Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-81

 Each unit contains 1 unit of insulin glargine and 0.33 mcg lixisenatide (fixed ratio).

• Administration: Given within one hour before the first meal of the day. • Titrate: 2-4 units every week on the basis of FPG. o +2 units (2 units of insulin glargine and 0.66 mcg of lixisenatide) o +4 units (4 units insulin glargine and 1.32 mcg lixisenatide) • Maximum Total Daily dose : 60 units insulin glargine U ‐ 100/20 mcg lixisenatide Concentrated insulins Insulin dose requirements often increase with weight gain for both people with type 1 and type 2 diabetes. In type 2 diabetes, insulin resistance coupled with declining beta cell function and obesity often results in the need for large total doses of insulin >2.0 units/kg to achieve glycemic targets (200). As the insulin dose increases, the volume of insulin injected under the subcutaneous tissue increases which can alter insulin absorption, cause pain/discomfort with injections, and insulin leakage. Concentrated insulins are providing more options for people taking insulin and have been shown to improve insulin absorption, glucose control and minimize the need for multiple injections when taking large doses at one time (>60-80 units). Currently available concentrated insulins are two- to five-fold the concentration of U-100 insulin: • Degludec U-200, Lispro ® U-200 Insulin Regular Humulin R U-500 (Entuzity™) (201) Entuzity™ is concentrated short-acting human insulin that has five times the concentration of U- 100 insulin. Entuzity™ is indicated to improve glycemic control in people with diabetes mellitus requiring more than 200 units of insulin per day. Given a long duration of action (onset 15 minutes, peak 4-8h, duration 17-24h), Insulin Regular ® U-500 provides both bolus and basal insulin coverage (202). • Entuzity™ should not be used with other insulins and should only be given with a subcutaneous pen injection. It should not be given intravenously or intramuscularly. • Small studies in people with obesity and type 2 diabetes comparing Insulin Regular ® U-500 with alternate insulin therapies, basal-bolus regimen, and use in insulin pump therapy demonstrated the following (200). Compared with other insulin regimens, treatment with Humulin R U-500 resulted in an A1C reduction 1.2% to 1.6%, with mean weight gain ranging • Glargine U-300 • Regular U-500

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