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ToolsWisconsin Diabetes Mellitus Essential Care Guidelines • 2012
40
DIA
BET
ES M
ELLI
TUS
MED
ICAT
ION
S 20
12O
RA
L G
LUC
OSE
-LO
WER
ING
AG
ENTS
RX
Avai
l. D
osag
eIn
itial
Dos
eIn
itial
Dos
e (e
lder
ly)
Dos
e A
djus
tmen
t S
ched
ule
Usu
al
Mai
nt.
Dos
age
Max
. E
ffect
tive
Dos
e
A1C
Lo
wer
ing
Wt
Ren
al
Dos
ing
Hep
atic
D
osin
gLa
b M
onito
ring
Com
mon
Sid
e E
ffect
sC
ontra
indi
catio
ns/ P
reca
utio
ns
Dru
g C
lass
: Sul
fony
urea
sA
ctio
ns: S
timul
ates
insu
lin s
ecre
tion;
low
ers
fast
ing
plas
ma
gluc
ose
Indi
catio
ns: T
ype
2 di
abet
es a
s m
onot
hera
py o
r in
com
bina
tion
with
insu
lin, m
etfo
rmin
, DP
P-IV
inhi
bito
rs, i
ncre
tin m
imet
ics,
or T
ZDs
Glip
izid
e5
mg
10 m
g5
mg
2.5
mg/
day
Incr
ease
by
2.5
to 5
mg
(> 1
5 m
g/da
y =
BID
) af
ter 1
-2 w
ks
5-15
mg/
day
20 m
g/da
y
1.0-
2%+
N/A
Sta
rt at
2.
5 m
g/da
y
N/A
• hyp
ogly
cem
ia
• wei
ght g
ain
• Use
cau
tion
in p
eopl
e w
ith s
ulfa
al
lerg
ies
• Use
gly
burid
e w
ith c
autio
n du
e to
gr
eate
r ris
k of
hyp
ogly
cem
ia• U
se c
autio
n w
ith re
nal o
r hep
atic
in
suffi
cien
cy (g
lipiz
ide
or g
limep
iride
pr
efer
red
choi
ces)
• Im
med
iate
rele
ase
and
exte
nded
re
leas
e gl
ipiz
ide
dose
s ar
e no
t eq
uivi
vale
nt
Glip
izid
e E
R2.
5 m
g5
mg
10 m
g 5
mg/
day
Incr
ease
by
5 m
g af
ter 1
-2
wks
5-10
mg/
day
20 m
g/da
y
Glim
epiri
de1
mg
2 m
g 4
mg
1-2
mg
1 m
gIn
crea
se b
y 1
-2
mg
afte
r 1-2
w
ks
1-4
mg/
day
8 m
g/da
y
Sta
rt at
1
mg/
day
and
mon
itor
Mild
--st
art
at 1
mg
(mon
itor)
S
ever
e--
avoi
d
Gly
burid
e1.
25 m
g 2.
5 m
g 5
mg
2.5-
5 m
g1.
25 m
g/da
y
Incr
ease
by
2.5-
5 m
g af
ter
1-2
wks
1.25
-10
mg/
day
10 m
g/da
y
Do
NO
T us
e if
CrC
l < 5
0 m
l/min
Con
ser-
vativ
e 1.
25 m
g/da
y
Dru
g C
lass
: Big
uani
des
Act
ions
: Tar
gets
hep
atic
cel
ls; d
ecre
ases
hep
atic
glu
cose
pro
duct
ion;
doe
s no
t stim
ulat
e in
sulin
sec
retio
n; lo
wer
s fa
stin
g pl
asm
a gl
ucos
eIn
dica
tions
: Typ
e 2
diab
etes
as
mon
othe
rapy
or i
n co
mbi
natio
n w
ith a
ny o
ther
age
nt o
r ins
ulin
; ove
rwei
ght;
dysl
ipid
emic
; chi
ldre
n (a
ppro
ved
for ≥
age
10)
Met
form
in50
0 m
g85
0 m
g10
00 m
g50
0 m
g B
ID
Use
with
ca
utio
n,
espe
cial
ly if
>
80 y
ears
Incr
ease
by
500
mg
afte
r 1-2
w
ks
1000
-200
0 m
g/da
y
2550
mg/
day
(10-
16 y
o =
2000
mg/
day)
1.0-
2%0/
-
Con
train
-di
cate
d if
SC
r ≥
1.5
mal
es,
≥ 1.
4 fe
mal
es
or e
GFR
<
50
Avoi
d du
e to
risk
of
lact
ic
acid
osis
BUN, Cr & CBC: prior to initiation then yearly.LFTs: prior to initiation.Vitamin B12 levels: every year for those at high risk of Vitamin. B12 deficiency
• dia
rrhe
a• n
ause
a• a
bdom
inal
bl
oatin
g• a
nore
xia
• Do
not u
se w
ith h
epat
ic in
suf-
ficie
ncy
• Con
sult
with
dia
bete
s sp
ecia
list
is re
com
men
ded
for S
Cr >
1.5
or
eGFR
< 5
0• U
ncom
pens
ated
CH
F• E
xces
sive
alc
ohol
inta
ke• O
ver a
ge 8
0 (c
autio
n)• A
ceta
zola
mid
e• W
ithho
ld th
erap
y fo
r 48
hour
s af
ter
iodi
nate
d co
ntra
st m
edia
is u
sed
• May
cau
se o
vula
tion
to re
sum
e in
an
ovul
ator
y, p
rem
enop
ausa
l wom
en
Met
form
in
ER
500
mg
750
mg
500
mg
500-
2000
m
g/da
y20
00 m
g/da
y
Dru
g C
lass
: TZD
(Thi
azol
idin
edio
nes)
Act
ions
: Reg
ulat
es in
sulin
resp
onsi
ve g
enes
nec
essa
ry fo
r glu
cose
and
lipi
d m
etab
olis
m; i
mpr
oves
sen
sitiv
ity to
insu
lin in
ske
leta
l and
adi
pose
tiss
ueIn
dica
tions
: Typ
e 2
diab
etes
as
mon
othe
rapy
or i
n co
mbi
natio
n w
ith a
ny o
ther
age
nts;
Act
os is
als
o ap
prov
ed fo
r use
with
insu
linN
ote:
Ros
iglit
azon
e is
not
list
ed o
n th
is c
hart
due
to re
stric
ted
use
by F
DA
. For
mor
e in
form
atio
n, s
ee: h
ttp://
ww
w.fd
a.go
v/D
rugs
/Dru
gSaf
ety/
Pos
tmar
ketD
rugS
afet
yInf
orm
atio
nfor
Pat
ient
sand
Pro
vide
rs/u
cm22
6976
.htm
piog
litaz
one
(Act
os)
15 m
g30
mg
45 m
g15
-30
mg
Sam
eIn
crea
se b
y 15
mg
6-12
wks
15-4
5 m
g/da
y
45 m
g/da
y (3
0 m
g if
on
insu
lin)
1-1.
5%+
N/A
Do
NO
T us
e if
ALT
>
2.5X
U
LN
LFTs: prior to initiation then periodically
• wei
ght g
ain,
ed
ema
• hea
rt fa
ilure
sy
mpt
oms,
m
acul
ar e
dem
a• i
ncre
ased
fra
ctur
e ra
te• i
ncre
ase
risk
of
blad
der c
ance
r
• CH
F III
& IV
or a
ny s
ympt
omat
ic
hear
t fai
lure
• Clin
ical
evi
denc
e of
live
r dis
ease
or
ALT
> 2
.5 U
LN• D
o no
t use
rosi
glita
zone
in c
ombi
na-
tion
with
insu
lin o
r nitr
ates
(may
in
crea
se ri
sk o
f MI)
• Use
cau
tion
in fe
mal
es a
t hig
h ris
k fo
r fra
ctur
es• M
onito
r for
incr
ease
ede
ma
• May
cau
se o
vula
tion
to re
sum
e in
an
ovul
ator
y, p
rem
enop
ausa
l wom
en
ToolsWisconsin Diabetes Mellitus Essential Care Guidelines • 2012
41
DIA
BET
ES M
ELLI
TUS
MED
ICAT
ION
S 20
12O
RA
L G
LUC
OSE
-LO
WER
ING
AG
ENTS
RX
Avai
l. D
osag
eIn
itial
Dos
eIn
itial
Dos
e (e
lder
ly)
Dos
e A
djus
tmen
t S
ched
ule
Usu
al
Mai
nt.
Dos
age
Max
. E
ffect
tive
Dos
e
A1C
Lo
wer
ing
Wt
Ren
al
Dos
ing
Hep
atic
D
osin
gLa
b M
onito
ring
Com
mon
Sid
e E
ffect
sC
ontra
indi
catio
ns/ P
reca
utio
ns
Dru
g C
lass
: Meg
litin
ides
Act
ions
: Aug
men
ts g
luco
se in
duce
d in
sulin
out
put;
mor
e ra
pid
onse
t of e
ffect
and
sho
rter d
urat
ion
of a
ctio
n th
an s
ulfo
nylu
reas
Indi
catio
ns: T
ype
2 di
abet
es a
s m
onot
hera
py o
r in
com
bina
tion
with
oth
er o
ral a
gent
s; p
eopl
e w
ith s
ulfa
alle
rgie
s; h
ypog
lyce
mia
on
low
dos
es o
f sul
fony
lure
as
repa
glin
ide
(Pra
ndin
)
0.5
mg
1 m
g2
mg
A1C
< 8
%:
0.5
mg
w/
each
mea
lA
1c>8
:1-2
m
g w
/eac
h m
eal
Sam
e(c
autio
n if
Ren
al D
z)
Dou
ble
afte
r 1-2
w
ks
0.5-
4 m
g be
fore
m
eals
16 m
g/da
y1-
1.5%
+/-
CrC
l < 4
0 m
l/min
, st
art a
t 0.
5 m
gU
se
Cau
tion
N/A
• hyp
ogly
cem
ia• w
eigh
t gai
n
• nat
eglin
ide:
act
ive
met
abol
ites,
rena
l ex
cret
ion
• rep
aglin
ide:
no
activ
e m
etab
olite
s,
min
imal
rena
l exc
retio
n, m
ore
effe
ctiv
e th
an n
ateg
linid
e in
clin
ical
tri
als
nate
glin
ide
(Sta
rlix)
60 m
g12
0 m
g
60-1
20
mg
befo
re
mea
ls
Sam
e (c
autio
n if
Live
r Dz)
Incr
ease
by
60m
g at
eac
h m
eal a
fter 1
-2
wks
60-1
20
mg
befo
re
mea
ls12
0 m
g TI
D0.
5-1%
N/A
Dru
g C
lass
: Alp
ha-g
luco
sida
se In
hibi
tors
Act
ions
: Slo
ws
abso
rptio
n of
car
bohy
drat
es; r
educ
es p
ost-p
rand
ial b
lood
glu
cose
Indi
catio
ns: T
ype
2 di
abet
es a
s m
onot
hera
py o
r in
com
bina
tion
with
sul
fony
lure
a,m
etfo
rmin
or i
nsul
in; p
ost-p
rand
ial h
yper
glyc
emia
acar
bose
(P
reco
se)
25 m
g50
mg
100
mg
25 m
g TI
D
with
mea
lsS
ame
Dou
ble
curr
ent
dosi
ng re
gim
en
afte
r 4-8
wks
25-1
00 m
g TI
D w
ith
mea
ls
Wt.
< 60
kg
= 5
0 m
g TI
D W
t. >
60 k
g =
100
mg
TID
0.5-
1%0
Trea
t-m
ent n
ot
reco
m-
men
ded
if S
Cr >
2
N/A
Ser
um
Tran
sam
inas
es
q 3
mo.
X 1
ye
ar
• fla
tule
nce
• dia
rrhe
a• a
bdom
inal
pai
n (le
ss s
ever
e if
titra
ted
slow
ly)
• The
mec
hani
sm o
f act
ion
show
s th
e co
rrec
tion
of h
ypog
lyce
mia
so
treat
hy
pogl
ycem
ia w
ith g
luco
se ta
blet
s• C
hron
ic in
test
inal
dis
ease
• Ren
al d
ysfu
nctio
n • (
crea
tinin
e >
2.0)
(Gly
set)
• Cirr
hosi
s (P
reco
se)
mig
litol
(G
lyse
t)
50-1
00 m
g TI
D w
ith
mea
ls10
0 m
g TI
DN
/A
Dru
g C
lass
: Dip
eptid
yl P
eptid
ase
4 In
hibi
tors
(DP
P-IV
)A
ctio
ns: I
ncre
ases
insu
lin re
leas
e an
d de
crea
ses
gluc
agon
leve
ls in
the
circ
ulat
ion
in a
glu
cose
-dep
ende
nt m
anne
rIn
dica
tions
: Typ
e 2
diab
etes
as
mon
othe
rapy
or i
n co
mbi
natio
n w
ith s
ulfo
nylu
reas
, met
form
in, o
r TZD
s
sita
glip
tin
(Jan
uvia
)
25 m
g50
mg
100
mg
100
mg
daily
Sam
eIf
mak
ing
adju
stm
ents
, w
ait 4
-6 w
ks
100
mg
daily
100
mg
daily
0.6-
0.8%
0/-
CrC
l 30
-50
ml/
min
: 50
mg
daily
C
rCl <
30
ml/m
in:
25 m
g da
ily
N/A
BU
N, C
r prio
r to
initi
atio
n th
en
year
ly• h
eada
che,
nas
o-• p
hary
ngiti
s,
uppe
r res
pira
tory
tra
ct in
fect
ion
• rar
ely
seve
re
alle
rgic
reac
tions
• If
usin
g in
com
bina
tion
with
so
lfonu
ylur
ea a
nd m
etgl
itini
de, m
ay
need
low
er d
ose
of s
ulfo
nylu
rea
to
prev
ent h
ypog
lyce
mia
• At t
he re
duce
d do
ses
sugg
este
d fo
r sta
ge 4
or w
orse
CK
D, t
he
med
icat
ions
may
be in
effe
ctiv
e; u
se
with
ext
rem
e ca
utio
n, if
at a
ll in
S
tage
5 C
KD
.vsa
xagl
iptin
(O
ngly
za)
2.5
mg
5 m
g
2.5
or 5
m
g da
ily
(2.5
mg
for r
enal
im
pairm
ent
of if
giv
en
with
a
CY
P3A
4/5
Inhi
bito
r)
Sam
eN
/A5
mg
daily
5 m
g da
ily0.
5-0.
8%0
CrC
l < 5
0 m
l/min
: 2.
5 m
g da
ily
N/A
BU
N, C
r prio
r to
initi
atio
n an
d th
en y
early
linag
liptin
(T
radj
enta
)5
mg
5 m
g da
ily
with
or
with
out
food
Sam
eN
/A5
mg
daily
5 m
g da
ily0.
4%
mon
o-th
erap
y0
No
ad-
just
men
t ne
eded
N/A
N/A
• nas
opha
ryng
itis
5.8%
, m
onot
hera
py
(pla
cebo
5.5
%-
not s
tatis
tical
ly
sign
ifica
nt)
• If u
sed
with
sul
fony
lure
a or
m
etgl
itini
de, c
onsi
der l
ower
ing
dose
to
pre
vent
hyp
ogly
cem
ia• S
trong
P-g
lyco
prot
ein/
CY
P 3A
4 in
duce
r
v B
ased
on
expe
rt op
inio
n.
ToolsWisconsin Diabetes Mellitus Essential Care Guidelines • 2012
42
DIA
BET
ES M
ELLI
TUS
MED
ICAT
ION
S 20
12IN
JEC
TAB
LE N
ON
-INSU
LIN
GLU
CO
SE-L
OW
ERIN
G A
GEN
TSR
XAv
ail.
Dos
age
Initi
al D
ose
Dos
e A
djus
tmen
t S
ched
ule
Max
. D
ose
Mea
l Tim
ing
A1C
Lo
wer
ing
Wt
Ren
al
Dos
ing
Hep
atic
D
osin
gLa
b M
onito
ring
Sta
bilit
yC
omm
on
Sid
e E
ffect
sC
ontra
indi
catio
ns/
Pre
caut
ions
Dru
g C
lass
: GLP
-1 a
goni
stA
ctio
ns: s
timul
ates
the
panc
reas
to in
crea
se in
sulin
pro
duct
ion
and
supp
ress
glu
cago
n se
cret
ion.
S
econ
dary
act
ions
incl
ude
inhi
bitio
n of
gas
tric
empt
ying
and
redu
ctio
n of
app
etite
and
food
inta
ke.
Indi
catio
ns: T
ype
2 di
abet
es a
s m
onot
hera
py o
r in
com
bina
tion
with
sul
fony
lure
as, m
etfo
rmin
, or T
ZDs.
Se
e in
divi
dual
dru
g in
sert
reco
mm
enda
tions
for w
hen
it is
app
ropr
iate
to u
se w
ith a
spe
cific
type
of b
asal
insu
lin in
adu
lts w
ith ty
pe 2
dia
bete
s. N
ot a
ppro
ved
for u
se w
ith ty
pe 1
dia
bete
s.
exen
atid
e (B
yetta
)
5 m
cg p
er
dose
, 60
dose
s, 1
.2
mL
prefi
lled
pen
10 m
cg
per d
ose,
60
dose
s, 2
.4
mL
prefi
lled
pen
Type
2 D
M:
5 m
cg B
ID a
t any
tim
e w
ithin
the
60-m
inut
e pe
riod
befo
re th
e 2
mai
n m
eals
of t
he d
ay,
appr
oxim
atel
y 6
hour
s or
mor
e ap
art
Type
2 D
M:
May
be
incr
ease
d to
10
mcg
BID
af
ter o
ne m
onth
of
ther
apy
10 m
cg
twic
e a
day
With
in 6
0 m
inut
e pe
riod
befo
re
mor
ning
an
d ev
enin
g m
eals
1%-
Do
not u
se
if C
rCl <
30
ml/m
inN
/A
Mon
itor
INR
for
patie
nts
on
war
farin
Sto
re u
nuse
d pe
n in
re
frige
rato
r.A
fter f
irst u
se,
may
be
kept
at
room
tem
p
(up
to 7
7° F
) for
up
to 3
0 da
ys.
• nau
sea
• oth
er G
I di
stur
banc
e
• Sev
ere
gast
ro-e
soph
agea
l re
flux
diso
rder
(GE
RD
)• G
astro
pare
sis
• Pan
crea
titis
exen
atid
e ex
tend
ed-
rele
ase
(Byd
ureo
n)
2 m
g si
ngle
do
se tr
ays
2 m
g ev
ery
7 da
ysN
one
2 m
g/
wee
kIn
depe
nden
t of
mea
ls1.
60%
-
Do
not u
se
if C
rCl <
30
ml/m
in U
se
with
cau
tion
if 30
- 50
C
rCl
N/A
Mon
itor
INR
for
patie
nts
on
war
farin
Adm
inis
tor
imm
edia
tely
af
ter
susp
ensi
on
• nau
sea,
ot
her G
I di
stur
banc
e • I
njec
tion
site
nod
ules
• Avo
id u
se in
peo
ple
with
risk
for p
ancr
eatit
is,
prev
ious
pan
crea
titis
an
d or
ver
y el
evat
ed
trigl
ycer
ides
• Avo
id in
peo
ple
with
risk
fo
r pan
crea
titis
• Sev
ere
gast
ro-e
soph
agea
l re
flux
diso
rder
(GE
RD
)• G
astro
pare
sis
• Pan
crea
titis
• See
Bla
ck B
ox W
arni
ng:
Thyr
oid
C-C
ell T
umor
s,
Med
ulla
ry T
hyro
id
Car
cino
ma
(MTC
) and
M
ultip
le E
ndoc
rine
Neo
plas
ia S
yndr
ome
Type
2-
(ME
N 2
)
lirag
lutid
e (V
icto
za)
0.6
mg/
mL
3 m
L pr
efill
ed
syrin
ges
Type
2 D
M:
0.6
mg
subc
uta-
neou
sly
once
a
day
for 1
wee
k¥
Type
2 D
M:
Titra
te to
1.2
mg
afte
r 1 w
eek
then
m
ay in
crea
se to
1.
8 m
g if
1.2
mg
reve
als
no s
igni
fi-ca
nt c
hang
es
1.8
mg
one
time
daily
Inde
pend
ent
of m
eals
1-1.
5%-
No
dosa
ge
adju
stm
ent
nece
ssar
y.
Cau
tion
w/ r
enal
im
pairm
ent
N/A
No
dosa
ge
adju
stm
ent
nece
ssar
y,
caut
ion
w/
hepa
tic
impa
irmen
t
N/A
Sto
re u
nuse
d pe
n in
re
frige
rato
r. A
fter f
irst u
se
can
be k
ept i
n re
frige
rato
r or
room
tem
p
(up
to 8
6° F
) for
up
to 3
0 da
ys.
Kee
p pe
n ca
p on
.
• nau
sea
• oth
er G
I di
stur
banc
e
Dru
g C
lass
: Am
ylin
ana
logu
eA
ctio
ns: s
low
s ga
stric
em
ptyi
ng, d
ecre
ases
glu
cago
n se
cret
ion,
cen
trally
mod
ulat
es a
ppet
iteIn
dica
tions
: Typ
e 1
& 2
dia
bete
s as
adj
unct
trea
tmen
t to
thos
e w
ho u
se m
eal-t
ime
insu
lin a
nd fa
il to
ach
ieve
pos
tpra
ndia
l glu
cose
con
trol
Not
e: A
spe
cial
ist s
houl
d pr
escr
ibe
Sym
lin d
ue to
the
com
plex
ity o
f dos
ing
guid
elin
es.
pram
lintid
e (S
ymlin
)
0.6
mg/
mL
5 m
L vi
als
1 m
g/m
L pr
efill
ed p
ens
Type
1 D
M:
15 m
cg
imm
edia
tely
prio
r to
maj
or m
eals
Ty
pe 2
DM
: 60
mcg
im
med
iate
ly p
rior
to m
ajor
mea
ls z
Type
1 D
M:
Titra
te a
t 15
mcg
in
crem
ents
to
a m
aint
enan
ce
dose
of 3
0 or
60
mcg
, as
tole
rate
dTy
pe 2
DM
:In
crea
se to
a
dose
of 1
20 m
cg
as to
lera
ted v
120
mcg
be
fore
m
ajor
m
eals
Imm
edia
tely
be
fore
mea
ls
cont
aini
ng
≥ 25
0 kc
al o
r ≥
30 g
ram
s of
car
bo-
hydr
ate
0.4
– 0.
6%0/
-N
/AN
/AN
/A
Dis
card
28
days
af
ter f
irst u
se.
Ope
n bo
ttles
m
ay b
e re
frige
rate
d or
ke
pt a
t roo
m
tem
p.
• nau
sea
• Avo
id c
ombi
natio
n w
ith
GLP
-1 a
goni
st• G
astro
pare
sis
¥ M
ay b
e gi
ven
at a
ny ti
me
of d
ay in
depe
nden
t of m
eals
z R
educ
e pr
epra
ndia
l, ra
pid-
actin
g or
sho
rt-ac
ting,
insu
lin d
osag
es, i
nclu
ding
fixe
d-m
ix in
sulin
s by
50%
v D
ose
titra
tions
sho
uld
occu
r onl
y w
hen
no c
linic
ally
sig
nific
ant n
ause
a ha
s be
en s
een
for 3
day
s
ToolsWisconsin Diabetes Mellitus Essential Care Guidelines • 2012
43
INSU
LIN
¤ T
HER
APY
201
2 C
LAS
S
INS
ULI
N T
YP
E
BR
AN
D
FOR
MU
LATI
ON
S
ON
SE
T of
A
ctio
n P
EA
K
DU
RA
TIO
N o
f A
ctio
n B
AS
AL/
B
OLU
S
ME
AL
TIM
ING
A
PP
EA
RA
NC
E
Rap
id A
ctin
g
Lisp
ro
Hum
alog
<
Via
ls, c
artri
dges
, pe
ns
5-15
min
1-
2 ho
urs
2-4
hour
s
Bol
us
15 m
in b
efor
e or
imm
edia
tely
af
ter
Cle
ar
Asp
art
Nov
olog
V
ials
, car
tridg
es,
pens
2-
4 ho
urs
5-10
min
bef
ore
Glu
lisin
e A
pidr
a V
ials
, pen
2-
4 ho
urs
With
in 1
5 m
in b
efor
e or
with
in
20 m
in a
fter s
tarti
ng a
mea
l
Sho
rt A
ctin
g R
egul
ar
Hum
ulin
R<
V
ials
30
-60
min
2-
4 ho
urs
4-6
hour
s B
olus
30
min
bef
ore
mea
ls
Cle
ar
Nov
olin
R
Via
ls
Inte
rmed
iate
A
ctin
g
NP
H
Hum
ulin
N<
V
ials
, car
tridg
es
1-2
hour
s 4-
8 ho
urs
10- 2
0 ho
urs
Bas
al
With
in 1
5 m
in b
efor
e m
eals
w
hen
mix
ed w
ith ra
pid-
actin
g in
sulin
; 30
min
bef
ore
mea
ls
whe
n m
ixed
with
regu
lar i
nsul
in
Clo
udy
Nov
olin
N
Via
ls
Det
emir
Leve
mir
Via
ls, p
en
1-2
hour
s 6-
8 ho
urs
D
ose-
depe
nden
t #
B
asal
N
/A
Cle
ar
Long
Act
ing
Gla
rgin
e La
ntus
V
ials
, pen
s 1-
2 ho
ursH
Fl
atu
~2
4 ho
urs ⏏
Det
emir
Leve
mir
Via
ls, p
en
1-2
hour
s 6-
8 ho
urs
D
ose-
depe
nden
t #
B
asal
N
/A
Com
bina
tion
70 N
PH
/30
Reg
ular
H
umul
in 7
0/30
<
Via
ls, p
ens
30-6
0 m
in
10-1
6 ho
urs
A
ppro
xim
atel
y 30
min
bef
ore
mea
ls
Clo
udy
Nov
olin
70/
30
Via
ls
70 a
spar
t pro
tam
ine/
30
insu
lin a
spar
t N
ovol
og M
ix 7
0/30
V
ials
, car
tridg
es,
pens
10
-20
min
W
ithin
15
min
of m
eal
75 li
spro
pro
tam
ine/
25
lispr
o H
umal
og M
ix
75/2
5 V
ials
, pen
s Le
ss th
an
30 m
in
15
-18
hour
s
Hig
h S
treng
th
U-5
00 In
sulin
R
egul
ar
Hum
ulin
RU
-500⌘
V
ials
30
min
2-
4 ho
urs
6.5-
8 ho
urs
Bas
al/
Bol
us
Var
ies⌘
C
lear
¤ T
he ti
me
cour
se o
f act
ion
(ons
et o
f act
ion,
pea
k, d
urat
ion
of a
ctio
n) o
f any
insu
lin m
ay v
ary
in d
iffer
ent i
ndiv
idua
ls o
r at d
iffer
ent t
imes
in th
e sa
me
indi
vidu
al a
nd c
an s
omet
imes
be
depe
nden
t on
dose
. Tim
e pe
riods
indi
cate
d
sho
uld
be c
onsi
dere
d a
gene
ral g
uide
onl
y. T
ime
may
var
y ba
sed
on in
itial
and
sub
sequ
ent d
oses
. Con
sult
with
insu
lin p
acka
ge in
sert
for a
dditi
onal
info
rmat
ion.
⌘ U
-500
is a
hig
h-st
reng
th c
once
ntra
tion
of in
sulin
(5-fo
ld h
ighe
r con
cent
ratio
n th
an U
-100
insu
lin) a
nd ty
pica
lly u
sed
in p
eopl
e w
ith v
ery
high
insu
lin re
sist
ance
; con
sulta
tion
with
a d
iabe
tes
spec
ialis
t is
reco
mm
ende
d. S
ee S
ectio
n 4:
G
lyce
mic
Con
trol f
or m
ore
info
rmat
ion
rela
ted
to U
-500
use
and
pre
caut
ions
. u S
ome
peop
le m
ay h
ave
a pe
ak a
t 10-
14 h
ours
and
the
dura
tion
may
be
<24
hour
s.
# D
ose
resp
onse
stu
dies
indi
cate
an
appr
oxim
ate
dura
tion
of a
ctio
n of
6-1
2 ho
urs
for D
etem
ir do
se o
f <0.
4 un
its/k
g an
d du
ratio
n of
act
ion
of 2
0-24
hou
rs fo
r Det
emir
dose
of ≥
0.4
units
/kg.
H
A
4-5
hou
r ons
et o
f act
ion
with
initi
al d
osin
g m
ay o
ccur
bas
ed o
n ex
pert
opin
ion.
⏏
Som
e pe
ople
may
ben
efit
from
a B
ID d
ose
sche
dule
. <
Ava
ilabl
e in
Hum
ulin
®/R
eliO
n® in
sulin
man
ufac
ture
d fo
r Wal
mar
t by
Eli
Lilly
