PRENANCY TARGETS
(A1C <6.1 if possible)
- If targets not achieved in 1-2 weeks,
start meds
- Screen @24-28 weeks, earlier if risk factors.
- INSULIN (BOLUS - RAPID ONLY) – Metformin – Glyburide
● MODY (Maturity Onset Diabetes of the Young) → under 25 years of age
○ Monogenic diabetes; rare genetic disorder → familial
○ NON-INSULIN DEPENDENT (use PO meds)
● Drug-Induced Hyperglycemia (can also destroy beta cells) Pre-diabetes diagnosis
○ GLUCOCORTICOIDS
■ <1%-46%; varies with dose, duration and
route
■ Increased gluconeogenesis (liver),
increased insulin resistance, decreased
pancreatic insulin secretion
- Cortisol impairs insulin secretion
- Incretins (intestine) → GLP-1inhibit glucagon
secretion, delays gastric emptying & promotes
satiety
-
● LADA (Latent Autoimmune Diabetes in Adults) → over 30 years of age
○ Type 1.5
○ Slower progression of beta cell failure
○ Insulin dependence within 6 years (while Type 1 is immediate)
○ Some insulin resistance (Type 1 is none and Type 2 is yes)
, ● Normal pancreatic function → total daily insulin in lean, healthy is 0.5 units/kg/day
Insulin Type Name Onset Peak Duration
Bolus (Rapid) Aspart 9-20 min 1-1.5 h 3-5 h
Bolus (Ultra Rapid) Aspart (Fiasp) 4 min 0.5-1.5 h 3-5 h
Bolus (Rapid) Glulisine 10-15 min 1-1.5 h 3.5-5 h
Bolus (Rapid) Lispro 10-15 min 1-2 h 3-4.75 h
Bolus (Short Acting) Insulin Regular 30 min 2-3 h 6.5 h
Basal (Intermediate) NPH 1-3 h 5-8 h Up to 18 h
Basal (Long Acting) Detemir 1.5 h N/A 16-24 h
Basal (Long Acting) Glargine 1.5 h N/A 24 h (>30 h if U300)
Basal (Long Acting) Degludec 1.5 h N/A 42 h
Pre-Mixed (SA+ Int) Regular + NPH 0.5-1 h 3-12 h 10-16 h
Pre-Mixed (RA+ Int) Apart or Lipro + NPH 5-15 min 1-4 h 10-16 h
● Concentrated Insulins
○ Toujeo U-300 may take 5 days to see max effect
○ Degludec may cause less nocturnal hypos
(A1C <6.1 if possible)
- If targets not achieved in 1-2 weeks,
start meds
- Screen @24-28 weeks, earlier if risk factors.
- INSULIN (BOLUS - RAPID ONLY) – Metformin – Glyburide
● MODY (Maturity Onset Diabetes of the Young) → under 25 years of age
○ Monogenic diabetes; rare genetic disorder → familial
○ NON-INSULIN DEPENDENT (use PO meds)
● Drug-Induced Hyperglycemia (can also destroy beta cells) Pre-diabetes diagnosis
○ GLUCOCORTICOIDS
■ <1%-46%; varies with dose, duration and
route
■ Increased gluconeogenesis (liver),
increased insulin resistance, decreased
pancreatic insulin secretion
- Cortisol impairs insulin secretion
- Incretins (intestine) → GLP-1inhibit glucagon
secretion, delays gastric emptying & promotes
satiety
-
● LADA (Latent Autoimmune Diabetes in Adults) → over 30 years of age
○ Type 1.5
○ Slower progression of beta cell failure
○ Insulin dependence within 6 years (while Type 1 is immediate)
○ Some insulin resistance (Type 1 is none and Type 2 is yes)
, ● Normal pancreatic function → total daily insulin in lean, healthy is 0.5 units/kg/day
Insulin Type Name Onset Peak Duration
Bolus (Rapid) Aspart 9-20 min 1-1.5 h 3-5 h
Bolus (Ultra Rapid) Aspart (Fiasp) 4 min 0.5-1.5 h 3-5 h
Bolus (Rapid) Glulisine 10-15 min 1-1.5 h 3.5-5 h
Bolus (Rapid) Lispro 10-15 min 1-2 h 3-4.75 h
Bolus (Short Acting) Insulin Regular 30 min 2-3 h 6.5 h
Basal (Intermediate) NPH 1-3 h 5-8 h Up to 18 h
Basal (Long Acting) Detemir 1.5 h N/A 16-24 h
Basal (Long Acting) Glargine 1.5 h N/A 24 h (>30 h if U300)
Basal (Long Acting) Degludec 1.5 h N/A 42 h
Pre-Mixed (SA+ Int) Regular + NPH 0.5-1 h 3-12 h 10-16 h
Pre-Mixed (RA+ Int) Apart or Lipro + NPH 5-15 min 1-4 h 10-16 h
● Concentrated Insulins
○ Toujeo U-300 may take 5 days to see max effect
○ Degludec may cause less nocturnal hypos
