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Levemir To Lantus Conversion Calculator

Levemir Dosage

Levemir Dosage

For those who are beginning diabetes treatment with Levemir, dosage recommendations will vary, based on factors such as your weight, the dosage of other insulin medications you are taking, and other medical conditions you have. Levemir comes in injectable form, and is typically used once or twice a day. Your Levemir dosage can be injected into the skin and fat layer of the stomach, upper arm, or thigh. Levemir Dosage: An Introduction The dose of Levemir® (insulin detemir) your healthcare provider recommends will vary, depending on a number of factors, including: Your current dose of other insulins Your weight How you respond to Levemir (especially as measured by your blood sugar levels) Other medications you are taking, including other diabetes medications Other medical conditions you may have. As is always the case, do not adjust your dose unless your healthcare provider specifically instructs you to do so. What Is a "Unit" of Levemir? In order to understand the dosing of Levemir and other insulin medications, it is important to understand what exactly a "unit" of insulin means. There are various different types of insulin. A single unit of insulin should have the same biological activity, no matter what type of insulin you use, as all insulins are compared to a single standard. Levemir Dosing Guidelines You can take Levemir once or twice a day. If you take it just once a day, you should take it consistently, either at bedtime or with your evening meal. If you take it twice a day, the first dose should be in the morning, and the second dose can be with your evening meal, at bedtime, or 12 hours after the first dose. Your healthcare provider will help you determine which way is best for you. If you are currently using a "basal-bolus" insulin regimen (a long- or interme 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 >>

An Analysis Of Dosing Equivalence Of Insulin Detemir And Insulin Glargine: More Evidence?

An Analysis Of Dosing Equivalence Of Insulin Detemir And Insulin Glargine: More Evidence?

Current guidelines for the management of type 2 diabetes call for the use of basal insulin when glycemic targets are not achieved, despite the use of oral antihyperglycemic medications.1,2 Controversy remains in the medical literature regarding the comparative efficacy of insulin detemir and insulin glargine, both of which have demonstrated superiority over neutral protamine Hagedorn insulin. While two published studies have demonstrated noninferiority of insulin detemir and insulin glargine, both studies were designed to dose insulin detemir twice daily if predinner glucose levels were elevated, whereas insulin glargine was only dosed once daily regardless of predinner glucose levels.3,4 A third study is underway with a similar design,5 but does not address the comparative efficacy of once-daily administration of these two basal insulins. In this issue of Journal of Diabetes Science and Technology, Dr. Allen King provides further important details of his previously published trial that provides important data in addressing this issue.6,7In this randomized, double-blinded, crossover trial, once-daily insulin detemir was compared with insulin glargine in 29 patients with type 2 diabetes under relatively good glycemic control (average hemoglobin A1c 7.1%). Several design features help provide new information about the use of both of these basal insulins. First, both insulins were restricted to once-daily use in the evening at 8 pm, whereas previous comparison trials allowed for twice-daily usage of insulin detemir. No mealtime insulins were administered in the trial. Second, the crossover design allowed for the patients to serve as their own controls, i.e., each patient used both forms of insulin in the trial. Third, continuous glucose monitoring (CGM) was used to more cl Continue reading >>

Comparing Dosing Of Basal Insulin Analogues Detemir And Glargine: Is It Really Unit-per-unit And Dose-per-dose?

Comparing Dosing Of Basal Insulin Analogues Detemir And Glargine: Is It Really Unit-per-unit And Dose-per-dose?

Abstract To review the available evidence regarding dosing conversion between glargine and detemir in an effort to assist clinicians in performing dosing conversion. A MEDLINE literature search was performed using the search terms glargine and detemir for articles published through August 2013. All English-language clinical trials were reviewed for inclusion of dosing and/or pharmacokinetic data. A total of 7 large (n ≥ 258) randomized controlled trials (RCTs) comparing glargine and detemir in patients with type 1 and 2 diabetes had dosing equivalency data available. In these 7 RCTs, on average, a 38% higher detemir dose was required (range = 8.0%-77.2%) to achieve glucose control comparable to that achieved with glargine. A 24-hour isoglycemic clamp study conducted in 11 patients with type 1 diabetes demonstrated that the duration of action of detemir is dose dependent, with increasing doses of detemir resulting in increased duration of action of detemir. Pharmacokinetic studies conducted in patients with type 2 diabetes are conflicting, although the majority of evidence suggests that glargine provides a longer duration of glycemic control as compared with detemir. When performing conversion between glargine and detemir, prescribers should be aware that higher doses of detemir as compared with glargine may be necessary to achieve the same glycemic control. Additionally, twice-daily injections of detemir should be considered in clinical situations in which glucose control appears to decline after 12 hours, especially with doses ≤0.4 units/kg/d in patients with type 1 diabetes. Juliet P. Wallace, PharmD1, Jessica L. Wallace, PharmD, BCPS1,2, Objective: To review the available evidence regarding dosing conversion between glargine and detemir in an effort to search ter Continue reading >>

Multiple Dose Insulin In Type 2 Diabetes

Multiple Dose Insulin In Type 2 Diabetes

Introduction Levemir (Detemir) & Lantus (Glargine) & quick-acting insulin before meals This page is aimed at people with type 2 diabetes needing multiple dose insulin (basal bolus). If you have a fair amount of insulin from your pancreas still, you will not need this intensive insulin regime, and may just need tablets or once daily insulin as opposite. If your type 2 diabetes is quite severe, and you have very little remaining insulin, then your diabetic control is similar to type 1 diabetes. This page discusses intensive insulin control, and this is taken further in the insulin dose adjustment pages above. You naturally need to speak to your diabetes nurse and doctor for individual advice. If you have no or very little remaining insulin from you pancreas, and are prone to hypos, then your diabetes is nearly equivalent to the type 1 diabetes patient, and you may benefit from the same intensive insulin 'regime'. This is discussed on this page below and the adjusting insulin dose pages taken from the DAFNE Program. Complex insulin regimes do lead to better glucose control, fewer hypos, and better weight control than twice daily insulin (NEJM 2009). Controversies First The two long acting insulins are Levemir (detemir) or Lantus (glargine). Levemir is shorter acting, with a peak 9-12 hours. Lantus generally has no peak in the first 24 hours, and its action may take 3 days to complete. Therefore anyone with a slightly irregular lifestyle in theory will be better off using twice daily Levemir rather than once daily Lantus. At present, this decision is usually made by diabetes doctors and nurses. If you do use once daily Lantus, and your glucose levels fluctuate, then you should consider twice daily Levemir instead. Second Another controversy is the use of analogue insulins s Continue reading >>

Levemir

Levemir

LEVEMIR® (insulin detemir [rDNA origin]) Injection DESCRIPTION LEVEMIR® (insulin detemir [rDNA origin] injection) is a sterile solution of insulin detemir for use as a subcutaneous injection. Insulin detemir is a long-acting (up to 24-hour duration of action) recombinant human insulin analog. LEVEMIR® is produced by a process that includes expression of recombinant DNA in Saccharomyces cerevisiae followed by chemical modification. Insulin detemir differs from human insulin in that the amino acid threonine in position B30 has been omitted, and a C14 fatty acid chain has been attached to the amino acid B29. Insulin detemir has a molecular formula of C267H402O76N64S6 and a molecular weight of 5916.9. It has the following structure: Figure 1: Structural Formula of insulin detemir LEVEMIR® is a clear, colorless, aqueous, neutral sterile solution. Each milliliter of LEVEMIR® contains 100 units (14.2 mg/mL) insulin detemir, 65.4 mcg zinc, 2.06 mg m-cresol, 16.0 mg glycerol, 1.80 mg phenol, 0.89 mg disodium phosphate dihydrate, 1.17 mg sodium chloride, and water for injection. Hydrochloric acid and/or sodium hydroxide may be added to adjust pH. LEVEMIR® has a pH of approximately 7.4. Continue reading >>

100/33 (insulin Glargine And Lixisenatide Injection) 100 Units/ml And 33 Mcg/ml

100/33 (insulin Glargine And Lixisenatide Injection) 100 Units/ml And 33 Mcg/ml

Important Safety Information for SOLIQUA® 100/33 (insulin glargine and lixisenatide injection) 100 Units/mL and 33 mcg/mL Contraindications During episodes of hypoglycemia. In patients with known hypersensitivity to the active substance(s) or to any of the product components. Warnings and Precautions 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 SOLIQUA 100/33. 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 SOLIQUA 100/33, 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, SOLIQUA 100/33 should promptly be discontinued. If pancreatitis is confirmed, restarting SOLIQUA 100/33 is not recommended and other antidiabetic therapies should be considered. Never Share a SOLIQUA 100/33 SoloStar® Pen between Patients: Pen-sharing poses a risk for transmission of blood-borne pathogens, even if the needle is changed. Do not withdraw SOLIQUA 100/33 from the pen with a syringe. Hyperglycemia or Hypoglycemia with Changes in Insulin Continue reading >>

Basal Insulins

Basal Insulins

Lantus and Levemir are long-acting insulins that supply the background insulin needed to supply cells with glucose around the clock while preventing release of excess glucose from the liver and excess fat from fat cells. The waking glucose level best measures the activity of these insulins. All Type 1s and many Type 2s also require a faster insulin (Humalog, Novolog, or Apidra) to cover meals and lower any high glucose. Some Type 2s who have adequate insulin production do well with one of these long-acting insulins, plus oral medications or a daily or weekly injection of a GLP-1 agonist. Lantus® insulin (glargine) made by Sanofi-Aventis is promoted as a once a day background insulin. However, many users find that it does not last a full 24 hours for them and these users often notice a peak in activity about 6-8 hours after the injection. If once a day injection is giving you good control, there is no need to change and a bedtime injection is typically best. For others, splitting the dose and injecting twice a day (usually at breakfast and bedtime) often works better, lessens peaks and gaps in activity, and helps those who cannot inject Lantus within one hour of the same time each day. Lantus is slightly acidic and some may notice slight discomfort at the injection site. Levemir insulin (detemir) made by Novo Nordisk works for about 18 hours and may have a peak in activity 4-6 hours after the injection. It is taken twice a day. Different people react to each insulin differently. The best advice is trying the other insulin if one does not seem to be working well for you. Both insulins generally work quite well, but neither can be mixed in a syringe with fast-acting insulin, and neither should ever be used in an insulin pump. Keep in mind that an older insulin called NPH Continue reading >>

Conversion Chart For Humulin R U-500 Insulin Dose

Conversion Chart For Humulin R U-500 Insulin Dose

When using a U-100 insulin syringe or a tuberculin syringe, use this handy U-500 Conversion Chart. Humulin U-500 Conversion Chart Mar 2011 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 >>

Basaglar, An Insulin ‘follow On,’ Prepares To Do Battle With Lantus

Basaglar, An Insulin ‘follow On,’ Prepares To Do Battle With Lantus

In December, Eli Lilly and Boehringer Ingelheim became proud parents, launching a new insulin product into the world. They dubbed it Basaglar, and it bore a striking resemblance to Sanofi’s Lantus, the world’s top-selling basal insulin. Whether Basaglar can be deemed a biosimilar is a question that veers into the arcana of FDA approval pathways. But there is no doubt that Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices. But turmoil can open windows of opportunity. Industry observers say the timing could be perfect for Basaglar, a cheaper rival to one of the best-selling insulin products on the market. Payers would love to see some downward pressure on insulin prices. So would the millions of Americans with diabetes who have difficulty paying for their diabetes medications. But any kind of Basaglar effect on prices and expenditures may be brief and modest. Eli Lilly, Novo Nordisk, and Sanofi, the three companies that dominate the market for diabetes drugs, continue to roll out new products. This steady stream benefits some patients but it also swamps payer budgets. Diabetes was second only to inflammatory conditions on the list of the most expensive therapeutic classes in Express Scripts’s 2016 Drug Trend Report (see below), and insulin products account for 40% of the diabetes drug spend, according to the PBM. Per-member, per-year spend for the top 10 drug therapy classes, 2016 Top 5 diabetes drugs by market share The billions spent on diabetes medications each year in the United States is an equation tha Continue reading >>

Levemir Cartridge 100 Units/ml - Penfill, Levemir Pre-filled Pen 100 Units/ml - Flexpen And Innolet

Levemir Cartridge 100 Units/ml - Penfill, Levemir Pre-filled Pen 100 Units/ml - Flexpen And Innolet

Levemir Penfill 100 units/ml solution for injection in cartridge. Levemir FlexPen 100 units/ml solution for injection in pre-filled pen. Levemir InnoLet 100 units/ml solution for injection in pre-filled pen. Levemir Penfill 1 ml of the solution contains 100 units insulin detemir* (equivalent to 14.2 mg). 1 cartridge contains 3 ml equivalent to 300 units. Levemir FlexPen/Levemir InnoLet 1 ml of the solution contains 100 units insulin detemir* (equivalent to 14.2 mg). 1 pre-filled pen contains 3 ml equivalent to 300 units. *Insulin detemir is produced in Saccharomyces cerevisiae by recombinant DNA technology. For the full list of excipients, see section 6.1. Levemir is indicated for treatment of diabetes mellitus in adults, adolescents and children aged 1 year and above. Posology The potency of insulin analogues, including insulin detemir, is expressed in units, whereas the potency of human insulin is expressed in international units. 1 unit insulin detemir corresponds to 1 international unit of human insulin. Levemir can be used alone as the basal insulin or in combination with bolus insulin. It can also be used in combination with oral antidiabetic medicinal products and/or GLP-1 receptor agonists. When Levemir is used in combination with oral antidiabetic medicinal products or when added to GLP-1 receptor agonists it is recommended to use Levemir once daily, initially at a dose of 0.1–0.2 units/kg or of 10 units in adult patients. The dose of Levemir should be titrated based on the individual patient's needs. When a GLP-1 receptor agonist is added to Levemir, it is recommended to reduce the dose of Levemir by 20% to minimise the risk of hypoglycaemia. Subsequently, dosage should be adjusted individually. For individual dose adjustments, the following two titration gu Continue reading >>

Guidelines For Temporary Removal Of The Insulin Pump

Guidelines For Temporary Removal Of The Insulin Pump

the pump is broken and a new one won’t arrive for a few days the pump is lost or stolen you need to be admitted to the hospital and will be unable to operate your pump you want to take a “pump break” ( eg. while at the beach) When off the pump, it is best to stick as close as possible to a “basal-bolus” routine. The following are guidelines only for calculating an insulin dose. Extra blood sugar testing will be needed including overnight, to assess how it’s working for you or your child. Please let your doctor or nurse know when you need to go back on injections, so that we can help you with the “fine-tuning”. These guidelines are dependent on your knowing your pump’s settings, ie. basal rates, meal bolus ratio’s, and correction factors (insulin sensitivity factors). ALWAYS KEEP RECORDS OF YOUR CURRENT PUMP SETTINGS. Insulin pumps are machines that can break or malfunction. Don’t rely on your doctor or nurse to have all your data up-to-date. 1- Short term off pump (less than 24 hrs): Rapid-acting insulin (Novorapid or Humalog) will need to be given approximately every 3 – 4 hours. Combine: 3 - 4 hours of basal insulin a pre-meal bolus for carbs a correction bolus if needed At 8:00 a.m. – the blood sugar reading is 14.8 breakfast is 40 grams carb ratio is 1/15g correction factor (insulin sensitivity factor) is 4.0 the basal rate is 0.60 units/hr until noon 4 hours of basal: 4 X 0.60 = 2.4 units breakfast food bolus: 40/15 = 2.7 units correction bolus: 14.8 – 6.0/4.0 = 2.2 units Total dose: 2.4 + 2.7 + 2.2 = 7.3 units, rounded off to 7.0 2- Long term off pump (24 hrs or more): There are 3 options Give long-acting insulin (Lantus or Levemir) as basal, and rapid insulin for boluses Give intermediate-acting insulin (NPH or N) ** call the doctor on Continue reading >>

Considering Levemir®

Considering Levemir®

Do not share your Levemir® FlexTouch® with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them. Who should not take Levemir®? Do not take Levemir® if: you have an allergy to Levemir® or any of the ingredients in Levemir®. How should I take Levemir®? Read the Instructions for Use and take exactly as directed. Know the type and strength of your insulin. Do not change your insulin type unless your health care provider tells you to. Check your blood sugar levels. Ask your health care provider what your blood sugar levels should be and when you should check them. Do not reuse or share your needles with other people. You may give other people a serious infection, or get a serious infection from them. Never inject Levemir® into a vein or muscle. Do not share your Levemir FlexTouch with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them. Who should not take Levemir®? Do not take Levemir® if: you have an allergy to Levemir® or any of the ingredients in Levemir®. Before taking Levemir®, tell your health care provider about all your medical conditions including, if you are: pregnant, plan to become pregnant, or are breastfeeding. taking new prescription or over-the-counter medicines, including supplements. Talk to your health care provider about how to manage low blood sugar. How should I take Levemir®? Read the Instructions for Use and take exactly as directed. Know the type and strength of your insulin. Do not change your insulin type unless your health care provider tells you to. Check your blood sugar levels. Ask your health care provider what your blood sugar levels should be and when you should ch Continue reading >>

U-500 Insulin: Not For Ordinary Use

U-500 Insulin: Not For Ordinary Use

US Pharm. 2010;35(5)(Diabetes suppl):14-17. If not already seeing them, pharmacists should anticipate encountering prescriptions for U-500 regular insulin. U-500 insulin is five times more potent than standard U-100 and is utilized in patients requiring high doses of insulin. Prescribing of U-500 is on the rise due to the obesity epidemic, adoption of tighter glucose control protocols, increased insulin resistance, and utilization of insulin pumps.1 Potential for adverse drug events exists due to unfamiliarity with U-500 and its higher potency. This review is intended to enable safe provision of U-500 insulin by increasing awareness of the drug and its correct administration. As insulin resistance worsens, greater doses of insulin are required to meet glycemic goals. This is especially true for persons with insulin resistance (IR) syndromes. These are patients with an insulin requirement of 200 U/day and greater. FIGURE 1 illustrates the body’s response to insulin as the dose increases. Note that for patients with IR syndromes, the dose response to insulin is significantly diminished. This is especially true when insulin doses exceed 100 U. However, this phenomenon does not mean greater doses are without effect.2 In fact, higher doses of insulin eventually achieve therapeutic targets. For this reason, use of high-dose insulin should not be avoided in insulin-resistant patients. Otherwise, these patients will fail to achieve glycemic goals by underdosing insulin. Use of standard insulin becomes problematic when patients require over 200 U/day or greater than 100 U per injection. At these doses, the volume of U-100 insulin is physically too large for single subcutaneous administration, and multiple injections are required to deliver a single dose. With more injections, Continue reading >>

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