Type 1 Diabetes - Dcpa.us

Patient Education• How should I use Symlin?• Symlin and insulin should not be mixed and must beadministered separately• Different syringes for Symlin & insulin should be used• Symlin is injected under the skin of the stomach area orthigh• Symlin should be injected at a site >2 inches away fromwhere insulin was injected• What are the possible side effects of Symlin?• Hypoglycemia*• Nausea• Decreased appetite, vomiting, stomach pain, dizziness,indigestion*Boxed warning: insulin-induced severe hypoglycemia in type 1 diabetesSymlin [package insert]. San Diego, CA; Amylin Pharmaceuticals, Inc; 2005.15304560120Patient EducationSymlin Dose in mcgSymlin Dosing ChartThis amount should be drawn in U-U100 Insulin Syringe (units)2 ½57 ½1020This table should be used to match the patient’s Symlin dose to insulin syringe units•When should I not use Symlin?• Blood sugar too low• Should not be used if a meal is skipped• Sick and cannot eat a usual meal•How should I store Symlin?• Unopened vials should be refrigerated• Opened vials can be refrigerated or kept at room temperature for up to 28 daysSymlin [package insert]. San Diego, CA; Amylin Pharmaceuticals, Inc; 2005.Insulin detemir (Levemir®)• Long-acting insulin analogue used as basal insulin, incombination with meal-related short- or rapid-actingactinginsulin in type 1 or type 2 diabetes• FDA approval September 2005• Advantages:• Time action profile is less variable and more predictable thanthat for NPH insulin• Lower risk of nocturnal hypoglycemia• No associated weight gain• Disadvantages:• Cannot be mixed with other insulin, necessitating additionalinjections• Cost comparable to insulin glargine: $75-$225$225Drug classMechanism ofactionFormulationDosage/RouteTmax/Duration ofactionHalf-lifelifeMetabolismSpecialPopulationsPharmacologyLong-acting human insulin analogueFacilitated uptake of glucose following binding of insulinto receptors on muscle and fat cellsSimultaneous inhibition of glucose output from the liver100 U/mL solution for injection in a pre-filled penSubcutaneous6 and 8 hours after administration24 hours5 and 7 hours depending on the doseDegradation of insulin detemir is similar to that ofhuman insulin; all metabolites formed are inactiveNo clinically relevant differences in the PK of insulindetemir between elderly & young subjectsLevemir [package insert]. Bagsvaerd, Denmark. Novo Nordisk.2005.Levemir [package insert]. Bagsvaerd, Denmark. Novo Nordisk.2005.ReferenceVagueet al.Home etal.Efficacy/Safety Clinical TrialsN,Diagnosis448,type 1408,type 1TreatmentInsulin detemir + aspartNPH + aspartInsulin detemir(morning & bedtime)+aspartBlood GlucoseHbA1c 7.60±0.09%HbA1c 7.64±0.10%HbA1c 7.78±0.07% FPG 160.92±6.666.66mg/dLWeightChange a-0.2 kg+0.7 kg+0.24 kgHypoglycemicEvents7522 (all severities) a923 (nocturnal) a4820 (all severities) a689 (nocturnal) a83% (anytime) a ,34% (nocturnal) aInsulin detemir vs. NPH in Type 1DM: Randomized Clinical TrialInsulin detemir (12 hapart)+ aspartNPH (morning &bedtime) + aspartHbA1c 7.75±0.07% FPG 175.5±6.66 mg/dLHbA1c 7.94±0.07% FPG 202.32±6.84 mg/dL+0.22 kg+0.86 kg84% (anytime) a ,44% (nocturnal) a84% (anytime) a ,50% (nocturnal) aRaslovaet al.395,type 2Insulin determir +aspartHbA1c 7.46% b+0.51kg65% (nocturnal) bNPH +InsulinHbA1c 7.52% b+1.13 kg70% (nocturnal) ba Statistically significant compared with control groupb Not statistically significantAnn Pharmacother. 39:502-7. 2005Home P, Bartley P, Russell-Jones D. et.al. Insulin detemir offers improved glycemic control compared with NPH insulin inpeople with type 1 diabetes. Diabetes Care 27:1081-1087, 2004.