Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-39

o Switching to glargine U300

 From glargine U100 to U300

▪ Can be done unit-to-unit. ▪ May need approximately 10-18% higher dose to achieve glycemic control. It is important to inform the patient to expect an increase and that it reflects the nature of the insulin versus worsening glycemic control (84).  From once-daily basal insulin to once-daily glargine U300, can be done unit- to-unit.  From twice-daily basal insulin to once-daily glargine U300, reduce the total daily dose of basal insulin that is being discontinued by 20% (84). o Switching from glargine U300  To glargine U100 or other basal insulins ▪ Reduce their dose by 20% (84)  To glargine U100 ▪ There is an increased risk of hypoglycemia during the first week (84) albumin-bound). When insulin detemir leaves the circulation and reaches the interstitial fluid in target tissues, albumin binding will again take place. The contribution of this albumin binding to protraction is negligible, however, as insulin detemir has a much greater affinity for insulin receptors and buffers against variable absorption (4080). • It has an onset of 90 minutes (78). • The duration of action is dose dependent: o Approximately 12 hours at 0.2 units/kg and 20-24 hours at 0.4 units/kg (80). o Duration is: 16-24 hours, dose dependant (78). • Once or twice daily administration: o When given BID, a steady state occurs after two to three dose administrations (85). Detemir (Levemir) • Insulin detemir forms hexamer aggregates that slowly dissociate. Once absorbed into the circulation, monomeric detemir will bind to albumin in blood (about 98% is