Tag Archives: cda

Diabetes 3: Insulin and Official Launch

Classes of insulin and different treatment regimens are discussed in the third episode of a 3-part series on diabetes. This episode also marks the conclusion of our coverage of the “Big Three” of modern medicine (hypertension, dyslipidemia, and diabetes), and with it, we make an official announcement of the launch of the Family Pharm Podcast to the world (aka Facebook)!

 

Class Drug Onset Peak Duration
Very Rapid-acting Insulin Analogues insulin aspart
(NovoRapid)
10–15 min 60–90 min 4–5 h
insulin glulisine
(Apidra)
insulin lispro
(Humalog)
Rapid-acting Insulin insulin regular
(Humulin R, Novolin ge Toronto)
30–60 min 2–4 h 5–8 h
Intermediate-acting Insulin insulin NPH
(Humulin N, Novolin ge NPH)
1–2 h 5–8 h 14–18 h
Long-acting Insulin Analogues insulin detemir
(Levemir)
1.5 h Flat, no discernible peak 24 h
insulin glargine
(Lantus)
Mixed (regular/NPH) Human Insulin insulin regular/insulin NPH
Humulin 30/70,
Novolin ge 30/70, 40/60, 50/50
Combination of individual components
Mixed Insulin Analogues insulin lispro/lispro protamine
Humalog Mix25, Humalog Mix50
10–15 min Not available Not available
Mixed Insulin Analogues insulin aspart/aspart protamine
NovoMix 30
10–15 min 60–90 min 15–18 h

Classes of insulin preparations. Adapted from Therapeutic Choices 6th edition.

CDA guideline on insulin for Type 1 diabetes, including description of basal-bolus regimen by carb counting:

Examples of insulin regimens from CDA:

Self monitoring:

Diabetes 2: antihyperglycemics

We reviewed the CDA 2013 guidelines on antihyperglycemic therapy for type 2 diabetes (http://guidelines.diabetes.ca/executivesummary/ch13), and explored the pharmacological properties of each of the major classes:

  • Biguanides: Metformin
  • Sulfonylureas: chlorpropamide, gliclazide, glimepiride, glyburide, and tolbutamide
  • Thiazolidinediones: pioglitazone and rosiglitazone
  • Meglitinides: Nateglinide and repaglinide
  • Alpha-glucosidase inhibitors: Acarbose
  • Dipeptidyl Peptidase-4 inhibitors (DPP4 inhibitors): Saxagliptin and sitagliptin
  • Glucagon Like Peptide-1 Analogues (GLP-1 analogues): Liraglutide and Exenatide

Drug information:

Diabetes 1: CDA 2013 Guideline

To round up the “Big Three”, we turned out attention on diabetes. We reviewed the CDA guidelines on diabetes management and summarized the most relevant points that we think all family doctors and pharmacists would find interesting.

http://guidelines.diabetes.ca/ 

The CDA also prepared many apps and calculators that help HCPs make clinical decisions. As well, there are many other clinical practice guidelines on many different aspects of the care of diabetes that we cannot cover in this podcast. We recommend listeners to visit the CDA website to get a fuller picture than our synopsis here.