SSI Therapy may Result in Wide Fluctuations in BG Levels
A reactive rather than proactive way of controlling glucose levels
- Treats hyperglycemia after it happens
- Patients do not receive insulin if their BG levels are normal
- If BG increases, insulin is given, regardless of basal or prandial needs
- Wide fluctuations in BG levels can result from use of this regimen
- Patients treated with SSI were more likely to have hyperglycemia than patients not
treated with SSI76
RABBIT 2 Dosing—Proven Basal-Prandial Therapy for Inpatients with Type 2 Diabetes59
RABBIT 2=Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management
of Patients with Type 2 Diabetes.59
- Insulin dosing must be individualized. Frequent blood glucose monitoring is vital
in all patients taking insulin. Insulin needs may be altered during stress, illness,
or with changes in activity, meal patterns, or coadministered drugs
- Monitor blood glucose in all patients treated with insulin. Insulin regimens should
be modified 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
- Hypoglycemia is the most common adverse reaction of insulin therapy, including LANTUS®,
and may be life-threatening
Basal-Prandial Regimen Significantly Reduced BG vs SSI Monotherapy
a RHI q6h without basal coverage.
Multicenter, prospective, open-label, randomized study (N=130) comparing efficacy
of LANTUS® + APIDRA® with standard SSI monotherapy in insulin-naive nonsurgical
patients aged 18 to 80 years with type 2 diabetes. Glargine was dosed once daily
and glulisine before meals at a starting dose of 0.4 Units/kg/dafor BG 140-200 mg/dL
or 0.5 Units/kg/day for BG 201-400 mg/dL. SSI was given 4 times per day for BG >140
mg/dL.
From Umpierrez.59
The Majority of Patients Reached Goal
d Hypoglycemia defined as BG <60 mg/dL.
e Severe hypoglycemia defined as BG <40
mg/dL.
Data were not available to determine significance.
From Umpierrez.59
- No episodes of hypoglycemia were associated with adverse outcomes in either group
- Of 1005 BG readings in the basal-prandial group, 4 (0.4%) indicated hypoglycemia,
and of 1021 BG readings in the SSI group, 2 (0.2%) indicated hypoglycemia
Switching from SSI Monotherapy to Basal-Prandial Regimen
A total of 9 of 65 inpatients with type 2 diabetes were switched from SSI to basal-prandial
therapy. Hyperglycemia decreased significantly in those patients.
9 patients (14%) treated with SSI monotherapy had persistent BG>240mg/dL and were
switched to basal-prandial regimen.
Switch to basal-prandial insulin regimen was associated with significant, rapid
BG lowering (P<0.05).
The importance of mealtime coverage >
CONTRAINDICATIONS
Lantus® is contraindicated in patients hypersensitive to insulin glargine or
one of its excipients.
WARNINGS AND PRECAUTIONS
Monitor blood glucose in all patients treated with insulin. Insulin regimens should
be modified 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.
Do not dilute or mix Lantus® with any other insulin or solution. If mixed or
diluted, the solution may become cloudy, and the onset of action/time to peak effect
may be altered in an unpredictable manner. Do not administer Lantus® via an
insulin pump or intravenously because severe hypoglycemia can occur. Insulin devices
and needles must not be shared between patients.
Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®,
and may be life-threatening.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur.
A reduction in the Lantus® dose may be required in patients with renal or hepatic
impairment.
DRUG INTERACTIONS
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
Other adverse reactions commonly associated with Lantus® are injection site
reaction, lipodystrophy, pruritus, and rash.
Lantus® SoloSTAR® is a disposable prefilled insulin pen. To help ensure
an accurate dose each time, patients should follow all steps in the Instruction
Leaflet accompanying the pen; otherwise they may not get the correct amount of insulin,
which may affect their blood glucose.
Lantus® is a long-acting insulin analog indicated to improve glycemic control
in adults and children (6 years and older) with type 1 diabetes mellitus and in
adults with type 2 diabetes mellitus. Lantus® should be administered once a
day at the same time every day.
Important Limitations of Use: Lantus® is not recommended for the treatment of
diabetic ketoacidosis. Use intravenous short-acting insulin instead.
Lantus® SoloSTAR® is a disposable prefilled insulin pen.
Please click here for full prescribing information.
CONTRAINDICATIONS
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. Change 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 Apidra® 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 Apidra®,
which may be serious.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur.
All insulins, including Apidra®, can cause hypokalemia, which if untreated,
may be serious.
A reduction in the Apidra® dose may be required in patients with renal or hepatic
impairment.
Apidra® for subcutaneous injection should not be mixed with insulins other than
NPH. Do not mix Apidra® with any insulin when used in the pump or for intravenous
administration. Insulin devices and needles must not be shared between patients.
DRUG INTERACTIONS
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
Other adverse reactions commonly associated with Apidra® include injection site
reactions, lipodystrophy, pruritus, and rash.
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.
Please click here for full prescribing information for Apidra®
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