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A patient guide for premixed insulin

A Patient Guide for Pre-Mixed Insulin

What is Premixed Insulin?

“Premixed analogues provide both basal and postprandial coverage starting with 1 injection, but they are generally administered twice daily (BID), 1 injection at breakfast and 1 at supper.”1

“Premixed human insulin consists of a basal component of human insulin (70%) and a prandial component of unmodified regular human insulin (30%). Premixed insulin analogues have 2 components in their formulation: the prandial component is a rapid-acting analogue (either insulin lispro or aspart), and the basal component is insulin lispro or aspart protamine suspension. The rapid-acting analogue is also derived from recombinant DNA, but with an amino acid modification to make its action rapid, and an intermediate-acting analogue derived  from the addition of protamine.”1

Measuring Your Sugar Levels When On Pre-Mixed Insulin Regimen

“When initiating treatment with premixed analogue insulin BID, it is recommended that patients measure [blood glucose] BG just before breakfast and dinner as well as when there are symptoms consistent with hypoglycemia. However, if the patient has a snack midafternoon, it is recommended to measure BG before the snack instead of before dinner because the carbohydrate content of the snack will influence BG levels before dinner. When glycemic control is achieved, measurements of BG can be performed less frequently (preferably before breakfast, 1–2 times a week) to confirm that adequate glycemic control is being maintained. Approximately 3 months after reaching BG objectives, measurement of A1C is recommended.”1

“In cases in which the established treatment goal has not been achieved, it is suggested that paired measurements of BG before and after main meals be performed to define when the use of corrective dietary measures and/or a larger dosage of insulin is required. Whenever optimal glycemic control is achieved, the patient might perform less frequent BG measurements. It is important to note that patients can achieve lower postprandial BG concentrations by reducing high glycemic index carbohydrates (potatoes, white rice, white bread, white flour, white pasta, polenta, etc.) in their diets.”1

Who Should Use Premixed Insulin

“Such patients include those who have A1C around 8.5%, have higher elevations in postprandial glucose (difference between preprandial and postprandial >50 mg/dL), are less capable or willing to perform several measurements of self-monitored BG during the day, and are able to eat regularly.”1

A study performed indicated that “inpatient treatment with premixed human insulin resulted in similar glycemic control but in significantly higher frequency of hypoglycemia compared with treatment with basal-bolus insulin regimen in hospitalized patients with diabetes.”2

How are Premixed Insulins Titrated In Hospitals?

Algorithm for titration of premixed insulin
Fig. 1. Algorithm for titration of premixed insulin. Tambascia MA, Nery M, Gross JL, Ermetice MN, De oliveira CP. Diabetol Metab Syndr. 2013;5(1):50
Algorithm for premixed insulin titration – adjustment according to postprandial glucose
Fig. 2. Algorithm for premixed insulin titration – adjustment according to postprandial glucose. Tambascia MA, Nery M, Gross JL, Ermetice MN, De oliveira CP. Diabetol Metab Syndr. 2013;5(1):50

References:

(1) Tambascia MA, Nery M, Gross JL, Ermetice MN, De oliveira CP. Evidence-based clinical use of insulin premixtures. Diabetol Metab Syndr. 2013;5(1):50. Available from: https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-5-50 Accessed November 8, 2018.

(2) Bellido V, Suarez L, Rodriguez MG, et al. Comparison of Basal-Bolus and Premixed Insulin Regimens in Hospitalized Patients With Type 2 Diabetes. Diabetes Care. 2015;38(12):2211-6. Available from: http://care.diabetesjournals.org/content/38/12/2211 Accessed November 9, 2018.

Artur Dzhurinskiy
19 July, 2019

Written by

My name is Artur Dzhurinskiy and I graduated from St. Louis College of Pharmacy in 2014 with a doctor of pharmacy degree. Through my academics I gained valuable experience learning about various medications that are...read more:

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