For Hospitalized Patients With Diabetes
Insulin is the recommended agent for treating hyperglycemia
A basal-prandial dosing option for inpatients with type 2 diabetes from the RABBIT 2 Study
A basal-prandial regimen may not be appropriate for all patients. Glucose levels must be monitored often to help minimize hypoglycemic events and help achieve optimum glycemic control1
In non-critically ill hospitalized patients with type 2 diabetes
Consider a basal-prandial approach instead of SSI
In the RABBIT 2 study
A basal-prandial regimen significantly reduced BG vs SSI monotherapy
RABBIT 2=Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients
with Type 2 Diabetes.
- Primary endpoint: difference in glycemic control as measured by mean daily BG
- 66% of basal-prandial patients reached premeal BG study goal of <140 mg/dL compared with 38% of patients treated with SSI
Indications and Usage for
Lantus® (insulin glargine [rDNA origin] injection)
Important Limitations of Use:
Indications and Usage for Apidra® (insulin glulisine [rDNA origin] injection)
Apidra® is a rapid-acting insulin analog indicated to improve glycemic control in adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes.
When used as a mealtime insulin, the dose of Apidra® should be given within 15 minutes before or within 20 minutes after starting a meal. Apidra® given by subcutaneous injection should normally be used in regimens that include a longer-acting insulin.
Important Safety Information for
Lantus® (insulin glargine [rDNA origin] injection) & Apidra® (insulin glulisine [rDNA origin] injection)
Apidra® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to Apidra® or any of its excipients.
Warnings and Precautions
Closely monitor blood glucose in all patients treated with insulin. Modify insulin regimens cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. As with all insulin preparations, the time course of action may vary by individual or at different times in the same individual and is dependent on many conditions, including the site of injection, local blood supply, or local temperature.
Hypoglycemia is the most common adverse reaction of insulin therapy, including
Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue
A reduction in the
Fluid retention, which may lead to or exacerbate heart failure, can occur with concomitant use of thiazolidinediones (TZDs) with insulin. These patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of TZD must be considered.
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and close monitoring of blood glucose. The signs of hypoglycemia may be reduced in patients taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine).
Adverse reactions commonly associated with
Important Safety Information for
- Moghissi ES, Korytkowski MT, Dinardo M, et al. Diabetes Care. 2009;32(6): 1119-1131.
- American Diabetes Association. Diabetes Care. 2011;33(suppl 1):S11-S61.
- Deedwania P, Kosiborod M, Barrett E, et al. Circulation. 2008;117(12):1-10.
- Clement S, Braithwaite SS, Magee MF, et al. Diabetes Care. 2004;27(2):553-591.
- American Medical Directors Association. Diabetes Management in the Long-Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA; 2010.
- Queale WS, Seidler AJ, Brancati FL. Arch Intern Med. 1997;157(5):545-552.
- Browning LA, Dumo P. Am J Health-Syst Pharm. 2004;61(15):1611-1614.
- Umpierrez GE, Smiley D, Zisman A, et al. Diabetes Care. 2007;30(9):2181-2186.