Insulin therapy intermediate-acting

Add bedtime intermediate-acting insulin or once-daily glargine before supper intermediate-regular insulin or lispro/ aspart mix add third oral agent or switch to split dose insulin or insulin analog therapy consider referral to endocrinologist... 

The pharmacokinetic profiles for both the NPH crystals and the co-crystals also reflected a similar pattern. Co-crystals containing 75% C8-HI demonstrated a more uniform and favorable pharmacokinetic profile over a period of 24 hours than the NPH crystals. Studies measuring the insulin AUC indicated a much faster absorption rate for the NPH crystals i.e. higher insulin AUC values) in the first 12 hours than the co-crystals, in accordance with the dissolution results. However, in the 12-24 hour period, there was a significant decrease in the AUC for the NPH insulin, while that for the co-crystals remained comparable to the 0-12 hour period. This uniformity and prolonged absorption rate made the co-crystals more suitable for basal therapy in gly-cemic control than the existing intermediate-acting NPH crystals. 

The treatment of type 1 diabetes is the subcutaneous injection of insulin, as insulin cannot be administered orally because it would be broken down in the stomach due to the low pH. Initially, animal insulin was used in the treatment of diabetes, since bovine and porcine insulin are structurally similar to human insulin. Nowadays, most of the insulin used in the treatment of diabetes is human insulin produced via recombinant DNA (see Ch. 27). There are a number of insulin formulations available, e.g. short-, intermediate- or long-acting and biphasic (a mixture short- and intermediate-acting insulin), and these are described in more detail in Chapter 27. There is a range of therapy protocols indicated, based on the individual condition of the patient. 

Regular insulin typically is given subcutaneously, often in combination with an intermediate-or long-acting preparation. Special buffered formulations of regular insulin are available for use in subcutaneous infusion pumps that are less likely to crystallize in the tubing during the slow infusion associated with this type of therapy. 

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