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Which Insulin Is Basal?

Once Weekly Exenatide Is An Alternative Treatment To Daily Basal Insulin

Once Weekly Exenatide Is An Alternative Treatment To Daily Basal Insulin

Typically, basal insulin is chosen as the add-on treatment in patients with severe hyperglycemia. However, it has been questioned whether it is the best option, according to research presented in June at the American Diabetes Association 73rd Scientific Sessions, in Chicago A recent study conducted in San Diego compared the efficacy and tolerability of exenatide once weekly with those of daily basal insulin in patients with Type 2 diabetes mellitus who had a baseline A1C of 8.5% or higher and who were taking metformin with or without SFU. Data were pooled from two 26-week, randomized, controlled studies: 137 patients were taking weekly exenatide, and 126 patients were taking daily basal insulin. According to the study results, patients treated with weekly exenatide had a significantly greater decrease in A1C from baseline than those treated with basal insulin and were significantly more likely to reach an A1C goal of less than 7.0% (39.4% in the exenatide group compared with 23.0% in the basal insulin group). There was less decrease in fasting plasma glucose in the weekly exenatide group than in the daily basal insulin group. Additionally, mean weight loss with weekly exenatide was -2.4 ± 0.23 kg, whereas weight gain with basal insulin was 2.0 ± 0.24 kg. Patients in the weekly exenatide group were significantly more likely to achieve a composite goal (A1C <7.0%, no weight gain, and no hypoglycemia [requiring assistance or self-treated with blood glucose <54 mg/dL]) than were patients in the basal insulin group (33.6% compared with 3.2%). Hypoglycemia occurred at a rate of 0.08 exposure-adjusted events per patient year in the exenatide group and 0.37 events in the basal insulin group. In the basal insulin group, the most common adverse events were hypoglycemia (38.9%) Continue reading >>

In My Opinion: There Is No 24-hour Basal Insulin

In My Opinion: There Is No 24-hour Basal Insulin

by Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S. Diabetes Health You can make any insulin last longer by injecting a large enough shot. In fact, about 25 years ago, Dr. John Galloway of Eli Lilly and Company performed an important experiment that demonstrated this very fact. In his experiment, Dr. Galloway injected 70 units of Regular insulin into the arm of a non-diabetic man. To prevent the patient from having serious hypoglycemia, his blood sugar was tested every half hour and glucose was infused into his bloodstream as needed. Given that the package insert for Regular stated that the insulin would work for four to twelve hours after injection, one might expect that Dr. Galloway could have stopped the glucose drip after twelve hours. As it turned out, however, the subject’s blood sugar kept dropping for a full week, and the glucose drip had to be continued for that long just to prevent him from going low. It certainly makes sense that a large volume of any liquid injected under the skin will require more time to be fully absorbed by nearby blood vessels than a small volume. When I was young and injected 120 units a day of NPH insulin to cover my high carbohydrate ADA diet, it would take about two weeks for the lump at each injection site to disappear. The message of Dr. Galloway’s work is apparently very familiar to modern insulin manufacturers who claim 24-hour action for their basal insulin analogues. Of course, several studies have been published to support their claims that both Lantus and Levemir last 24 hours. The single daily injection in these studies, however, is based upon using 0.3 to 0.4 units of insulin per 2.2 pounds (one kilogram) of body weight. For a 154-pound person, this comes to 21 to 28 units per daily injection. In my experience, a Continue reading >>

Insulin Glargine 300 U/ml For Basal Insulin Therapy In Type 1 And Type 2 Diabetes Mellitus

Insulin Glargine 300 U/ml For Basal Insulin Therapy In Type 1 And Type 2 Diabetes Mellitus

Authors Lau IT, Lee KF, So WY, Tan K, Yeung VTF Accepted for publication 20 April 2017 Checked for plagiarism Yes Peer reviewer comments 3 1Department of Medicine, Tseung Kwan O Hospital, 2Department of Medicine and Geriatrics, Kwong Wah Hospital, 3Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, 4Department of Medicine, Queen Mary Hospital, University of Hong Kong, 5Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, Hong Kong, China Objective: To review published clinical studies on the efficacy and safety of new insulin glargine 300 units/mL (Gla-300), a new long-acting insulin analog, for the treatment of type 1 and type 2 diabetes mellitus (T1DM, T2DM) Materials and methods: Data sources comprised primary research articles on Gla-300, including pharmacodynamic, pharmacokinetic, and clinical studies. Results: In pharmacodynamic and pharmacokinetic studies, Gla-300 showed a flatter time–action profile and longer duration of action than Gla-100. Noninferiority of Gla-300 versus Gla-100 for lowering of glycated hemoglobin was demonstrated in Phase III clinical studies covering a range of T1DM and T2DM patient populations. Over 6–12 months of follow-up, Gla-300 consistently showed comparable glycemic efficacy with less hypoglycemia vs Gla-100, even during the first 8 weeks of treatment. Although titrated insulin doses were 11%–17% higher with Gla-300 vs Gla-100, changes in body weight were similar or favored Gla-300. Conclusion: Clinical studies provide evidence that the pharmacodynamic and pharmacokinetic properties of Gla-300 may translate into clinical benefits in both T1DM and T2DM. Gla-300 may provide a new option for people initiating basal insulin, those requiring higher basal insulin dos Continue reading >>

What Is Insulin? Everything To Know If You Have Diabetes

What Is Insulin? Everything To Know If You Have Diabetes

When you think about diabetes in a general sense, your mind might immediately flash to finger pricks. But while insulin therapy is common, it’s not for everyone who has been diagnosed with the disease. Indeed, according to the Centers for Disease Control and Prevention (CDC), only 18 percent of adults with the disease take insulin to manage diabetes, while 13 percent take insulin and oral medications. If you have type 2 diabetes, it’s important to understand the basics on insulin before making a decision with your doctor about whether you need it to control your blood sugar — including what it is, what it does, what its potential benefits are, and how to overcome the fear of finger pricks if you’ve been prescribed the therapy. What Does the Pancreas Do, and How Does Insulin Affect Blood Sugar Levels? The pancreas, a gland located deep in our abdomen, releases the hormone insulin. Insulin’s primary purpose is to help transport glucose, or blood sugar, to our liver, muscle, and fat cells to be used for energy or to be stored for later use, according to the National Institute of Diabetes and Digestive and Kidney Diseases. In people without diabetes, this process works smoothly, with the pancreas meeting the body’s demands for insulin and that sufficient insulin transporting glucose to cells. Consequently, blood sugar levels stay within a normal range. But when insulin resistance occurs, the body’s cells don’t respond correctly to insulin. With this condition — which can also occur in the absence of type 2 diabetes — the pancreas’s beta cells attempt to release more and more insulin to ferry glucose to cells. When beta cells aren’t able to meet the body’s demands for insulin, blood sugar accumulates, leading to diabetes and other health issues. How Continue reading >>

Insulin Regimens

Insulin Regimens

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. The appropriate insulin regimen for each patient with diabetes will depend on their type of diabetes and their individual needs and circumstances. Regimens which attempt to improve glycaemic control will require more active involvement of the patient, both with the number of injections and with the need for close self-monitoring of blood glucose. See the separate Diabetes Education and Self-management Programmes article. Insulin regimens should be tailored to the individual, taking into account the patient's type of diabetes, previous control, age, dexterity, eyesight, and personal and cultural preferences. Insulin is usually injected into the upper arms, thighs, buttocks or abdomen. The absorption may be increased if the limb is used in strenuous exercise after the injection. Lipodystrophy can be minimised by using different injection sites in rotation. Local allergic reactions may occur but are rare.[1] Effective patient education for people using insulin treatment is essential, including 'sick day' guidance. See also the separate Diabetes and Intercurrent Illness article. Insulin Passports and patient information booklets should be offered to patients receiving insulin.[2] Insulins are classified according to their duration of action.[3] Short-acting insulins Short-acting (soluble) insulin is usually injected 15 to 30 minutes before meals. Soluble insulin is also the most appropriate form of insulin for use in diabetic emergencies - eg, diabetic ketoacidosis and at the time of Continue reading >>

Adding Basal Insulin To Oral Agents In Type 2 Diabetes Might Offer Best Glycemic Control

Adding Basal Insulin To Oral Agents In Type 2 Diabetes Might Offer Best Glycemic Control

Clinical question: When added to oral diabetic agents, which insulin regimen (biphasic, prandial or basal) best achieves glycemic control in patients with Type 2 diabetes? Background: Most patients with Type 2 diabetes mellitus (DM2) require insulin when oral agents provide suboptimal glycemic control. Little is known about which insulin regimen is most effective. Study design: Three-year, open-label, multicenter trial. Setting: Fifty-eight clinical centers in the United Kingdom and Ireland. Synopsis: The authors randomized 708 insulin-naïve DM2 patients (median age 62 years) with HgbA1c 7% to 10% on maximum-dose metformin or sulfonylurea to one of three regimens: biphasic insulin twice daily; prandial insulin three times daily; or basal insulin once daily. Outcomes were HgbA1c, hypoglycemia rates, and weight gain. Sulfonylureas were replaced by another insulin if glycemic control was unacceptable. The patients were mostly Caucasian and overweight. At three years of followup, median HgbA1c was similar in all groups (7.1% biphasic, 6.8% prandial, 6.9% basal); however, more patients who received prandial or basal insulin achieved HgbA1c less than 6.5% (45% and 43%, respectively) than in the biphasic group (32%). Hypoglycemia was significantly less frequent in the basal insulin group (1.7 per patient per year versus 3.0 and 5.5 with biphasic and prandial, respectively). Patients gained weight in all groups; the greatest gain was with prandial insulin. At three years, there were no significant between-group differences in blood pressure, cholesterol, albuminuria, or quality of life. Bottom line: Adding insulin to oral diabetic regimens improves glycemic control. Basal or prandial insulin regimens achieve glycemic targets more frequently than biphasic dosing. Citation: Holm Continue reading >>

My Go-to Insulin Pump Feature: Temp Basal

My Go-to Insulin Pump Feature: Temp Basal

One of my favorite things about my insulin pump (other than being pink, of course) is that I can use as few or as many of the advanced features during different phases of my life as I want. After over a decade on my pump, I’ve pretty much used it all, but I have a few “go-to” features that I use the most and one is the temporary basal rate (or “temp basal”).As a reminder, “basal insulin” is the background insulin needed throughout the day to maintain your blood glucose and accounts for about half of your daily insulin requirements. There are a few key terms related to basal rates which include “temp basal” “max basal” and “basal patterns,” all of which you can learn more about here.A temporary basal rate allows you to change the amount of background insulin you are taking for a set period of time (30 minutes to 24 hours). So for the life events that don’t seem to take long enough to actually change your pump settings like your day to day basal rates, this can really come in handy when you need to take more or less insulin than you usually do. You can set the temp basal as a type: either a specific amount of units of insulin, or a percentage of your current basal rate. I use the percentage setting as I find that the easiest to comprehend, especially if I can’t recall all of my current pump settings off the top of my head. The times that I find that I use this feature the most are during exercise, during times of sickness or stress, and any time I feel that my normal basal rates aren’t meeting my true needs for the day based on the numbers on the screen of my glucose meter. Tip: If you want to suspend your pump for a specific time (like during a low, or if you know you don’t need insulin for a set amount of time but don’t actually need Continue reading >>

Insulin Glargine: A New Basal Insulin Analogue

Insulin Glargine: A New Basal Insulin Analogue

Introduction Currently, the therapeutic challenges in the treatment of both type 1 and 2 diabetes mellitus (DM) are the maintenance of near‐normal glycaemia, to prevent long‐term complications,1,2 and the avoidance of episodes of hypoglycaemia. For many people with DM, intensive insulin therapy means multiple insulin injections and frequent blood sampling, at the expense of an increased risk of hypoglycaemia. This article will discuss the potential use of a new long‐acting insulin analogue, insulin glargine, already prescribed in the US but expected to be available in the UK later this year. Normal insulin secretion consists of discrete components: low basal levels secreted between meals, through the night and during fasting; and very high levels secreted post‐prandially (Figure 1). Basal‐bolus insulin regimens attempt to reproduce this insulin secretion profile, which consists of one or two injections per day of intermediate or long‐acting insulins (basal) and multiple mealtime (bolus) injections of rapid‐acting or regular insulins. The disadvantages of conventional insulin preparations include variable absorption with considerable intra and inter‐subject variation, pronounced peaks after injections, and prolonged duration of action, all contributing to the difficulty in obtaining normoglycaemia (Table 1). Hypoglycaemia is the limiting factor in the maintenance of tight glycaemic control.3 Hypoglycaemia ranks high among the fears of patients using insulin, resulting in a decrease in quality of life, reduced awareness of subsequent hypoglycaemia and thereby increased risk of severe hypoglycaemia.4,5 Type of insulin Onset Peak effect Duration Rapid acting Insulin lispro (Humalog) 0–15 min 30–90 min <5 h Short acting Regular human insulin (Humalin S, A Continue reading >>

Effects Of Biphasic, Basal-bolus Or Basal Insulin Analogue Treatments On Carotid Intima-media Thickness In Patients With Type 2 Diabetes Mellitus: The Randomised Copenhagen Insulin And Metformin Therapy (cimt) Trial

Effects Of Biphasic, Basal-bolus Or Basal Insulin Analogue Treatments On Carotid Intima-media Thickness In Patients With Type 2 Diabetes Mellitus: The Randomised Copenhagen Insulin And Metformin Therapy (cimt) Trial

Objective To assess the effect of 3 insulin analogue regimens on change in carotid intima-media thickness (IMT) in patients with type 2 diabetes. Design and setting Investigator-initiated, randomised, placebo-controlled trial with a 2×3 factorial design, conducted at 8 hospitals in Denmark. Participants and interventions Participants with type 2 diabetes (glycated haemoglobin (HbA1c)≥7.5% (≥58 mmol/mol), body mass index >25 kg/m2) were, in addition to metformin versus placebo, randomised to 18 months open-label biphasic insulin aspart 1–3 times daily (n=137) versus insulin aspart 3 times daily in combination with insulin detemir once daily (n=138) versus insulin detemir alone once daily (n=137), aiming at HbA1c≤7.0% (≤53 mmol/mol). Outcomes Primary outcome was change in mean carotid IMT (a marker of subclinical cardiovascular disease). HbA1c, insulin dose, weight, and hypoglycaemic and serious adverse events were other prespecified outcomes. Results Carotid IMT change did not differ between groups (biphasic −0.009 mm (95% CI −0.022 to 0.004), aspart+detemir 0.000 mm (95% CI −0.013 to 0.013), detemir −0.012 mm (95% CI −0.025 to 0.000)). HbA1c was more reduced with biphasic (−1.0% (95% CI −1.2 to −0.8)) compared with the aspart+detemir (−0.4% (95% CI −0.6 to −0.3)) and detemir (−0.3% (95% CI −0.4 to −0.1)) groups (p<0.001). Weight gain was higher in the biphasic (3.3 kg (95% CI 2.7 to 4.0) and aspart+detemir (3.2 kg (95% CI 2.6 to 3.9)) compared with the detemir group (1.9 kg (95% CI 1.3 to 2.6)). Insulin dose was higher with detemir (1.6 IU/kg/day (95% CI 1.4 to 1.8)) compared with biphasic (1.0 IU/kg/day (95% CI 0.9 to 1.1)) and aspart+detemir (1.1 IU/kg/day (95% CI 1.0 to 1.3)) (p<0.001). Number of participants with severe hypogly Continue reading >>

Insulin Basics

Insulin Basics

Diabetics need insulin therapy because they can't make their own. Insulin therapy tries to mimic natural insulin secretion — what happens automatically in non-diabetics. The ultimate goal of insulin therapy is to mimic normal insulin levels. Unfortunately, current insulin replacement therapy can only approximate normal insulin levels. Insulin therapy for type 2 diabetes ranges from one injection a day to multiple injections and using an insulin pump (continuous subcutaneous insulin infusion – CSII). The more frequent the insulin injections, the better the approximation of natural or normal insulin levels. Discuss with your medical provider the insulin regimen that is best for you. On this page you will learn about: Normal or Non-diabetic blood sugar levels and insulin release from the pancreas Natural insulin (i.e. insulin released from your pancreas) keeps your blood sugar in a very narrow range. Overnight and between meals, the normal, non-diabetic blood sugar ranges between 60-100mg/dl and 140 mg/dl or less after meals and snacks. See the picture below of blood sugar levels throughout the day in someone who does not have diabetes. To keep the blood sugar controlled overnight, fasting and between meals, your body releases a low, background level of insulin. When you eat, there is a large burst of insulin. This surge of insulin is needed to dispose of all the carbohydrate or sugar that is getting absorbed from your meal. All of this happens automatically! More About Natural Insulin Release Insulin is continuously released from the pancreas into the blood stream. Although the insulin is quickly destroyed (5-6 minutes) the effect on cells may last 1-1/2 hours. When your body needs more insulin, the blood levels quickly rise, and, the converse – when you need less, Continue reading >>

Being A Pancreas: Basal And Bolus Insulin And Juvenile Diabetes

Being A Pancreas: Basal And Bolus Insulin And Juvenile Diabetes

So: as a surrogate pancreas you’ve got to get familiarize yourself with what one does. That’s how you’ll understand the difference between basal and bolus insulin. Typical Pancreatic Activity When we sleep (and are not eating), the liver releases some of its stores of glycogen into the bloodstream, to give the brain the energy it needs. In a normal pancreas, insulin is released slowly and continuously. It does this to keep blood glucose levels in balance. Blood glucose levels would rise without this continuous supply of insulin. When a meal is eaten, the pancreas emits a larger amount of insulin to keep pace with the blood glucose that is being released into the bloodstream from the process of digestion. All of this activity keeps the person without type one diabetes and without insulin resistance at blood glucose levels that range from 65 mg/DL to 150 mg/DL. To Treat Type One Diabetes You’ve got to imitate the pancreas. Your child will have two types of insulin. Basal insulin is like the continuous supply of insulin while bolus is what happens around eating. Basal is “extended release” insulin while bolus is “fast-acting” insulin. Basal insulin starts working within an hour of injection and will has a12 to 24 hour activity duration in the body. Bolus insulin starts to work within 15 minutes of injection and lasts about 4 hours. It is at its peak at around 1 1/2 to 2 hours after injection. Bolus insulin is given when your child has eaten anything with carbohydrates or when his/her insulin level is high. How much? Basal insulin Your endocrinologist will prescribe the amount of basal insulin your child receives based on your child’s age and weight. It will also be based on a week’s worth of multiple night-time blood glucose readings. The basal levels w Continue reading >>

Setup Insulin Pump Basal Rates

Setup Insulin Pump Basal Rates

1. Select “Insulin Pump Basal Rates” in Settings under “Medications & Automation”. 2. Select “Add a Basal Rate”. 3. Enter units/hr and the start time of your basal rate by scrolling through the clock. 4. Select “Save” when you are done. To set the type of Basal Insulin 1. “Add a Basal Rate”. 2. Select a basal rate you already added to your meds or select “Manage Meds” and add a pump basal insulin. 3. Scroll through list of insulins or tap the “Search Basal Insulins” field and type the name of your insulin. 4. Once you locate your insulin, tap the name and then tap “Save” In the upper right hand corner of the screen. Continue reading >>

Development Of New Basal Insulin Peglispro (ly2605541) Ends In A Disappointing Result

Development Of New Basal Insulin Peglispro (ly2605541) Ends In A Disappointing Result

On 4 December 2015, Eli Lilly and Company (Indianapolis, IN, USA) announced that they made the decision to end the basal insulin peglispro (BIL) development program, which was on its way to phase III trials. Stable and prolonged pharmacokinetic (PK) and pharmacodynamic (PD) profiles are very important for basal insulin, and several analog insulins for basal supplement have been developed in this decade [1]. More efficient and safer glycemic control has been realized with subsequent new basal insulins. Established long-acting basal insulins available in Japan include insulin glargine 100 U/ml [2], insulin detemir [3], insulin degludec [4], and insulin glargine 300 U/ml [5, 6]. LY2605541 is a novel PEGylated basal insulin known as BIL. Insulin lispro is a 5.8-kDa peptide hormone; 20-kDa polyethylene glycol (PEG) is a neutral linear conjugated to insulin lispro to give rise to the basal analog LY2605541. It is able to bind three molecules of water, allowing it to become highly hydrated, thereby increasing the hydrodynamic size of the molecule, which delays absorption and reduces renal filtration, resulting in a protracted half-life of LY2605541. The PEGylation process also protects against proteolytic degradation. PEGylation is novel in the context of insulin but is a well-established strategy to improve therapeutic properties of proteins, as shown for interferon. In the phase I study, LY2605541 showed flat PK and PD profiles accompanied by glucose normalization, prandial insulin dose reduction, and no severe hypoglycemia [7]. In addition to the long and flat PK/PD profile, LY2605541 demonstrates preferential hepatic versus peripheral action relative to insulin glargine in healthy individuals [8]. In this euglycemic clamps study, insulin glargine resulted in increased gluc Continue reading >>

New Basal Insulins: Toujeo And Tresiba

New Basal Insulins: Toujeo And Tresiba

By Tricia Santos Cavaiola, MD Did you know that insulin has been around since the 1920’s? Although insulin sometimes gets a bad rap, to this day, it is still one of the best medications we have to treat diabetes. Despite the fact that insulin has been around for so long, the current insulin medications are not perfect. However, two new insulins were approved in 2015, Toujeo and Tresiba, which may offer some advantages. Basal Insulin Each of these new medications is a basal insulin, which is necessary in all patients with type 1 diabetes and some patients with type 2 diabetes. The main purpose of basal insulin is to control glucose levels in the “fasting state”, which is overnight and in between meals. Therefore, the ideal basal insulin should have a steady effect throughout the day and night. Basal insulin should also last a full 24 hours in every patient. You wouldn’t want your basal insulin to run out before your next dose is due! Both Toujeo and Tresiba are longer-acting basal insulins compared to the other available long-acting insulins, which do not last 24 hours in every patient. Toujeo and Tresiba will allow for more flexibility in the timing of the dose and they also appear to be more “steady” throughout the 24 hours with fewer peaks and valleys. Let’s look at each of them in a little more detail. Toujeo (Insulin Glargine U-300) Insulin Toujeo is not actually “new.” It simply is three times more concentrated than insulin glargine (Lantus), so you can inject a smaller volume of insulin to get the same effect. Most of the insulin available today comes in a U-100 concentration, including Lantus (glargine U-100). This means there are 100 units in 1 milliliter of fluid. Toujeo is more concentrated with 300 units in 1 milliliter of fluid. It is there Continue reading >>

How Do You Use Basal Insulin?

How Do You Use Basal Insulin?

When the first long-lasting basal insulin analogs (insulin glargine [brand name Lantus] and insulin detemir [Levemir]) came out, they were supposed to last 24 hours. You injected once a day. That schedule clearly doesn’t work for everyone. Why is that, and what works for you? First of all, what is “basal” insulin? “Basal” insulin is that background level of insulin you need 24 hours a day. It’s not for the food you eat; it’s for everything else insulin has to do in your body. As I wrote here, insulin keeps glucose stored in the liver, fat stored in fat cells, and promotes cell reproduction, along with several other functions. People with Type 1 and many with Type 2 have very low or no basal insulin. Without basal insulin, your liver can pump out glucose all the time. Your sugars can go way up even if you don’t eat, like at night. So the invention of a 24-hour basal insulin was a great advance. It brought people’s A1C levels way down, but it doesn’t always work as advertised. Dr. Richard Bernstein, author of Diabetes Solution, says “In my opinion, there is no 24-hour basal insulin.” Larger insulin doses take longer to absorb. According to Dr. Bernstein, drug companies used larger-than-needed doses to make them last 24 hours. “The large basal doses needed to make ‘long-acting insulins’ last 24 hours,” he says, “[can cause] a number of undesirable consequences. These include hypoglycemic episodes [lows], weight gain, and possible [blood vessel] effects.” At the proper doses, basal insulin will frequently not last 24 hours. A study in Diabetes Care found a window of low insulin levels when the daily dose has worn off and the next day’s dose hasn’t yet kicked in. The authors suggested twice daily dosing would provide better coverage. O Continue reading >>

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