Insulin 10/11/17. Disclosures. Objectives. Speaker and Consultant for Jansen and Healthscripts Speaker and Consultant for Boehringer Ingelheim (BI)
|
|
- Gladys Hicks
- 6 years ago
- Views:
Transcription
1 Insulin The What, When, Where, Who and Why Disclosures Speaker and Consultant for Jansen and Healthscripts Speaker and Consultant for Boehringer Ingelheim (BI) Objectives Define background and history of the hormone, insulin Identify subjective and objective signs and symptoms of hyperglycemia and define glucose toxicity Guidelines for use of insulin in Diabetes Mellitus Pharmodynamics and pharmokinetics of current insulins available Initiation and titration of insulin via multi-dose injection or insulin infusion via insulin pump 1
2 Background: History of Insulin During the 19 th century, observations of patients who died of DM showed pancreatic damage In 1869, a German medical student by the name of Paul Langerhans, found that within the pancreatic tissue that produces digestive juices were clusters of cells whose function was unknown These cluster of pancreatic cells were later revealed to be beta cells which produce insulin. In honor of Paul Langerhans, they were named Islets of Langerhan In 1889, two German scientists, working with dogs, discovered if the pancreas was removed the dogs developed diabetes. In their research, they also discovered if the pancreatic duct was ligated, the dog developed only minor digestive issues but no diabetes Background: Insulin Based on this research it was theorized the pancreas had two functions: To produce digestive enzymes To produce a substance that regulates blood sugar It was not until 1921, Charles Banting an unemployed, orthopedic surgeon and Charles Best a medical student performed experiments on dogs and isolated the hormone we know as insulin In late 1921, a biochemist by the name of Bertram Collip was added to the team to purify the newly discovered insulin so it could be injected into humans The scientist self injected insulin initially and learned how to diminish the effects by treating with fast acting glucose Photo of Leonard Thompson 2
3 Background: Insulin January 1922, the first person received insulin: Leonard Thompson 14 year old Leonard Thompson had been dx with DM three years prior and was near death, drifting in and out of a diabetic coma in Toronto General Hospital. Since the starvation diet was the only treatment for Diabetes at that time, Leonard weighed a mere 65 lbs. First injection resulted in an allergic reaction. A more pure insulin was extracted and developed by Collip and given again to Leonard. It was after the second injection, his condition improved rapidly Leonard Thompson lived for 13 more years and passed away from Pneumonia Hyperglycemia Hyperglycemia: elevated blood sugar Results from body lacking insulin or using insulin inefficiently Symptoms of hyperglycemia: may be none until blood sugar is consistently above 200 Weakness and fatigue: T1DM ++ T2DM + Polyuria and thirst: T1DM ++ T2DM + Polyphagia and weight loss: T1DM ++ T2DM + Recurrant blurred vision: T1DM + T2DM ++ Vulvovaginitis or pruritus: T1DM + T2DM ++ Peripheral neuropathy: T1DM + T2DM ++ Nocturnal enuresis: T1DM ++ T2DM Often asymptomatic: T1DM - T2DM ++ (Gardner and Shoback 2011) Glucose Toxicity: what It is Definition: pathologic consequence of prolonged hyperglycemia (Campos, 2012) Some cells are more prone to cellular damage as result of hyperglycemia. These include: pancreatic B cells, neuronal cells, vascular endothelial cells( 2012) This results in decrease of functioning beta cells and damage to endothelial cells resulting in microvascular and macrovascular complications 3
4 Insulin Indication: Individuals with Type 1 DM as well as those with Type 2 whose hyperglycemia does not respond to diet therapy and other diabetes agents Human insulin is now produced by recombinant SNA techniques. Animal insulins are no longer available in the United States (Gardner and Shobeck, 2011) Present day insulin is stable and refrigeration is not needed as long as extremes in temperature are avoided (2011) Available in u100, u200, u300 and u500 concentrations Available insulin preparations Short acting and Rapid analogs Rapid acting: Lispro (Humalog, Lilly) Aspart (Novolog, NovoNordisk) Glusisine (Apidra, Sanofi) Short acting: Regular (Lilly, NovoNordisk) Clear solutions at neutral PH Contain small amounts of zinc to improve stability and shelf life Rapid acting insulin is designed for subcutaneous administration while regular insulin can be given can also be given intravenously Insulin aspart is also approved for intravenous use but there is no advantage over regular insulin by this route (Gardner and Shoback, 2011) 4
5 Available insulin preparations Short acting onset, peak effect and duration of action Regular insulin: Short acting Onset 30 minutes after subcutaneous administration Peaks in two hours Lasts for 5-7 hours with usual quantities (ie 5-15 units) Duration is extended prolonged when larger doses are used Available insulin preparations Rapid acting onset, peak, and duration of action Produced by recombinant technology, that is amino acids are reversed (lispro), substituted (aspart) or replaced (gluisine) When injected, absorbed rapidly and reach peak values in as soon as 1 hour Onset is minutes Duration of action is 3-4 hours irrespective of dosage(2011) Available Insulin preparations Long acting NPH Glargine(Toujeo) u100 and u300 Detemir(Levemir) Degludec (Tresiba)u100 and u200 5
6 NPH Onset, peak and duration of action Intermediate insulin Onset of action is 2-4 hours Peak action of NPH is 6-8 hours Duration of action is hours, rarely may last up to 20 hours Given twice daily: am and bedtime Long Acting insulin preparations Glargine Two concentrations now available: u100 and u 300 Unit for unit conversion Onset No pronounced peak Cannot be mixed with any other insulin because of its acidic PH Half life of glargine u100 is 11 hours while half life of u300 glargine is 19.6 hours Clinical trials comparing glargine u100 with glargine u300 suggest lesser nocturnal hypoglycemia with the u300 concentration (cite trial here) Once daily dosing for u300 whereas u100 can be split into BID dosing although no real benefit once doses of 20 units achieved Long Acting insulin preparations Determir Concentration is u100 No pronounced peak Duration of action is 17 hours Half life is 11 hours Inject once or twice daily to achieve stable basal dose since duration of action is 17 hours 6
7 Ultralong acting insulin Onset minutes No peak Long acting insulin preparatio ns: Degludec Duration of action is longer than 24 hours Injected once daily Approved for use in adults 18 years and older with T1 or T2 DM U500 Insulin Behaves similarly to NPH in peak and duration of action Onset is minutes Peak: 4-8 hours Duration of action: 12+ hours Indicated for patients on TDD in excess of 200 units daily Can be given twice daily or TID dosing Requires patient education prior to initiating Consider referral to Diabetes Center or specialist when transitioning patient to u500 Initiation of Insulin Type 1 DM Weight based formula: units/kg/day for total day dose OR 0.2units/kg/day of basal and units f rapid acting insulin/kg administered before meals Example: 24 yo male recently diagnosed, A1C 13.8%. Current weight is 138 lbs KG X 0.4 = 27 units TDD. 40% of TDD should be basal insulin = 11 units basal. 60% should be given at meals = 16 units divided between three meals = ~5 units rapid acting insulin 7
8 Initiation of insulin T2DM 0.3 to 0.5 units/kg/day for total daily dose (TDD) Example: 50 YO female A1C is 10.2%. Weight is 245lbs or 111kg x 0.5u = 56 units TDD % needs to be basal = 28 units basal dosing. 28 units as mealtime divided by three meals = 9 units with meals. 70/30: Insulin mixes 75/25: 50/50: 8
9 Description: Peak: GLP1a with basal insulin(s) Onset: Titration: Insulin administration with insulin pump Description: insulin infusion with basal/bolus capabilities Basal Bolus( based on CHO ratio) Correction or sensitivity: one unit of insulin will lower BS x points Target blood sugar: typically range is IOB: usual is 3-4 hours Insulin pump(cont) Upload Example of setting page 9
10 Insulin pump(cont) upload Example of upload of readings Case presentation(s) T1DM on MDI, newly diagnosed T1DM on MDI, titration T2DM A1C of >9%, initiation of insulin: basal T2DM A1C of 8.9% already on basal, adding mealtime insulin Insulin is growth hormone needed for healthy cell metabolism Add insulin when blood sugars are elevated : according to guidelines Conclusion Insulin works! Explain the benefits of insulin to your patient. Also explain the s/s of hypoglycemia and how to treat 10
11 References 11
8/21/2017 UNRAVELING THE CROWED INSULIN SCENE. A Practical Overview of Insulin Focusing on New Insulin Preparations
UNRAVELING THE CROWED INSULIN SCENE A Practical Overview of Insulin Focusing on New Insulin Preparations Patricia Garnica MS, ANP-BC, CDE, CDTC North Shore University Hospital, Manhasset, N.Y. October
More informationType 2 Diabetes Mellitus Insulin Therapy 2012
Type 2 Diabetes Mellitus Therapy 2012 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Preparations Onset Peak Duration
More informationInsulin Management. By Susan Henry Diabetes Specialist Nurse
Insulin Management By Susan Henry Diabetes Specialist Nurse The Discovery of Insulin - 1921 - Banting & Best University Of Toronto Discovered hormone insulin in pancreatic extract of dog - Marjorie the
More informationType I Type II Insulin Resistance
Insulin An aqueous hormonal solution made in the pancreas. Affects metabolism by allowing glucose to leave the blood and enter the body cells, preventing hyperglycemia. It is measured in units, e.g. 100
More informationInsulin Prior Authorization with optional Quantity Limit Program Summary
Insulin Prior Authorization with optional Quantity Limit Program Summary 1-13,16-19, 20 FDA LABELED INDICATIONS Rapid-Acting Insulins Humalog (insulin lispro) NovoLog (insulin aspart) Apidra (insulin glulisine)
More informationInsulin Initiation and Intensification. Disclosure. Objectives
Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School
More informationMixed Insulins Pick Me
Mixed Insulins Pick Me Alvin Goo, PharmD Clinical Associate Professor University of Washington School of Pharmacy and Department of Family Medicine Objectives Critically evaluate the evidence comparing
More informationAACN PCCN Review. Endocrine
AACN PCCN Review Endocrine Presenter: Carol A. Rauen, RN, MS, CCNS, CCRN, PCCN, CEN Independent Clinical Nurse Specialist & Education Consultant rauen.carol104@gmail.com Endocrine I. INTRODUCTION Disorders
More informationDisclosure 1/16/2017. Michael R. Brennan D.O., M.S., F.A.C.E Director Beaumont Endocrine Center Chief of Endocrine Beaumont Grosse Pointe 1/16/2017 2
Therapy For Diabetes Michigan Association of Osteopathic Family Physicians Mid-Winter Family Medicine Update Shanty Creek Resort, MI January 19-22nd 2017 Michael R. Brennan D.O., M.S., F.A.C.E Director
More informationNewer Insulins. Boca Raton Regional Hospital 15th Annual Internal Medicine Conference
Newer Insulins Boca Raton Regional Hospital 15th Annual Internal Medicine Conference Luigi F. Meneghini, MD, MBA Professor of Internal Medicine, UT Southwestern Medical Center Executive Director, Global
More informationINSULIN OVERVIEW. Type Brand Name Onset Peak Duration Role in glucose management Page Rapid-Acting lispro min. 3-5 hrs min.
INSULIN OVERVIEW Type Brand Name Onset Peak Duration Role in glucose management Page Rapid-Acting lispro Humalog 15-30 min 30-90 min 3-5 hrs aspart glulisine Short-Acting Regular insulin NovoLog Apidra
More informationLearning Objectives. Are you ready for more insulin formulations?
Are you ready for more insulin formulations? Shara Elrod, PharmD, BCACP, BCGP Learning Objectives Review pharmacology and dosing of new insulin formulations Compare and contrast new insulin formulations
More informationInsulin Basics. Bryan Primary Care Conference May 21, 2016 Shannon Wakeley MD Complete Endocrinology
Insulin Basics Bryan Primary Care Conference May 21, 2016 Shannon Wakeley MD Complete Endocrinology Disclosures Speakers Bureau for Sanofi, Astra Zeneca, Janssen, Boehringer-Ingelheim Objectives Discuss
More informationBRIAN MOSES, MD, FRCPC (INTERNAL MEDICINE) CHIEF OF MEDICINE, SOUTH WEST HEALTH
Insulin Initiation BRIAN MOSES, MD, FRCPC (INTERNAL MEDICINE) CHIEF OF MEDICINE, SOUTH WEST HEALTH Disclosures In the past 12 months, I have received speakers honoraria from AstraZeneca, Boehringer Ingelheim,
More informationAgenda. Indications Different insulin preparations Insulin initiation Insulin intensification
Insulin Therapy F. Hosseinpanah Obesity Research Center Research Institute for Endocrine sciences Shahid Beheshti University of Medical Sciences November 11, 2017 Agenda Indications Different insulin preparations
More informationDegludec lantus conversion
Degludec lantus conversion Search embarazadas con elevado riesgo de enfermedad tiroidea usando la. There are various possible causes of a high blood sugar level in the morning: The Dawn Phenomenon which
More informationINSULIN INITIATION AND INTENSIFICATION WITH A FOCUS ON HYPOGLYCEMIA REDUCTION
INSULIN INITIATION AND INTENSIFICATION WITH A FOCUS ON HYPOGLYCEMIA REDUCTION Jaiwant Rangi, MD, FACE Nov 10 th 2018 DISCLOSURES Speaker Novo Nordisk Sanofi-Aventis Boheringer Ingleheim Merck Abbvie Abbott
More informationINSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE
INSULIN IN THE OBESE PATIENT JACQUELINE THOMPSON RN, MAS, CDE SYSTEM DIRECTOR, DIABETES SERVICE LINE SHARP HEALTHCARE OBJECTIVES DESCRIBE INSULIN, INCLUDING WHERE IT COMES FROM AND WHAT IT DOES STATE THAT
More informationBasal Bolus Insulin Therapy Frequently Asked Questions
1. What is Basal Bolus Insulin Therapy (BBIT)? 2. What evidence supports the use of subcutaneous Basal Bolus Insulin Therapy? 3. Does Basal Bolus Insulin Therapy apply to all patients? 4. What s wrong
More informationInsulin Regimens: Hitting Glycemia Targets
Insulin Regimens: Hitting Glycemia Targets Grant Kelley MD March 1 st, 2018 Faculty Disclosure: Financial relationships with commercial interests None Overview Mortality and Morbidity Insulin and Insulin
More informationTimely!Insulinization In!Type!2! Diabetes,!When!and!How
Timely!Insulinization In!Type!2! Diabetes,!When!and!How, FACP, FACE, CDE Professor of Internal Medicine UT Southwestern Medical Center Dallas, Texas Current Control and Targets 1 Treatment Guidelines for
More informationIndividualizing Care for Patients with Type 2 Diabetes
Individualizing Care for Patients with Type 2 Diabetes Disclosures Speaker: AstraZeneca, Novo Nordisk, BI/Lilly, Valeritas, Takeda Advisor: Tandem Diabetes, Sanofi Objectives Develop individualized approaches
More informationMANAGEMENT OF TYPE 1 DIABETES MELLITUS
MANAGEMENT OF TYPE 1 DIABETES MELLITUS INVESTIGATIONS AND TREATMENT MANSI NAIK VII SEMESTER INVESTIGATIONS FASTING BLOOD SUGAR PLASMA GLUCOSE HEMOGLOBIN A 1c SYMPTOMS OF TYPE 1 DIABETES MELLITUS Polyuria
More informationTips and Tricks for Starting and Adjusting Insulin. MC MacSween The Moncton Hospital
Tips and Tricks for Starting and Adjusting Insulin MC MacSween The Moncton Hospital Progression of type 2 diabetes Beta cell apoptosis Natural History of Type 2 Diabetes The Burden of Treatment Failure
More informationDEMYSTIFYING INSULIN THERAPY
DEMYSTIFYING INSULIN THERAPY ASHLYN SMITH, PA-C ENDOCRINOLOGY ASSOCIATES SCOTTSDALE, AZ SECRETARY, AMERICAN SOCIETY OF ENDOCRINE PHYSICIAN ASSISTANTS ARIZONA STATE ASSOCIATION OF PHYSICIAN ASSISTANTS SPRING
More informationNph insulin conversion to lantus
Nph insulin conversion to lantus Search 26-2-2003 RESPONSE FROM AVENTIS. We appreciate the opportunity to respond to Dr. Grajower s request for information regarding Lantus ( insulin glargine [rdna origin.
More informationFinding Ways Around High Dose Insulin Requirements: U-500 Insulin, Weight Loss, and Future Therapies
Finding Ways Around High Dose Insulin Requirements: U-500 Insulin, Weight Loss, and Future Therapies Elaine K. Cochran, MSN, CRNP, BC-ADM National Institute of Diabetes and Digestive and Kidney Diseases
More informationInsulin glulisine (Apidra) for type 1 diabetes mellitus in adolescents and children
Insulin glulisine (Apidra) for type 1 diabetes mellitus in adolescents and children December 2008 This technology summary is based on information available at the time of research and a limited literature
More informationFor patients uncontrolled on multiple daily injections of insulin. A quick-start guide for your practice ALL-DAY CONTROL WITH
For patients uncontrolled on multiple daily injections of insulin A quick-start guide for your practice Dosing guidance 1,* V-Go: 3 options 1 For initiating V-Go in patients switching from MDI The majority
More informationDiabetes: We ve Come a Long Way, Baby! Amy Wachter, MD Christiana Care Endocrinology March 22, 2018
Diabetes: We ve Come a Long Way, Baby! Amy Wachter, MD Christiana Care Endocrinology March 22, 2018 Title of My Talk Ancient Times Diabetes has been affecting lives for thousands of years. Egyptians in
More informationObjectives. Navigating New Insulins. Disclosures. Diabetes: The Stats. Normal Insulin Release Individuals without diabetes. History of Insulin 5/23/17
Objectives Compare and contrast currently available products. Navigating New s Diana Isaacs, PharmD, BCPS, BC-ADM, CDE Clinical Pharmacy Specialist Cleveland Clinic Diabetes Center Determine the factors
More informationINSULIN 101: When, How and What
INSULIN 101: When, How and What Alice YY Cheng @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form
More informationDiabetic Ketoacidosis
October 2015 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Case History HPI: 24 yo man with recent 8 lb. weight loss, increased thirst and frequent
More informationInitiation and Titration of Insulin in Diabetes Mellitus Type 2
Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Greg Doelle MD, MS April 6, 2016 Disclosure I have no actual or potential conflicts of interest in relation to the content of this lecture.
More informationDiabetes: Definition Pathophysiology Treatment Goals. By Scott Magee, MD, FACE
Diabetes: Definition Pathophysiology Treatment Goals By Scott Magee, MD, FACE Disclosures No disclosures to report Definition of Diabetes Mellitus Diabetes Mellitus comprises a group of disorders characterized
More informationUpdate on Insulin-based Agents for T2D. Harry Jiménez MD, FACE
Update on Insulin-based Agents for T2D Harry Jiménez MD, FACE Harry Jiménez MD, FACE Has received honorarium as Speaker and/or Consultant for the following pharmaceutical companies: Eli Lilly Merck Boehringer
More informationDiabetes Head to Toe May 31, 2017
Innovations in Insulin Joanne Reid RN CDE jmreid@gbhs.on.ca Danielle Benedict RPh Outline Setting the stage Insulin as pancreas replacement therapy Commonly used insulins New insulins Case Studies Dosing
More informationInitiation and Adjustment of Insulin Regimens for Type 2 Diabetes
Types of Insulin Rapid-acting insulin: lispro (Humalog), aspart (NovoRapid), glulisine (Apidra) Regular short-acting insulin: Humulin R, Novolin ge Toronto, Hypurin Regular Basal insulin: NPH (Humulin
More informationBEST 4 Diabetes. Optimisation of insulin module
BEST 4 Diabetes Optimisation of insulin module Confidence and competence Where would you rate yourself? Why do all of our patient not achieve optimal blood glucose control? Insulin Therapy Goals and Purpose
More informationNew Therapies for Diabetes Management: Hope or Headache?
New Therapies for Diabetes Management: Hope or Headache? Elizabeth Stephens, MD, FACP PMG- Endocrinology Elizabeth.Stephens@providence.org November 2018 Disclosures None 1 Objectives Discussion of 3 rd
More informationBEST 4 Diabetes. Optimisation of insulin module
BEST 4 Diabetes Optimisation of insulin module Confidence and competence Where would you rate yourself? Why do all of our patient not achieve optimal blood glucose control? Insulin Therapy Goals and Purpose
More informationRole of Academia In Achieving Targets in Diabetes Care
Role of Academia In Achieving Targets in Diabetes Care Disclosures Member of NovoNordisk, Lilly, Metavention, Sanofi, and Janssen Diabetes Advisory Boards Role of Academia in Discovering New Treatments
More informationNew basal insulins Are they any better? Matthew C. Riddle, MD Professor of Medicine Oregon Health & Science University Keystone Colorado 15 July 2011
New basal insulins Are they any better? Matthew C. Riddle, MD Professor of Medicine Oregon Health & Science University Keystone Colorado 15 July 2011 Presenter Disclosure I have received the following
More informationThis certificate-level program is non-sponsored.
Program Name: Diabetes Education : A Comprehensive Review Module 5 Intensive Insulin Therapy Planning Committee: Michael Boivin, B. Pharm. Johanne Fortier, BSc.Sc, BPh.LPh, CDE Carlene Oleksyn, B.S.P.
More informationIn-hospital management of diabetes
Dr. Tom Elliott MBBS, FRCPC Medical Director 400-210 W Broadway phone: 604.683.3734 Vancouver, BC fax: 604.628.3821 V5Y 3W2 Canada email: moa@bcdiabetes.ca In-hospital management of diabetes General Management
More informationUKPDS: Over Time, Need for Exogenous Insulin Increases
UKPDS: Over Time, Need for Exogenous Insulin Increases Patients Requiring Additional Insulin (%) 60 40 20 Oral agents By 6 Chlorpropamide years, Glyburide more than 50% of UKPDS patients required insulin
More informationI. General Considerations
1 2 3 I. General Considerations A. Type I ( Juvenile Onset or IDDM) IDDM results from autoimmune destruction of beta cells inability to secrete insulin --> ketone formation --> DKA 4 Diabetic Ketoacidosis
More informationPoll Question 2. Special Boot Camp Workshop Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services.
Special Boot Camp Workshop Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Poll Question 1 Mary takes 6 units lispro (Humalog) before dinner. Which BG result reflects
More informationPast, Present and Future of Diabetes
Past, Present and Future of Diabetes Dr Ketan Dhatariya Consultant in Diabetes Norfolk and Norwich University Hospital NHS Trust To Begin With, Some History διαβήτης to stand apart or a a siphon first
More informationThe York Diabetes Care Model
This Session The York Diabetes Care Model The annual review what s it for and how to do it How to make the diagnosis of diabetes and who to test Categorisation of diabetes at diagnosis Basics of Insulin
More informationBackground: Brief review of epidemiology, diagnosis, classification and pathophysiology of diabetes mellistus.
Insulin Therapy in Diabetes Mellitus Part 1 Lekshmi T. Nair, MD, MHS Assistant Professor Department of Internal Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio State University Wexner
More informationPediatric Diabetes Update Fran R. Cogen, MD, CDE Professor of Pediatrics Director, Diabetes Services
1.19.18 Pediatric Diabetes Update Fran R. Cogen, MD, CDE Professor of Pediatrics Director, Diabetes Services DISCLOSURES 1. No financial incentives 2. Volunteer Positions 1. National Certification Board
More informationDOWNLOAD OR READ : TYPE I JUVENILE DIABETES PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : TYPE I JUVENILE DIABETES PDF EBOOK EPUB MOBI Page 1 Page 2 type i juvenile diabetes type i juvenile diabetes pdf type i juvenile diabetes Diabetes means your blood glucose, or blood
More informationHistory of Investigation
Acini - Pancreatic juice (1º) (2º) Secretions- neuronal and hormonal mechanisms 1) Secretin - bicarbonate rich 2) Cholecystokinin - enzyme rich Islets of Langerhans (contain 4 cell types) Alpha cells (α)-
More informationLeslie K Scott PhD, PNP-BC, CDE University of Kentucky
Leslie K Scott PhD, PNP-BC, CDE University of Kentucky Review diabetes as it occurs in children Discuss the diagnosis of diabetes in children and the differentiation between type 1 and type 2 diabetes
More informationLearning Objectives. Perioperative SWEET Success
Perioperative SWEET Success PERIOPERATIVE SWEET SUCCESS PRESENTED BY: KENDRA MARTIN, RN, BSN, CDE JENNIFER SIMPSON, RN, BC-ADM, MSN, CNS Disclosure to Participants Notice of Requirements For Successful
More informationClinicalTrials.gov Identifier: sanofi-aventis. Sponsor/company:
These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription Sponsor/company: sanofi-aventis ClinicalTrials.gov
More informationPREDICTORS OF SUCCESS FOR ADULTS WITH TYPE 1 DIABETES ON CONTINUOUS SUBCUTANEOUS INSULIN INFUSION THERAPY: A RETROSPECTIVE REVIEW.
PREDICTORS OF SUCCESS FOR ADULTS WITH TYPE 1 DIABETES ON CONTINUOUS SUBCUTANEOUS INSULIN INFUSION THERAPY: A RETROSPECTIVE REVIEW A Thesis Presented in Partial Fulfillment of the Requirements for the Degree
More information24 Hour Support. Telephone Available 24 hours a day, 7 days a week
Contents Page What is SHAIRE? 1 What is basal-bolus regimen? 2 Why do I need a basal-bolus regimen? 3 How does basal insulin work? 3 How does rapid-acting insulin work? 4 How often should I test my Blood
More informationNew Drug Evaluation: Insulin degludec/aspart, subcutaneous injection
New Drug Evaluation: Insulin degludec/aspart, subcutaneous injection Date of Review: March 2016 End Date of Literature Search: November 11, 2015 Generic Name: Insulin degludec and insulin aspart Brand
More informationDrug Effectiveness Review Project Summary Report Long acting Insulins
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationInsulin analogues Das PP, Datta PG
The ORION Medical Journal 2007 Sep;28:497-500 Insulin analogues Das PP, Datta PG Introduction Diabetes mellitus is a very big challenge for our medical science. To overcome this problem we need newer generation
More informationObjectives. Recognize all available medical treatment options for diabetes. Individualize treatment and glycemic target based on patient factors
No disclosure Objectives Recognize all available medical treatment options for diabetes Individualize treatment and glycemic target based on patient factors Should be able to switch to more affordable
More informationINSULIN THERAY دکتر رحیم وکیلی استاد غدد ومتابولیسم کودکان دانشگاه علوم پزشکی مشهد
INSULIN THERAY DIABETES1 IN TYPE دکتر رحیم وکیلی استاد غدد ومتابولیسم کودکان دانشگاه علوم پزشکی مشهد Goals of management Manage symptoms Prevent acute and late complications Improve quality of life Avoid
More informationProviding Stability to an Unstable Disease
Basal Insulin Therapy Providing Stability to an Unstable Disease Thomas A. Hughes, M.D. Professor of Medicine - Retired Division of Endocrinology, Metabolism, and Diabetes University of Tennessee Health
More informationManagement of Diabetes New Concepts New Devices New Medications. Richard J. Comi, MD Professor of Medicine Geisel School of Medicine at Dartmouth
Management of Diabetes New Concepts New Devices New Medications Richard J. Comi, MD Professor of Medicine Geisel School of Medicine at Dartmouth Objectives: At the end of this lecture, the learner will
More informationInpatient Management of Diabetes Mellitus. Jessica Garza, Pharm.D. PGY-1 Pharmacotherapy Resident TTUHSC School of Pharmacy
Inpatient Management of Diabetes Mellitus Jessica Garza, Pharm.D. PGY-1 Pharmacotherapy Resident TTUHSC School of Pharmacy 2 Disclosure Jessica Garza does not have any actual or potential conflicts of
More informationDiabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical
Diabetes Technology Continuous Subcutaneous Insulin Infusion Therapy And Continuous Glucose Monitoring In Adults: An Endocrine Society Clinical Practice Guideline Task Force Members Anne Peters, MD (Chair)
More informationSafe use of insulin regular concentrated (500 units/ml) in severe insulin resistance
Safe use of insulin regular concentrated (500 units/ml) in severe insulin resistance Jodie S. Gee, Pharm.D., BCACP, CDE Clinical Pharmacy Specialist-Ambulatory Care Harris Health System Objectives To be
More informationDiabetes Mellitus in the Pediatric Patient
Diabetes Mellitus in the Pediatric Patient William Bryant, M.D. Chief of Section Pediatric Endocrinology Children s Hospital at Scott & White Texas A&M University Temple, Texas Disclosures None Definitions
More informationImportant Stuff. Basal Bolus What Adjustments? Pt weighs 80kg
Diabetes Boot Camp Class 4 Beverly Dyck Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Special Insulin and Pattern Management Diabetes Education Services 1998-2015. All rights
More informationCARBOHYDRATE METABOLISM Disorders
CARBOHYDRATE METABOLISM Disorders molecular formula C12H22O11 Major index which describes metabolism of carbohydrates, is a sugar level in blood. In healthy people it is 4,4-6,6 mmol/l (70-110 mg/dl)
More informationMANAGEMENT OF DIABETES IN PREGNANCY
MANAGEMENT OF DIABETES IN PREGNANCY Ministry of Health Malaysia Malaysian Endocrine & Metabolic Society Perinatal Society of Malaysia Family Medicine Specialists Association of Malaysia Academy of Medicine
More informationUpdate on Insulin-based Agents for T2D
Update on Insulin-based Agents for T2D Injectable Therapies for Type 2 Diabetes Mellitus (T2DM) and Obesity This presentation will: Describe established and newly available insulin therapies for treatment
More informationDiabetes in Pregnancy
Diabetes in Pregnancy Susan Drummond RN MSN C-EFM Objectives 1. Describe types of diabetes and diagnosis of gestational diabetes 2. Identify a management plan for diabetes during pregnancy 3. Describe
More informationInsulin Prior Authorization Criteria For Individuals Who Purchased BlueCare/KS Solutions/EPO Products
Insulin Prior Authorization Criteria For Individuals Who Purchased BlueCare/KS Solutions/EPO Products FDA LABELED INDICATIONS 1-13,16-21 Rapid-Acting Indication Onset Peak Duration Insulins Admelog (insulin
More informationInsulin Prior Authorization Criteria For Individuals who Purchased BlueCare / KS Solutions products
Insulin Prior Authorization Criteria For Individuals who Purchased BlueCare / KS Solutions products FDA LABELED INDICATIONS 1-13,16-20 Rapid-Acting Indication Onset Peak Duration Insulins Fiasp (insulin
More informationBasal-Bolus Insulin Therapy. Veronica Brady, PhD, FNP-BC, BC-ADM, CDE ECHO January
Basal-Bolus Insulin Therapy Veronica Brady, PhD, FNP-BC, BC-ADM, CDE ECHO January 18 2018 Terminology No longer using the term diabetic. Diabetes does not define people. People with diabetes are individuals
More informationSpecial Situations 1
Special Situations 1 Outline Continuous Nutrition Tube feeds TPN Steroids Pumps Perioperative BG Control 2 Patient receiving continuous TF or TPN Continuous nutrition coverage options: Analog q4hr Regular
More informationEffective Health Care Program
Comparative Effectiveness Review Number 57 Effective Health Care Program Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness Executive Summary Background Diabetes mellitus is
More informationThese Aren t Your Average Rookies: A Primer on New and Emerging Insulins. Alissa R. Segal, Pharm.D, CDE, CDTC, FCCP
These Aren t Your Average Rookies: A Primer on New and Emerging Insulins Alissa R. Segal, Pharm.D, CDE, CDTC, FCCP Disclosures Eli Lilly & Company: Advisory board member Boehringer Ingelheim: Advisory
More information4/16/2018. Flexible Intensive Insulin Therapy (FIIT) in People with Type 2 Diabetes: A Viable Option. Disclosures. Outline. No financial disclosures
Flexible Intensive Insulin Therapy (FIIT) in People with Type Diabetes: A Viable Option Kim Bisanz, MFCS, RDN, LDN, CDE Minnesota Academy of Nutrition & Dietetics Annual Meeting April 19, 18 18 MFMER slide-1
More informationAdjusting Insulin Doses
Adjusting Insulin Doses Everyone with diabetes, including you, will need to adjust your insulin doses at some time. There are several reasons why a person may need an insulin adjustment. These reasons
More informationInjecting Insulin into Out Patient Practice
Injecting Insulin into Out Patient Practice Kathleen Colleran, MD Associate Professor UNMHSC 4/22/10 Overview Natural history of Type 2 diabetes Reasons clinicians are reluctant to start insulin therapy
More informationDisclosures. The Endocrine System. Objectives. Diabetes. The Endocrine System 4/5/17. Common Medications in Pediatric Endocrinology
Disclosures Common Medications in Pediatric Endocrinology I have nothing to disclose Carrie A. Tolman, CPNP Nationwide Children s Hospital Objectives The Endocrine System Review common endocrine disorders
More informationMeghan Ames Mrs. Matuszak KNH 406 March 18, 2010 Diabetes Case Study #4 Understanding the Disease and Pathophysiology 1) Define insulin. Describe its major functions within normal metabolism. Insulin is
More informationType 1 Diabetes Update Robin Goland, MD
Naomi Berrie Diabetes Center Type 1 Diabetes Update 2008 Robin Goland, MD Type 1 diabetes is: A manageable condition A chronic condition Often challenging Entirely compatible with a happy and healthy childhood
More informationSelf-Monitoring Blood Glucose (SMBG) Frequency & Pattern Tool
Self-Monitoring Blood Glucose () Pattern Recommendation: Basal Insulin Only (To Target) NPH or long-acting analogue, typically given at. at least as often as is being given. Optional, less frequent can
More informationComplete this CE activity online at ProCE.com/InsulinPart2
Complete this CE activity online at ProCE.com/InsulinPart2 Case 1: A 67 year old male with T2DM History and Presentation John is a 67 year old retiree who has been visiting your pharmacy/clinic for over
More informationModule 5. Understanding Insulin Therapy
Module 5. Understanding Insulin Therapy EDUCATIONAL OBJECTIVES Upon completion of this activity, participants will be better able to: 1. Define the basic physiologic concept of basal-bolus insulin; 2.
More information9.3 Stress Response and Blood Sugar
9.3 Stress Response and Blood Sugar Regulate Stress Response Regulate Blood Sugar Stress Response Involves hormone pathways that regulate metabolism, heart, rate and breathing The Adrenal Glands a pair
More informationComprehensive Diabetes Treatment
Comprehensive Diabetes Treatment Joshua L. Cohen, M.D., F.A.C.P. Professor of Medicine Interim Director, Division of Endocrinology & Metabolism The George Washington University School of Medicine Diabetes
More informationPerioperative Management of the Patient with Endocrine Disease: A Focus on Diabetes & Thyroid Dysfunction
Perioperative Management of the Patient with Endocrine Disease: A Focus on Diabetes & Thyroid Dysfunction Luigi Meneghini, MD, MBA Professor, Internal Medicine (Endocrinology), UT Southwestern Medical
More informationComparative Effectiveness, Safety, and Indications of Insulin Analogues in Premixed Formulations for Adults With Type 2 Diabetes Executive Summary
Number 14 Effective Health Care Comparative Effectiveness, Safety, and Indications of Insulin Analogues in Premixed Formulations for Adults With Type 2 Diabetes Executive Summary Background and Key Questions
More informationThe New Age of Insulin: Exploring the Latest Trends in Insulin Therapy. The New Age of Insulin: Exploring the Latest Trends in Insulin Therapy
The New Age of Insulin: Exploring the Latest Trends in Insulin Therapy Susan Cornell, PharmD, CDE, FAPhA, FAADE Associate Director of Experiential Education Associate Professor of Pharmacy Practice Midwestern
More informationWhat s New in Type 1 and Type 2 Diabetes? Updates from 2013 CDA CPGs and Advancements in Insulin Therapy
What s New in Type 1 and Type 2 Diabetes? Updates from 2013 CDA CPGs and Advancements in Insulin Therapy 2013 Rocky Mountain/ACP Internal Medicine Conference November 15, 2013 David C.W. Lau, MD, PhD,
More informationBasal Insulin Drug Class Prior Authorization Protocol
Basal Insulin Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review of medical
More informationInpatient Glycemic Management:
Disclosure to Participants Conflict of Interest (COI) and Financial Relationship Disclosures: Dr. Seley attended Advisory Board Meeting: Alliance (Boehringer-Ingelheim/Lilly) Bayer Diabetes Care Sanofi
More informationBeyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM
Beyond Basal Insulin: Intensification of Therapy Jennifer D Souza, PharmD, CDE, BC-ADM Disclosures Jennifer D Souza has no conflicts of interest to disclose. 2 When Basal Insulin Is Not Enough Learning
More informationDiabetes Mellitus in Small Animals
Diabetes Mellitus in Small Animals Julie A Stephens, DVM, DACVIM Veterinary Emergency And Specialty Center of New Mexico Albuquerque, New Mexico Diabetes Mellitus Persistent hyperglycemia caused by a relative
More information