Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-86

o Short-acting insulin: 30 to 45 minutes before meals. • Basal insulins should be administered around the same time of day to maintain consistency in insulin action. • Intermediate or premixed insulins must be re-suspended prior to injecting by gently rolling 10 times then gently inverting (not shaking) the insulin 10 times (151). Failure to adequately re-suspend intermediate-acting insulins results in large variability in insulin absorption (203). Variables that can affect insulin action times Mixing insulin • Short-acting insulins can be mixed with intermediate-acting insulins with no effect on insulin action. • Rapid-acting insulin analogues (lispro/aspart/glulisine) bind rapidly with intermediate- acting insulins and must be injected within 15 minutes of mixing. • Glargine and detemir cannot be mixed with other insulins or solutions (166). Insulin dose • Larger doses of short-acting or intermediate-acting insulin result in a longer duration of action. For example, a dose of >20 units regular may last eight to 12 hours (38). • There is no effect on the duration of action with larger doses of rapid-acting insulin analogues (lispro/ aspart/glulisine) (161). • Duration of insulin action of the long-acting basal insulin analogues is directly proportional to the insulin dose. o Detemir at 0.24 IU/kg has a duration of action of 12.0 hours. o Detemir at 0.4 IU/kg has a duration of action of 19.9 ± 3.2 hours. o Glargine at 0.3 IU/kg has a duration of action of 20.5 ± 3.7 hours (166,176,180).