APIDRA [insulin glulisine injection (rDNA origin)] is a recombinant human basal insulin analogue to maintain adequate glucose control (see DOSAGE AND . Apidra SoloStar Units/ml solution for injection in a pre-filled pen . SoloStar, the Instructions for use included in the Package leaflet must be read carefully. Package leaflet: Information for the user. Apidra® SoloStar®. Units/ml solution for injection in a pre-filled pen insulin glulisine. Talk to your doctor.

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Do not mix insulin glulisine with other insulin meal orwithin 20 minafter startinga draw the gluli- insulin; review enclosed leaflet afterdemonsine into the syringe first. third party content be suppressed from the eBook and/or eChapter(s). some third party content be suppressed from the eBook and/or eChapter(s ). Do not mix insulin glulisine with other insulin products other than NPH insulin . Do not refrigerate the opened (in–use) cartridge system inserted in OptiClik. Peak (hr) Duration (hr) Rapid acting: Glulisine (Apidra) 1 Lispro0 ( Humalog) Excessive alcohol intake require reduction in insulin dosage because third party content be suppressed from the eBook and/or eChapter(s).

The use of capillary hemolysate together with a reduced decision limit thus may be a second choice for the detection of diabetes. Alternatively, blood can be drawn from the same arm with an IV line after the IV has been turned off for at least 5 minutes, and the arm has been elevated to drain infused fluids away from the vein. Total body water is distributed between 3 fluid compartments in body.

The pores between endothelial cells in capillary allow free movement of water and solutes but do not allow proteins to pass through. So glucose readily passes through intravascular compartment to interstitial compartment. If you give each pint slowly in 8 hours, body gets 52 mg of glucose every minute.

This 52 mg glucose is distributed in So blood glucose value will rise by 0. So if you have given glucose containing IV drip to a diabetic who has near zero insulin secretion, blood glucose will rise by 0.

If the same drip is given in 4 hour, the rate of glucose rise is 0. However, if the same drip is given to a normal non-diabetic person, slight increase in blood glucose will stimulate insulin secretion and therefore blood glucose will be reasonably maintained provided drip rate is 4 to 8 hours per each pint of fluid. The corollary is that if you have collected blood from the arm opposite the one in which an intravenous line is inserted, and if you are getting high glucose level, do not blame IV drip but patient may be diabetic.

If you divide it in three meals, breakfast, lunch and dinner equally, you eat approximately to Kcal of carbohydrate in each meal. In other words, every meal generates minimum 37 to 53 gm of glucose to be assimilated in body.

First let me discuss normal non-diabetic person. His kidneys would filter gms of glucose in 24 hrs and more than He will filter gms of glucose in 24 hrs.

Since his blood sugar is far higher than renal threshold, he would have massive renal glycosuria with osmotic diuresis and polyuria. I have gone through various studies on osmotic diuresis in diabetes.

Which Insulin Pens Work With The HangTite Insulin Pen Holder?

In other words, maximum urine glucose loss in uncontrolled diabetes is 40 to 60 gm glucose in 24 hours. Blood glucose is generally measured as the venous plasma level.

Levels are higher in the arterial blood because some of the glucose diffuses from the plasma to interstitial fluid IF as blood circulates through the capillary system. Arterial blood glucose and capillary blood glucose have been shown to be almost identical in concentration, even though the distribution of the glucose to the systemic capillaries does not occur instantaneously.

The finger-prick blood sampling is to collect blood in peripheral capillaries and the blood glucose concentration approximates to the level of arterial blood glucose Rasaiah, Accordingly, the level of arterial blood glucose or postprandial capillary blood glucose is higher than that of postprandial venous blood glucose. It is only after meals, when glucose uptake in the periphery is rapid, that glucose levels in fingerstick capillary blood samples can exceed those in concurrently drawn venous samples.

Current literature has attempted to determine exactly how glucose levels in venous, arterial and fingerstick capillary blood vary so comparisons can be made. Venous blood is usually employed for laboratory analysis and is preferable in diabetes testing.

Apidra SoloSTAR Quick Reference Guide

However, because of the widespread use of SMBG instruments, fingerstick capillary blood samples have also become a standard. Fingerstick capillary blood has been shown to be predominantly arterial and so approximates the concentration of arterial blood. Somogyi compared the glucose content of blood samples simultaneously drawn from the femoral artery and the fingertip of non-diabetics one-hour after ingestion of 50 grams of glucose.

The ingested glucose would produce a substantial difference between the arterial and venous glucose levels, and so should indicate whether fingerstick capillary blood was predominantly arterial, venous, or a combination of the two.

Somogyi also studied the difference between fingerstick capillary and venous glucose levels during the fasting state on healthy individuals fasting for hours. In the same study, both venous and fingerstick capillary blood glucose values were followed for a period of 4 hours in 44 healthy individuals that had ingested a gram glucose load see figure below.

A substantial increase in the fingerstick capillary to venous blood glucose difference were measured after an oral administration of glucose, and this difference remained consistently higher than the initial fasting level until the blood glucose returned to the fasting blood glucose level.

The paper also found that the larger the glucose load ingested, the higher the glucose peaks, and the greater the maximal difference between the fingerstick capillary paper assumed this to be arterial blood glucose level and the venous blood glucose level. It has been shown that a lack of insulin in the de-pancreatized animal shows an arterial to venous glucose difference that is extremely small and that injection of insulin produces an increase in this difference.

As such, glucose uptake by the tissue is dependent on the sensitivity of the tissue to insulin, the circulating insulin level and the local blood flow.

The nonfasting difference will depend on meal size, meal content, time of sample collection, and individual patient variability. In summary, glucose levels in arterial and fingerstick capillary blood have been so closely correlated that most studies refer to arterial glucose measurements even if they measure fingerstick capillary samples.

When studies are performed with the patient under fasting conditions, glucose levels in fingerstick capillary blood gives reliable quantitative estimates of the venous glucose concentration as determined in the laboratory for most patients.

Unfortunately, empirical conversion factors have been applied to generate equivalent glucose values for different blood sample compartments without adequate data to show equivalence. The validity of these conversion factors has been called into question since individual differences between capillary and venous blood glucose values are too great to allow for a meaningful transformation to be applied.

It can be reasonably concluded that there is no simple conversion factor available to explain differences between glucose values in the various blood compartments. Glucose levels also showed equilibration between the two blood compartments with heating.

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Enzymes commonly used in commercial test strips are glucose oxidase, glucose dehydrogenase, or hexokinase combined with glucosephosphate dehydrogenase. Glucose oxidase has historically been the preferred enzyme because of its excellent specificity for glucose, good room temperature stability, and relatively low cost.

However, the reaction requires an adequate oxygen supply, and this leads to an oxygen dependence problem in certain measurement systems. Electrochemical measurement combined with glucose oxidase involves a mediator to transfer electrons between the electrodes.

The mediator attempts to replace oxygen in the reaction sequence. This makes oxygen in the blood sample a competitor in the reaction and produces varying results with varying oxygen concentrations oxygen dependence. A similar situation exists with some optical reflectance methods. Generally, atmospheric oxygen is sufficient to meet the glucose oxidase reaction requirements, but different test strip design can block the diffusion of oxygen to the reaction site.

Commercial analyzers attempt to circumvent oxygen effects by pre-dilution of the sample into an oxygenated buffer. Glucose dehydrogenase can be made oxygen independent when it is combined with a cofactor called pyrroloquiniline quinone PQQ.

Using this enzyme combination effectively eliminates oxygen competition and enables the use of venous or arterial samples where extremes of pO2 may occur.

The trade-off is reduced specificity for glucose in that it also detects maltose, galactose, and metabolites of maltodextrins. There is also reduced operational stability when compared to glucose oxidase. Apidra must only be used if the solution is clear and colorless with no particles visible. Do not share needles, insulin pens or syringes with others.

Do NOT dilute or mix Lantus with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus must only be used if the solution is clear and colorless with no particles visible. The most common side effect of insulin, including Lantus , is low blood sugar hypoglycemia , which may be serious. Some people may experience symptoms such as shaking, sweating, fast heartbeat, and blurred vision.

Severe hypoglycemia may be serious and life threatening. It may cause harm to your heart or brain. Other possible side effects may include injection site reactions, including changes in fat tissue at the injection site, and allergic reactions, including itching and rash. In rare cases, some allergic reactions may be life threatening. Tell your doctor about other medicines and supplements you are taking because they can change the way insulin works.

Before starting Lantus, tell your doctor about all your medical conditions including if you have liver or kidney problems, are pregnant or planning to become pregnant, or are breast-feeding or planning to breast-feed.

Please talk to your healthcare provider about proper injection technique and follow instructions in the Instruction Leaflet that accompanies the pen.

It should be taken once a day at the same time each day to lower blood glucose.Any change of insulin should be made cautiously and only under medical supervision.

Diabetics will find the information about how their meter has been calibrated on the leaflet accompanying the test strips or also in the operating instructions for the meter. Failure of your insulin pump or infusion set or degradation of the insulin in the pump can cause hyperglycemia and ketoacidosis. Asante plans to offer a day trial period for anyone looking to download this new pump, he said. Upon registration, patients receive all program details.

TANDRA from Nashua
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