Table 2 summarizes the different types of insulin, dosage forms available on the market, and the pharmacokinetic properties of each type (ADA et al., 2022d; Lexicomp, 2022). Selection of an appropriate product will depend on the patient’s form of insulin administration, the dosing regimen, and insurance coverage. Most patients on a traditional basal–bolus regimen will require both a rapid-acting product and a long-acting product.
Self-Assessment Quiz Question #3 Rob will need to be initiated on an insulin regimen to manage his new type 1 diabetes mellitus diagnosis. Which of the following is the most appropriate basal dose to prescribe in the form of insulin glargine? His current weight is 30 kg.
a. 4 units. b. 8 units. c. 16 units. d. 30 units.
Table 2. Insulin Products for Pediatric Type I Diabetes Mellitus Insulin type Examples Dosage Forms Available
Onset
Peak Glycemic Effect
Duration
Rapid-acting
Insulin aspart (Fiasp, NovoLOG)
U-100 vial, U-100 cartridge, U-100 prefilled pen U-100 vial, U-100 prefilled pen U-100 vial, U-100 prefilled pen, U-100 cartridge, U-200 prefilled pen U-100 vial, U-100 prefilled pen, U-500 vial, U-500 prefilled pen
12–24 minutes
Fiasp: 1.5–2.5 hours NovoLOG: 1–3 hours
Fiasp: 5–7 hours NovoLOG: 3–7.2 hours
Insulin glulisine (Apidra)
12–30 minutes
1.6–1.8 hours
3–4 hours
Insulin lispro (Admelog, HumaLOG)
30–45 minutes
Admelog: 2.1 hours HumaLOG: 2.4–2.8 hours
Admelog: 6.9 hours HumaLOG: 5.7–6.7 hours
Short-acting
Insulin regular (HumuLIN R, NovoLIN R)
U-100: 30 minutes U-500: <15 minutes
U-100: 1.5–3.5 hours
U-100: 8 hours U-500: 13–24 hours
U-500: 4–8 hours (dose-dependent)
Intermediate- acting
Insulin NPH (HumuLIN N, NovoLIN N)
U-100 vial, U-100 prefilled pen
1–2 hours
4–12 hours
14–24 hours
Long-acting
Insulin degludec (Tresiba)
U-100 vial, U-100 prefilled pen, U-200 prefilled pen U-100 vial, U-100 prefilled pen U-100 vial, U-100 prefilled pen
1 hour
12 hours
>24 hours
Insulin detemir (Levemir) Insulin glargine (Basaglar, Lantus, Semglee)
3–4 hours
3–9 hours
6–23 hours (dose- dependent) ≥24 hours (Lantus ranges from 11 to ≥ 24 hours)
3–4 hours
Basaglar: 12 hours Lantus, Semglee : 10–12 hours
Source: Lexicomp. (2022). Insulin products. Lexi-comp. https://online.lexi.com As noted in Table 2, several insulin products are available in more concentrated dosage forms, indicated as U-200 or U-500. These values correspond with insulin concentrations of 200 units/mL and 500 units/mL, respectively. For patients on large doses of insulin, potent insulin formulations lessen the volume required for injection. There are corresponding U-200 and U-500 syringes available on the market to facilitate unit measurement at those concentrations. Insulin pens prefilled with concentrated insulin will also take the potency difference into account. It is important to counsel patients prescribed these concentrated products about appropriate measurement to minimize risk of overdose. In addition to the insulin products outlined in Table 2, there are several premixed insulin products on the market that combine different-onset formulations. These products are useful for patients on nonflexible insulin regimens who do not perform carbohydrate counting. Prandial insulin calculations are dependent on the patient’s current glucose level and the grams of carbohydrates in the meal or snack (ADA et al., 2022d). The patient’s current glucose level, if above goal, can be corrected utilizing the patient’s insulin sensitivity factor (ISF). An ISF is the blood glucose level (mg/dL) that is covered by 1 unit of insulin. For instance, if a patient’s ISF is 1:90, 1 unit of insulin is anticipated to decrease the patient’s
glucose level by 90 mg/dL. The units of insulin required to cover grams of carbohydrates in a meal is calculated utilizing the patient’s insulin-to-carbohydrate ratio (ICR). This value indicates how many grams of carbohydrates are covered by 1 unit of insulin. For instance, if a patient’s ICR is 1:25, 1 unit of insulin will cover 25 grams of carbohydrates. Putting the two parameters together, below is a patient example. Tim is a 10-year-old 40-kg male recently diagnosed with T1DM. His estimated total daily dose of insulin is calculated to be 20 units. As such, he is prescribed 10 units as his basal dose in the form of once-daily insulin glargine. His ISF is calculated to be 1:90, and his ICR is calculated to be 1:25. His goal blood glucose level is 100 mg/dL. If his current blood glucose level is 145 mg/ dL, and he plans to eat 40 grams of carbohydrates, how many units of rapid-acting insulin should he inject as his prandial dose? ● First, calculate the gap between current blood glucose level and goal blood glucose level: 145 – 100 mg/dL = 45 mg/dL. ● Next, divide this value by the patient’s ISF: 45 mg/dL/(1 unit/90 mg/dL) = 0.5 unit of insulin. The patient will need to inject 0.5 unit of insulin to correct the current blood glucose level. ● Now, calculate the units of insulin required to cover 40 grams of carbohydrates. Divide this value by the patient’s ICR: 40
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Book Code: AUS3024
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