glargine Insulin

Go to: Clinicians who treat children with type 1 diabetes often try to minimize the number of daily injections to reduce treatment burden and improve compliance. Despite the manufacturer's cautions against mixing glargine with rapid-acting insulin analogs, clinical studies have failed to demonstrate deleterious effects of mixing on glucose excursions or A1C levels. However, no formal glucose clamp studies have been performed to determine whether mixing with glargine has an adverse effect on the early pharmacodynamic action of rapid-acting insulin in humans. To examine this question, euglycemic glucose clamps were performed twice, in random order, in 11 youth with type 1 diabetes (age 15.1 ± 3 years, A1C 7.6 ± 0.6%) with 0.2 units/kg lispro and 0.4 units/kg glargine, given either as separate or as a single mixed injection. Mixing the two insulins shifted the time action curve to the right, with significantly lower glucose infusion rate (GIR) values after the mixed injections between 60 and 190 min and significantly higher values between 270 and 300 min, lowered the GIRmax (separate 7.1 ± 1 vs. mix 3.9 ± 1, P = 0.03), and markedly delayed the time to reach GIRmax (separate 116 ± 8 min vs. mix 209 ± 15 min, P = 0.004). The GIR area under the curve was significantly lower after the mixed injections. Mixing had similar effects on plasma insulin pharmacokinetics. These data demonstrate that mixing lispro with glargine markedly flattens the early pharmacodynamic peak of lispro and causes a shift to the right in the GIR curve changes that might lead to difficulties in controlling meal-related glucose excursions. Pharmacokinetic profiles. Insulin concentration, measured by ELISA with a reported cross-reactivity of 44% for insulin glargine, for separate and mixed injections Continue reading >>

Insulin Glargine (rdna Origin) Injection

Insulin Glargine (rdna Origin) Injection

Insulin glargine is used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). It is also used to treat people with type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood) who need insulin to control their diabetes. In people with type 1 diabetes, insulin glargine must be used with another type of insulin (a short-acting insulin). In people with type 2 diabetes, insulin glargine also may be used with another type of insulin or with oral medication(s) for diabetes. Insulin glargine is a long-acting, manmade version of human insulin. Insulin glargine works by replacing the insulin that is normally produced by the body and by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Using medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. Insulin glargine comes as a solution (liquid) to inject subcutaneously (under the Continue reading >>

Insulin Administration

Insulin Administration

Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the American Diabetes Association’s position statement “Continuous Subcutaneous Insulin Infusion” for further discussion on this subject.) INSULIN Insulin is obtained from pork pancreas or is made chemically identical to human insulin by recombinant DNA technology or chemical modification of pork insulin. Insulin analogs have been developed by modifying the amino acid sequence of the insulin molecule. Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin lispro and insulin a Continue reading >>

How To Inject Lantus® With A Vial And Syringe

How To Inject Lantus® With A Vial And Syringe

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 >>

High-alert Medications - Humalog (insulin Lispro)

High-alert Medications - Humalog (insulin Lispro)

Extra care is needed because Humalog is a high-alert medicine. High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed. Top 10 List of Safety Tips for Humalog When taking your medicine 1. Know your insulin. Humalog is a rapid-acting form of insulin that should be injected below the skin within 15 minutes before or immediately after a meal. Have food ready before injection. After injecting the insulin, do not skip a meal or delay eating. 2. Prepare your insulin. An intermediate- or long-acting insulin is often prescribed with Humalog. Humalog can be mixed with insulin NPH (intermediate-acting insulin), but always draw Humalog into the syringe first. Never mix Humalog with Lantus. Do not mix Humalog with other insulins if using an insulin pen or external pump. Do not vigorously shake insulin before use. 3. Don't reuse or recycle. Dispose of used syringes/needles, pens, and lancets in a sealable hard plastic or metal container (e.g., empty detergent bottle, special sharps container from your pharmacy). When the container is full, seal the lid before placing it in the trash. Do not reuse or recycle syringes/needles or lancets. 4. Don't share. Even if you change the needle, sharing an insulin pen or syringe may spread diseases carried in the blood, including hepatitis and HIV. To avoid serious side effects 5. Avoid mix-ups. If you use more than one type of insulin, make each vial or pen look different by putting a rubber band around one type of insulin. 6. Check your medicine. Humalog can be confused with NovoLog or Humulin (other insulins). When you pick up your insulin at the ph Continue reading >>

Insulin Types

Insulin Types

What Are the Different Insulin Types? Insulin Types are hormones normally made in the pancreas that stimulates the flow of sugar – glucose – from the blood into the cells of the body. Glucose provides the cells with the energy they need to function. There are two main groups of insulins used in the treatment of diabetes: human insulins and analog insulins, made by recombinant DNA technology. The concentration of most insulins available in the United States is 100 units per milliliter. A milliliter is equal to a cubic centimeter. All insulin syringes are graduated to match this insulin concentration. There are four categories of insulins depending on how quickly they start to work in the body after injection: Very rapid acting insulin, Regular, or Rapid acting insulins, Intermediate acting insulins, Long acting insulin. In addition, some insulins are marketed mixed together in different proportions to provide both rapid and long acting effects. Certain insulins can also be mixed together in the same syringe immediately prior to injection. Rapid Acting Insulins A very rapid acting form of insulin called Lispro insulin is marketed under the trade name of Humalog. A second form of very rapid acting insulin is called Aspart and is marketed under the trade name Novolog. Humalog and Novolog are clear liquids that begin to work 10 minutes after injection and peak at 1 hour after injection, lasting for 3-4 hours in the body. However, most patients also need a longer-acting insulin to maintain good control of their blood sugar. Humalog and Novolog can be mixed with NPH insulin and are used as “bolus” insulins to be given 15 minutes before a meal. Note: Check blood sugar level before giving Humalog or Novalog. Your doctor or diabetes educator will instruct you in determini Continue reading >>

Mixing Insulin Glargine With Rapid-acting Insulin: A Review Of The Literature

Mixing Insulin Glargine With Rapid-acting Insulin: A Review Of The Literature

Purpose. To review the literature examining the mixing of insulin glargine with rapid-acting insulin (RAI). Methods. A literature search was conducted via PubMed and Medline (from 1948 to August 2012) using the search terms “diabetes,” “insulin glargine,” “short acting insulin,” “rapid acting insulin,” and “mixing.” Literature was limited to English-language articles reporting on human studies. Studies with data describing mixing glargine with any short-acting insulin or RAI were included. Four studies met inclusion criteria. Results. Of the four studies assessing mixing glargine, one was a pharmacokinetic study. The other three assessed clinical outcomes in “real-world” settings. All of these studies were conducted in pediatric patients with type 1 diabetes. Two of the clinical outcomes studies did not report significant differences in A1C levels or preprandial, postprandial, or nocturnal blood glucose levels from mixing glargine and RAI. One of the clinical outcome studies reported improved blood glucose control (A1C and fasting blood glucose) with RAI mixed with glargine compared to RAI mixed with NPH insulin. There were no significant differences in hypoglycemia in any of the clinical outcome trials at any time measured. Conclusion. Initial small clinical trials indicate that there are no significant changes in clinical outcomes (blood glucose levels, A1C levels, and hypoglycemia) when mixing glargine with RAI. Additional studies with larger patient populations and longer trial durations are needed before mixing glargine with RAI can be recommended on a routine basis in clinical practice. Methodology A literature search was conducted via PubMed and Medline (articles published from 1948 to January 2012) using the search terms “diabetes,” Continue reading >>

Insulin: How To Give A Mixed Dose

Insulin: How To Give A Mixed Dose

Many people with diabetes need to take insulin to keep their blood glucose in a good range. This can be scary for some people, especially for the first time. The truth is that insulin shots are not painful because the needles are short and thin and the insulin shots are placed into fatty tissue below the skin. This is called a subcutaneous (sub-kyu-TAY-nee-us) injection. In some cases, the doctor prescribes a mixed dose of insulin. This means taking more than one type of insulin at the same time. A mixed dose allows you to have the benefits of both short-acting insulin along with a longer acting insulin — without having to give 2 separate shots. Usually, one of the insulins will be cloudy and the other clear. Some insulins cannot be mixed in the same syringe. For instance, never mix Lantus or Levemir with any other solution. Be sure to check with your doctor, pharmacist, or diabetes educator before mixing. These instructions explain how to mix two different types of insulin into one shot. If you are giving or getting just one type of insulin, refer to the patient education sheet Insulin: How to Give a Shot. What You Will Need Bottles of insulin Alcohol swab, or cotton ball moistened with alcohol Syringe with needle (You will need a prescription to buy syringes from a pharmacy. Check with your pharmacist to be sure the syringe size you are using is correct for your total dose of insulin.) Hard plastic or metal container with a screw-on or tightly-secured lid Parts of a Syringe and Needle You will use a syringe and needle to give the shot. The parts are labeled below. Wash the work area (where you will set the insulin and syringe) well with soap and water. Wash your hands. Check the drug labels to be sure they are what your doctor prescribed. Check the expiration date o Continue reading >>

Page 1 Of 14 Nda 21-081 Draft Package Insert (sponsor Revision #5) Date Of Submission: April 20, 2000

Page 1 Of 14 Nda 21-081 Draft Package Insert (sponsor Revision #5) Date Of Submission: April 20, 2000

Draft1 Prescribing Information as of April 20002 LANTUS®3 (insulin glargine [rDNA origin] injection)4 LANTUS® must not be diluted or mixed with any other insulin or solution.5 DESCRIPTION6 LANTUS® (insulin glargine [rDNA origin] injection) is a sterile solution of insulin glargine for use7 as an injection. Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-8 hour duration of action), parenteral blood-glucose-lowering agent (see CLINICAL9 PHARMACOLOGY). LANTUS is produced by recombinant DNA technology utilizing a non-10 pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine11 differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine12 and two arginines are added to the C-terminus of the B-chain. Chemically, it is 21A-Gly-30Ba-L-13 Arg-30Bb-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular14 weight of 6063. It has the following structural formula:15 Ile Val Glu Gln Cys Cys Thr Ser Ile Cys Ser Leu Tyr Gln Leu Glu Asn Tyr Tyr 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Cys Gly Leu 19 20 21 Leu Val Cys GlySer LeuAlaGluVal Glu HisGlyCysLeu Arg HisGlnAsnValPhe Phe Phe GlyTyrArg Lys Pro ThrThrArg B - chain 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 2223242526272829303132 S S S S S S Gly A - chain 16 LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS17 (insulin glargine injection) contains 100 IU (3.6378 mg) insulin glargine, 30 mcg zinc, 2.7 mg m-18 cresol, 20 mg glycerol 85%, and water for injection. The pH is adjusted by addition of aqueous19 solutions of hydrochloric acid and sodium hydroxide. LANTUS has a pH of approximately 4.20 Page 2 of 14 NDA 21-081 Continue reading >>

Insulin (and Other Injected Drugs)

Insulin (and Other Injected Drugs)

Diabetes is a disease affecting the body's production of insulin (type 1) or both the body's use and its production of insulin (type 2). Injectable insulin is a lifesaver for people who can no longer produce it on their own Continue reading >>

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