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Levemir To Lantus Conversion Calculator

Calculating Insulin Dose

Calculating Insulin Dose

You'll need to calculate some of your insulin doses. You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight. Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars. In this section, you will find: First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. Bolus – Carbohydrate coverage The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio. The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 6-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Bolus – High blood sugar correction (also known as insulin sensitivity factor) The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high bloo Continue reading >>

Diabetes W/out Insurance

Diabetes W/out Insurance

Phoenix Diabetes and Endocrinology has compiled this information to help our patients manage their diabetes in the event they have lost their health insurance or have a very limited budget and cannot afford preferred therapies. Many type II diabetics can maintain good blood sugar control if they focus on diet, weight management and exercise as the primary therapy and use these cheaper medications discussed below when additional therapies are needed. Type I or insulin deficient diabetes patients will have a much harder time controlling their blood sugars with cheaper medications. Several insulin manufacturers have programs for diabetics without any health insurance to provide insulin at no charge. The forms for these programs are found at our needymeds link. For the type II diabetics: Some types of diabetes medications do not have generic alternatives. These include Byetta and Januvia as well as many of the modern insulin. These medications may need to be discontinued. Older insulins such as Novolin N and Regular human insulin work differently and will require more blood sugar monitoring to be used safely. Therefore, understand that these recommendations are based on cost considerations rather than obtaining optimal diabetes control while your financial resources are limited. Additionally, realize ignoring diabetes is not wise either. One ER visit for dehydration or infection due to poorly controlled blood sugars will be very expensive. Therefore, these recommendations are intended to help control costs, not replace needed medical care. Lab work There are many places where discounted lab work is available at less than half the cost of traditional labs. One such place is Lab Express 602-273-9000. A comprehensive metabolic panel cost $45 and hemoglobin A1c costs $65. I bel 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 >>

Levemir Dosage

Levemir Dosage

Dosing LEVEMIR is a recombinant human insulin analog for once- or twice-daily subcutaneous administration. Patients treated with LEVEMIR once-daily should administer the dose with the evening meal or at bedtime. Patients who require twice-daily dosing can administer the evening dose with the evening meal, at bedtime, or 12 hours after the morning dose. The dose of LEVEMIR 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 dosing with LEVEMIR should only do so under medical supervision with appropriate glucose monitoring [see Warnings and Precautions (5.2)]. In patients with type 1 diabetes, LEVEMIR must be used in a regimen with rapid-acting or short-acting insulin. As with all insulins, injection sites should be rotated within the same region (abdomen, thigh, or deltoid) from one injection to the next to reduce the risk of lipodystrophy [see Adverse Reactions (6.1)]. LEVEMIR can be injected subcutaneously in the thigh, abdominal wall, or upper arm. As with all insulins, the rate of absorption, and consequently the onset and duration of action, may be affected by exercise and other variables, such as stress, intercurrent illness, or changes in co-administered medications or meal patterns. When using LEVEMIR with a glucagon-like peptide (GLP)-1 receptor agonist, administer as separate injections. Never mix. It is acceptable to inject LEVEMIR and a GLP-1 receptor agonist in the same body region but the injections should not be adjacent to each other. Initiation of LEVEMIR Therapy The recommended starting dose of LEVEMIR in patients with type 1 diabetes should be approximately one-third of the total daily insulin requirements. Rapid-acting or short-ac 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 >>

Conversion Back Onto Insulin Injections

Conversion Back Onto Insulin Injections

Thanks for our wonderful support group, GNO, and Sharon Roberson, here is a great guide for converting back to insulin shots from being on an insulin pump. This comes from a British site called Salford Diabetes Care (www.salforddiabetescare.co.uk) Why would you want to switch from a pump to injections? In an emergency situation, such as a pump failure, it may be necessary for you to convert back onto insulin injections. In case you are unable to recall information from your pump it is recommended that you should always keep a written record of your current basal rate and average total daily insulin usage. You are going on vacation and don’t want to be sporting an insulin pump at the beach or while scuba diving. You are just plain TIRED of managing the insulin pump. Your skin is sore, needs a break or you are simply running out of skin geography. How to Calculate Your Starting Dose Calculate using your average total daily dose (TTD) of insulin. TTD is all the insulin you have i.e. the basal and every bolus. Obtain this information by: Accessing the history of daily insulin totals in the memory of the pump or: From your records add together the daily set basal rate and the bolus doses together. Add 20% onto your average daily total of insulin then divide this in two equal parts. 50% is now your background insulin eg Lantus or Levemir. You should continue with your usual insulin to CHO ratio at mealtimes and give your usual correction dose. This formula provide a starting dose, further adjustments may be necessary depending on your blood sugar results Working example Daily average insulin total via the insulin pump = 36 units Add on 20% (36 x 20% extra insulin = 7 units) 36 units + 7 units= 43 units Divide into two equal parts = 43 units/2 = 22 units You would administer 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 >>

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 >>

Insulin Dosing Made Simple

Insulin Dosing Made Simple

I have found, in my years of practicing correctional medicine, that few practitioners who come to corrections are comfortable with insulin dosing. In my experience, this is especially true for physician assistants and nurse practitioners, but many physicians have problems, too. Insulin dosing can be complicated and tricky at times, but for most patients, 10 simple rules will get you to where you need to be. We first need to cover some groundwork and some terms. Insulin terminology can be confusing. First, it is very important to remember that this discussion applies to type 1 diabetics only. Type 2 diabetics sometimes use insulin, but that’s a “whole ‘nother ballgame.” There are two types of insulin used for two very different purposes when treating type 1 diabetics. The first is basal insulin, which is used to replace the insulin that the normal pancreas releases constantly—whether we eat or not. Long-acting insulin is used to provide coverage for the basal metabolic needs of type 1 diabetics. Examples are insulin glargine (Lantus) and insulin detemir (Levemir). The most commonly used long-acting insulin is Lantus, so I am going to use that name in this article. (I have no financial ties to the maker of Lantus—I use that name because it is the name most commonly used by patients). The second type of insulin that type 1 diabetics need is short-acting insulin, which is given to cover the carbohydrates in the food they eat. Short-acting insulins are given just before a meal or snack and, ideally, the dose should vary depending on how many carbohydrates are in the food. Examples of short acting insulins are insulin regular, insulin aspart (Novolog) and insulin lispro (Humalog). Again, I will use the term Humalog in this article because it is the term most often 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 >>

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 >>

(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 >>

Back To Shots

Back To Shots

There are a number of reasons why switching from your insulin pump back to shots (MDI), using insulin pens or syringes, is sometimes necessary. Reasons can include Pump malfunction Losing or misplacing pump Forgetting pump or supplies at home Hospital visit or surgery Spending a day at the beach or in water Taking a break from the pump all together Short term pump breaks If you will only be disconnected from your pump for a short period of time, your doctor may provide a guideline for you to use only rapid-acting insulin (i.e.: Novalog or Humalog) incrementally, every 3 to 4 hours until you can get back on your pump. Example (off the pump for less than 24 hours) Short-acting insulin doses while off the pump are necessary every 3-4 hours. To calculate, combine a food bolus and the insulin you would normally receive as a basal rate via pump. Here’s an example for a calculating a breakfast injection while off the pump for less than 24 hours: Step 1: Calculate breakfast bolus. Morning blood sugar value = 170 mg/dL Insulin to carbohydrate ratio (ICR) = 1 unit per 15 grams of carbs Insulin sensitivity factor (ICR) / Correction factor (CF) = 50 Breakfast is 60 grams of total carbohydrates Breakfast bolus = bolus for carbs + correction bolus. Cover carbs: 60/15 = 4 units Correction: (170-120)/50 = 1 unit 4 + 1 = 5 unit breakfast bolus Step 2: Calculate amount needed to cover basal rate. Basal rate (s) MN = 0.60 10:00 a.m. = 0.85 5:00 p.m. = 0.70 Combine sum of basal rates from 8 a.m. – 11:00 a.m. = 0.6 (8:00 a.m.) + 0.6 (9:00 a.m.) + 0.85 (10 a.m.) = 2.05 units Step 3: Combine breakfast bolus and amount needed to cover basal rate – this will be your breakfast dosage! 5 units (breakfast bolus) + 2.05 units (basal coverage) = 7.05 units Dose 7 units. *Reminder – repeat th Continue reading >>

Selected Important Safety Information

Selected Important Safety Information

Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening Tresiba® (insulin degludec injection) is indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus. Tresiba® is not recommended for treating diabetic ketoacidosis or for pediatric patients requiring less than 5 units of Tresiba®. Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening. Increase monitoring with changes to: insulin dose, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with hypoglycemia unawareness or renal or hepatic impairment Accidental mix-ups betwe Continue reading >>

Insulin: Compare Common Options For Insulin Therapy

Insulin: Compare Common Options For Insulin Therapy

Insulin therapy is a critical part of treatment for people with type 1 diabetes and also for many with type 2 diabetes. The goal of insulin therapy is to maintain blood sugar levels within your target range. Insulin is usually administered in the fat under your skin using a syringe, insulin pen or insulin pump. Which insulin regimen is best for you depends on factors such as the type of diabetes you have, how much your blood sugar fluctuates throughout the day and your lifestyle. Each insulin type is characterized by: How long it takes to begin working (onset) When it's working the hardest (peak) How long it lasts, ranging from about 3 to 26 hours Many types of insulin are available. Here's how they compare. Keep in mind that your doctor may prescribe a mixture of insulin types to use throughout the day and night. Insulin type and name Onset Peak How long it lasts Rapid-acting Insulin aspart (NovoLog) Insulin glulisine (Apidra) Insulin lispro (Humalog) 5-15 min. 45-75 min. 3-4 hours Short-acting Insulin regular (Humulin R, Novolin R) 30-45 min. 2-4 hours 6-8 hours Intermediate-acting Insulin NPH (Humulin N, Novolin N) 2 hours 4-12 hours 16-24 hours Long-acting Insulin glargine (Lantus/ Toujeo) Insulin detemir (Levemir) 2 hours No clear peak 14-24 hours In some cases, premixed insulin — a combination of specific proportions of intermediate-acting and short- or rapid-acting insulin in one bottle or insulin pen — may be an option. Continue reading >>

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