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Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Glucagon-like Receptor Agonists01:24

Glucagon-like Receptor Agonists

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Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
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Insulin Formulations: Types and Delivery01:27

Insulin Formulations: Types and Delivery

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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into...
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Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
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Comparing Postprandial Glycemic Control Using Fiasp vs Insulin Aspart in Hospitalized Patients With Type 2 Diabetes.

Sara M Alexanian1, Michael C Cheney1, Nicole L Spartano1

  • 1Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|December 6, 2024
PubMed
Summary

Fiasp demonstrated noninferior postprandial glucose control compared to Novolog in hospitalized patients with type 2 diabetes. This ultrarapid insulin showed similar safety, with no increased hypoglycemia risk.

Keywords:
continuous glucose monitoringimproving postprandial blood glucoseinpatient managementinsulin administration

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Clinical Medicine

Background:

  • Hospitalized patients with hyperglycemia face increased risks.
  • Basal-bolus insulin therapy is standard for inpatient diabetes management.
  • Efficacy of ultrarapid vs. rapid-acting insulins in this setting is not well-established.

Purpose of the Study:

  • To assess the noninferiority in efficacy and safety of Fiasp versus aspart (Novolog).
  • To evaluate these insulins as part of basal-bolus regimens in noncritically ill type 2 diabetes patients.
  • To compare postprandial glucose control and hypoglycemia rates.

Main Methods:

  • Prospective, open-label, randomized trial with 137 non-critically ill diabetic patients.
  • Treatment involved glargine at bedtime and either Fiasp or Novolog for mealtime/correction doses.
  • Primary endpoint: time in glucose range 100-180 mg/dL postprandially; safety assessed via hypoglycemia monitoring.

Main Results:

  • Fiasp group achieved 45% time in target glucose range vs. 36% for Novolog group (P=.012), meeting noninferiority criteria.
  • Glycemic metrics were comparable between the Fiasp and Novolog groups.
  • No significant difference in time spent in hypoglycemic ranges was observed.

Conclusions:

  • Fiasp offers noninferior postprandial glucose control compared to Novolog in hospitalized type 2 diabetes patients.
  • The use of Fiasp did not increase the risk of hypoglycemia.
  • Fiasp is a viable option for basal-bolus insulin therapy in this patient population.