Basal insulin

Long-acting insulins Amino acid substitutions generate a product that enters the bloodstream very slowly from the site of injection, thereby maintaining basal insulin blood levels over an extended period 11... 

The basal insulin component may be provided by once- or twice-daily NPH or detemir, or once-daily insulin glargine. Most type 1 DM patients require two injections of all insulins except insulin glargine. All of the insulins (with the exception of insulin glargine) have some degree of peak effect that must be considered in planning meals and activity. Insulin glargine or insulin detemir is a feasible basal insulin supplement for most patients. 

As an example, patients may begin on about 0.6 units/kg/day of insulin, with basal insulin 50% of the total dose and prandial insulin 20% of the total dose before breakfast, 15% before lunch, and 15% before dinner. Most patients require total daily doses between 0.5 and 1 unit/kg/day. 

If a patient has inadequate control on two drugs, adding a third class can be considered (e.g., a glitazone, exenatide, a dipeptidyl peptidase-IV inhibitor, or basal insulin). Therapy should be guided by the A 1C, FPG, cost, additional benefits (e.g., weight loss), and avoidance of side effects). 

Children (Humalog only) - Safety and efficacy in children younger than 18 years of age have not been determined for Humalog Mix. Adjustment of basal insulin may be required. To improve accuracy of dosing in children, a diluent may be used. If the diluent is added directly to the vial, the shelf life may be reduced. 

Another method for aggressive control of blood glucose levels is the use ofinsuiin pumps to cover basal insulin needs plus supplemental dosing at meals with fast-acting insulin. 

Progesterone has little effect on protein metabolism. It stimulates lipoprotein lipase activity and seems to favor fat deposition. The effects on carbohydrate metabolism are more marked. Progesterone increases basal insulin levels and the insulin response to glucose. There is... 

Basal insulin values of 5-15 WJ/mL (30-90 pmol/L) are found in normal humans, with a peak rise to 60-90 iMJ/mL (360-540 pmol/L) during meals. 

King AB, Armstrong D. A comparison of basal insulin delivery continuous subcutaneous insulin infusion versus glargine. Diabetes Care 2003 26(4) 1322. 

Hermansen K, Madsbad S, Perrild H, Kristensen A, Axelsen M. Comparison of the soluble basal insulin analogue insulin detemir with NPH insulin a randomized open crossover trial in type 1 diabetic subjects on basal-bolus therapy. Diabetes Care 2001 24(2) 296-301. 

Rosenstock J, Schwartz SL, Clark CM Jr, Park GD, Donley DW, Edwards MB. Basal insulin therapy in type 2 diabetes 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Diabetes Care 2001 24(4) 631-6. 

Zinman B, Ross S, Campos RV, Strack TThe Canadian Lispro Study Group. Effectiveness of human ultralente versus NPH insulin in providing basal insulin replacement for an insulin lispro multiple daily injection regimen. A doubleblind randomized prospective trial. Diabetes Care 1999 22(4) 603-8. 

A. Ahmann. Lessons on developing a better basal insulin. Diabetes Technol. Then 6 596-600, 2004. 

The effect of this subtle difference in device function can be seen when the measured signal in the presence of biofouling is modeled. As a model patient, we considered the transient response of an individual with basal insulin provided after each of the three daily meals. Blood glucose dynamics predicted by Sorensen was corrected for diffusion to subcutaneous tissue using the mass transport model of Schmidtke et al.24 25 Figure 11.1 shows a model comparison between the sensor response of an electrochemical sensor and an optical sensor with an assumed... 

Levemir human insulin analogue (rDNA origin) Long-acting basal insulin analogue metabolism... 

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