1. Insulin Therapy-What’s New
Veronica Brady,
PhD, FNP-BC, BC-ADM, CDE
April 21, 2016

2. Diabetes warrior

3. Insulin

4. Objectives Overview of Insulin Therapy Describe New Insulin Therapies
Identify Candidates for New Insulins
Questions

5. Normal Insulin Secretion
Basal: continuous insulin to compensate for liver glucose
Bolus: surge for food
1st phase: rapid rise in serum insulin levels inhibits glucagon release and therefore inhibits glycogenolysis
2nd phase: to maintain normoglycemia postprandially

6. Gycemic control algorithm
When insulin is needed

7. Therapy options
When insulin is needed

8. Everything you should know about the new insulins

9. New Insulins Rapid Acting Short Acting Intermediate Acting Long Acting
Ultra Long Acting
Inhaled

10. Insulin chart

11. Rapid Acting Insulin
Lispro/Humalog-U-200 Glulisine/Apidra Aspart/Novolog
Onset: 15 minutes
Peak: minutes
Duration:3-5 hours 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Meal and
Snack times
AM / PM
Onset
Peak
Duration
1st meal______
AM/PM
_____
____to____
1st snack______
2nd meal______
2nd snack_____
3rd meal______
3rd snack _____
Bedtime______

12. Long Acting Insulin Detemir/Levemir Onset: 0.8-2 hrs Peak: 3.2-9.3 hrs
Duration: up to 24 hrs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Meal and
Snack times
AM / PM
Onset
Peak
Duration
1st meal______
AM/PM
_____
____to____
1st snack______
2nd meal______
2nd snack_____
3rd meal______
3rd snack _____
Bedtime______

13. Long-Acting Insulin Glargine/Lantus Basaglar/Lantus** Onset: 1-2 hrs
Peak: peakless
Duration: 24 hrs
Meal and
Snack times
AM / PM
Onset
Peak
Duration
1st meal______
AM/PM
_____
____to____
1st snack______
2nd meal______
2nd snack_____
3rd meal______
3rd snack _____
Bedtime______ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 x B L D

14. Ultra Long Acting Insulin
Glargine U-300/Toujeo
Onset: hrs
Peak: peakless
Duration: hrs

15. Ultra Long Acting Insulin
Degludec/Tresiba
Onset: ½-1.5 hrs
Peak: peakless
Duration: 42 hrs

16. Rapid acting

17. Afrezza Generic Name: insulin human Brand Name: Afrezza
Manufacturer: Sanofi
Form: human
Delivery:packets 4,8, & 12 units (90 packets & 2 inhalers)
Storage: inhaler good for 15 days (packet = 1 month-fridge or 10 days sealed and 3 days opened)
Onset: minutes
Peak: minutes
Duration:180 minutes

18. Afrezza Considerations:
Lung function-no smoking (none within 6 months)
Set doses—not possible to get 3 units
Amount of insulin needed for each meal
Must be at room temp for 10 minutes before use

19. Humalog U-200 Generic Name- lispro U-200 Brand Name: Humalog U-200
Manufacturer: Eli Lilly
Form: analog
Delivery: pre-filled pen (600 units)
Storage: in use 28 days—do not refridgerate
Onset: 15 minutes
Peak: minutes
Duration: 3-5 hours

20. Intermediate acting

21. U-500 pens Generic Name-regular U-500 Brand Name: Humulin R U-500
Manufacturer: Eli Lilly
Form: human
Delivery: 3 ml pen fill (1500 units)
Storage- in use do not refrigerate—28 days
Onset: 30 minutes
Peak: 8 hours
Duration: up to 24 hours

22. U-500 pens Considerations:
Indicated for patients requiring more than 200 units of insulin/day.
Administer 2-3 times a day 30 minutes before meals
Do not mix with other insulins

23. Long acting

24. Basaglar(coming 12/15/16) Generic Name-glargine Brand Name: Basaglar
Manufacturer: Eli Lilly
Form: analog
Delivery: 3 ml pen fill
Storage-pen in use 28 days
Onset: one hour
Peak: no peak
Duration: 24 hours

25. Toujeo Generic Name: glargine U-300 Brand Name: Toujeo
Manufacturer: Sanofi
Form: Analog
Delivery: (450unit) prefilled pen
Storage-pen in use good for 42 days
Onset: 6 hours
Peak: No peak
Duration: 36 hours
Maximum single injection: 80 units

26. Comparison of U-100 & U-300 insulin glargine

27. Tresiba Generic Name: degludec Brand Name: Tresiba
Manufacturer: Novo Nordisk
Form: Analog
Delivery: prefilled pen u-100 (300) u-200 (600)
Storage: in use room temperature up to 48 days
Onset: one hour
Peak: No peak
Duration: 42 hours
Maximum single dose: 160 units

28. Candidates for New Insulins-Basal
Patients requiring large doses of insulin
Those with overnight hypoglycemia
Those with variable schedules that interfere with consistent insulin injections

29. New Insulins Advantages Disadvantages Basals-longer duration of action
Less overnight hypoglycemia
Small volume
Cost

30. Patient education

31. Which one? They look so much alike, I can’t remember. Oops!!!
Did I just use the Humalog pen or the Lantus pen?

32. Administration Instructions
Read label carefully if using more than one pen filled device.
Do not draw insulin out of pen with syringe
Be sure to rotate sites
**No need to perform dosage conversions when using u-200 or u-300 insulins

33. Coming soon!!!??

34. New on the Horizon
Smart Insulin- Merck
Insulin+GLP-1

35. Questions