1. Insulin Delivery Systems Atlanta Diabetes Associates
New Insulins
and
Insulin Delivery Systems
Bruce W. Bode, MD, FACE
Atlanta Diabetes Associates
Part 4

2. Novo Nordisk devices in diabetes care
First pen (NovoPen 1) launched in 1985
Committed to developing one new insulin administration system per year.

3. Lilly Insulin Pens

4. Prefilled Syringe with Flexible Dosing
Title
Subtitle
Prefilled Syringe with Flexible Dosing

5. NovoLog® FlexPen® 82% of DNEs Preferred FlexPen® ®
Title
Subtitle
82% of DNEs Preferred FlexPen®
Source: Diabetes Nurse Educators In-Depth Study—Reactions to FlexPen.

6. Starting MDI Starting insulin dose is based on weight
0.2 x wgt. in lbs. or 0.45 x wgt. in kg
Bolus dose (aspart/lispro) = 20% of starting dose at each meal
Basal dose (glargine/NPH) = 40% of starting dose at bedtime

7. Starting MDI in 180 lb person
Starting dose = 0.2 x wgt. in lbs.
0.2 x 180 lbs. = 36 units
Bolus dose = 20% of starting dose at each meal
20% of 36 units = 7 units ac (tid)
Basal dose = 40% of starting dose at bedtime
40% of 36 units = 14 units at HS

8. Estimating the Carbohydrate to Insulin Ratio (CIR)
Individually determined
CIR = (2.8 x wgt in lbs) / TDD
Anywhere from 5 to 25 g CHO is covered by 1 unit of insulin

9. Correction Bolus (Supplement)
Must determine how much glucose is lowered by 1 unit of short- or rapid-acting insulin
This number is known as the correction factor (CF)
Use the 1700 rule to estimate the CF
CF = 1700 divided by the total daily dose (TDD)
ex: if TDD = 36 units, then CF = 1700/36 = ~50
meaning 1 unit will lower the BG ~50 mg/dl

10. Correction Bolus Formula
Current BG - Ideal BG
Glucose Correction factor
Example:
Current BG: mg/dl
Ideal BG: mg/dl
Glucose Correction Factor: 50 mg/dl 50
=2.4u

11. Options to MDI
A Simpler Regimen
Insulin Pump
Premixed BID (DM 2 only)

12. Human Insulin Time-action Patterns
Title
Subtitle
Human Insulin Time-action Patterns
Normal insulin secretion
at mealtime
Regular insulin
NPH insulin
Premix 70/30
Change in serum insulin
Baseline
level
Time (h)
SC injection