New Insulins and Insulin Delivery Systems Bruce W

New Insulins and Insulin Delivery Systems Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Part 4

Novo Nordisk devices in diabetes care First pen (Novo. Pen 1) launched in 1985 Committed to developing one new insulin administration system per year.

Lilly Insulin Pens

Prefilled Syringe with Flexible Dosing

® Novo. Log Flex. Pen ® 82% of DNEs Preferred Flex. Pen® ® Source: Diabetes Nurse Educators In-Depth Study—Reactions to Flex. Pen.

Starting MDI l Starting insulin dose is based on weight 0. 2 x wgt. in lbs. or 0. 45 x wgt. in kg l Bolus dose (aspart/lispro) = 20% of starting dose at each meal l Basal dose (glargine/NPH) = 40% of starting dose at bedtime

Starting MDI in 180 lb person l Starting dose = 0. 2 x wgt. in lbs. 0. 2 x 180 lbs. = 36 units l Bolus dose = 20% of starting dose at each meal 20% of 36 units = 7 units ac (tid) l Basal dose = 40% of starting dose at bedtime 40% of 36 units = 14 units at HS

Estimating the Carbohydrate to Insulin Ratio (CIR) Individually determined CIR = (2. 8 x wgt in lbs) / TDD Anywhere from 5 to 25 g CHO is covered by 1 unit of insulin

Correction Bolus (Supplement) l Must determine how much glucose is lowered by 1 unit of short- or rapid-acting insulin l This number is known as the correction factor (CF) l Use the 1700 rule to estimate the CF l CF = 1700 divided by the total daily dose (TDD) ex: if TDD = 36 units, then CF = 1700/36 = ~50 meaning 1 unit will lower the BG ~50 mg/dl

Correction Bolus Formula Current BG - Ideal BG Glucose Correction factor Example: – Current BG: – Ideal BG: 220 mg/dl 100 mg/dl – Glucose Correction Factor: 50 mg/dl 220 - 100 =2. 4 u 50

Options to MDI l A Simpler Regimen l Insulin Pump l Premixed BID (DM 2 only)

Human Insulin Time-action Patterns Change in serum insulin Normal insulin secretion at mealtime Regular insulin NPH insulin Premix 70/30 Baseline level SC injection Time (h)