Administering Insulin and Insulin analog therapies

Standard ADA outpatient recommendation for treating hypoglycemia

15 g of carbohydrates

Dosage that is used in some hospitals for treating hypoglycemia

20 g of carbohydrates

Identify the type of insulin: Insulin aspart (Fiasp)

ultra-short

Identify the type of insulin: insulin lispro aabc

ultra-short

Identify the type of insulin: insulin lispro (humalog)

rapid-acting

Identify the type of insulin: insulin aspart (novolog)

rapid-acting

Identify the type of insulin: insulin glulisine (apidra)

rapid-acting

Identify the type of insulin: regular human

short-acting

Identify the type of insulin: NPH

intermediate

Identify the type of insulin: insuline glargine (lantus)

long-acting

Identify the type of insulin: insulin detemir (levemir)

long-acting

Identify the type of insulin: insulin glargine (toujeo)

ultra-long

Identify the type of insulin: insulin degludec (tresiba)

ultra-long

Identify the type of insulin: inhalation

ultra-rapid

Onset: inhalation

12 min

Onset insulin degludec

30-90 min

Onset insuline glargine U-300

6 h

Onset insulin detemir

60-120 min

insulin glargine U-100

70 min

Onset NPH

60-120 min

Onset regular human

30-60 min

Onset insulin glulisine

10-15 min

Onset insulin aspart (novolog)

10-20 min

Onset insulin lispro

15-30 min

Onset insulin lispro-aabc

1 min

Onset insulin aspart (Flasp)

2.5 min

peak insulin aspart (Fiasp)

1.5-2 h

peak insulin lispro-aabc

1 h

peak insulin lispro (humalog)

0.5-2.5 h

peak insulin aspart (novolog)

1-3 h

peak insulin glulisine

1-1.5 h

peak insulin regular

1-5 h

peak NPH

6-14 h

peak insulin determir

12-24

duration of action insulin degludec

up to 42 h

duration of action insulin glargine u-300

up to 36 h

duration of action insulin detemir

12-24 h

duration of action insulin glargine u-100

18-24

duration of action NPH

16-24 h

duration of action insulin regular

6-10 h

duration of action insulin gluslisline

3-5 h

duration of action insulin aspart (novolog)

3-5 h

duration of action insulin lispro

3-6 h

duration of action insulin lispro-aabc

6 h

duration of action insulin aspart (Fiasp)

5-7 h

duration of action insulin inhalation

1.5-3 h

side effects of insulin inhalatino

hypoglycemia, dry cough, and a scratchy or sore throat

Insulin inhalation contradication

presence of chronic lung disease

insulin degludec administration consideration

• Can be injected at any time of day, and its long half-life allows for dosing

intervals of up to 40 hours.

• Can achieve glycemic goals with a lower risk of hypoglycemia than other basal insulins

indulin glargine u-300 administration consideration

• The concentrated formulation (U-300) prolongs its duration of action.

• Administer by SUBQ injection once daily at the same time each day.

• Has little peak effect which may reduce hypoglycemia.

insulin detemir administration consideration

Administer by SUBQ injection once or twice daily at the same time each day.

insulin glargine u-100 administration consideration

• Administer by SUBQ injection once or twice daily at the same time each

day.

• Must be used with a regimen of rapid or short-acting inulin with type

I DM

NPH administration consideration

Administer by SUBQ injection twice daily. Generally used in regimens

with short-acting insulin.

regular administration consideration

Administer by SUBQ injection 30 minutes before a meal

insulin glulisine administration consideration

Administer by SUBQ injection within 15 min. before or within 20 min after

a meal

insulin aspart (novolog) administration consideration

Administer by SUBQ injection 5-10 minutes before meals

insulin lispro (humalog) administration consideration

Administer by SUBQ injection within 15 minutes before or just after a

meal.

insulin aspart and insulin lispro-aabc administration consideration

It's best to administer URAAs before meals when possible, but they are more flexible than other insulins because you can take them after a meal if you don’t know how much you will eat

The American Diabetes Association's (ADA) 2026 Definition of Diabetes Mellitus

A group of metabolic disorders characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Insufficient insulin secretion and/or impaired insulin action disrupt the body's ability to regulate blood glucose

The ADA recognizes four different classes of diabetes:

• T1D

• T2 D

• gestational diabetes mellitus

• other specific types

T1D age at onset

More common in young people but can occur at any age

T2D age at onset

More common in adults but can occur at any age. Incidence increasing in children.

T1D type of onset

usually abrupt, but disease process may be present for several years

T2D type of onset

gradual, may go undiagnosed for years

T1D endogenous insulin

absent

T2 endogenous insulin

Initially increased in response to insulin resistance.

Secretion decreases over time

T1 environmental factors

virus,toxins

T2 environmental factors

obesity, lack of exercise

T1 family hx

frequently negative

T2 family hx

frequently positive

T1 primary defect

Loss of pancreatic beta cells results in absent or minimal insulin production

T2 primary defect

Insulin resistance, decreased insulin production over time, and changes in adipokine production

T1 symptoms

Polydipsia, polyuria, polyphagia, fatigue, weight loss without trying

T2 symptoms

Often none. Fatigue, recurrent infections. May also have polyuria, polydipsia, and polyphagia

T1 ketosis

Present at onset or during insulin deficiency.

T2 ketosis

Not present except during infection or stress

T1 insulin therapy

required all

T2 insulin therapy

Required for some. The disease is progressive, and insulin treatment may need to be added to the treatment plan.

T1 nutrition

thin, normal, or obese

T2 nutrition

often overweight or obese. may be normal

ADA's recommendations for screening for presymptomatic type 1 diabetes (T1D) who to screen

Individuals with a family history of T1D or other known elevated genetic risk factors for T1D.

ADA's recommendations for screening for presymptomatic type 1 diabetes (T1D) screening test

A blood test to detect autoantibodies associated with T1D

ADA's recommendations for screening for presymptomatic type 1 diabetes (T1D) rationale

Early detection and intervention can potentially delay the onset of clinical T1D and mitigate risks like diabetic ketoacidosis.

ADA's recommendations for screening for presymptomatic type 1 diabetes (T1D) follow-up

For individuals with multiple confirmed autoantibodies, the ADA recommends referral to a specialized center for further evaluation

ADA's recommendations for screening for prediabetes and T2D in asymptomatic adults

• Testing should be considered in adults of any age with overweight or obesity (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) who have one or more risk factors

• For all other patients, testing should begin at age 35 years

ADA's recommendations for screening for prediabetes and T2D in asymptomatic adults screening

• Fasting plasma glucose -OR-

• 2-h plasma glucose during 75-g oral glucose tolerance test -OR-

• A1C

 If tests are normal, repeat screening is recommended at a minimum of 3-year intervals, sooner with symptoms or change in risk (i.e., weight gain).

ADA's recommendations for screening for prediabetes and T2D in children

after the onset of puberty or after 10 years of age, in children and adolescents with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) and who have one or more risk factor for diabetes

Risk factors for prediabetes and T2D children

• Maternal history of diabetes or gestational diabetes during the child’s gestation.

• Family history of type 2 diabetes in first or second-degree relative.

• Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander)

prediabetes

term used for people whose glucose levels do not meet the criteria for diabetes yet have abnormal carbohydrate metabolism.

Criteria for the Diagnosis of Prediabetes

1. A1C level

2. fasting plasma glucose

3. 2 h plasma

Criteria for the Diagnosis of Diabetes (T1D and T2D)

1. A1C level

2. fasting plasma glucose

3. 2 h plasma

4. presents with classic symptoms of hyperglycemia or hyperglycemic crisis, with a random plasma glucose ≥ 200 mg/dL.

Criteria for the Diagnosis of Prediabetes A1C

5.7-6.4%

Criteria for the Diagnosis of Diabetes (T1D and T2D) A1C

>6.5 %

Glycemic goals A1C

<7%

Criteria for the Diagnosis of Prediabetes fasting plasma glucose

100mg/dL to 125 mg/dL. Fasting is defined as no caloric intake for at least 8 hours

Criteria for the Diagnosis of Diabetes (T1D and T2D) fasting plasma

≥ 126 mg/dL. Fasting is defined as no caloric intake for at least 8 hours

Criteria for the Diagnosis of Prediabetes 2 h plasma

140mg/dL to 199 mg/dL during 75 g oral glucose tolerance test

Criteria for the Diagnosis of Diabetes (T1D and T2D) 2 hour plasma glucose

> 200 mg/dL during oral glucose tolerance test, using a glucose load of 75 g

Glycemic goals Pre-prandial capillary plasma glucose

80-130 mg/dL

Glycemic goals Peak post-prandial capillary plasma glucose

<180 mg/dL