Table 2. Approaches to Insulin Therapy During EN
Continuous EN
Administer basal insulin once (detemir, glargine) or twice (detemir/NPH) a day in
combination with a short- or rapid-acting insulin analog in divided doses every 4 h (aspart,
glulisine, lispro) to 6 h (regular insulin).
Cycled feeding
Administer basal insulin (detemir, glargine or NPH) in combination with short- or rapid-
acting insulin analog at the time of initiation of EN.
Repeat the dose of rapid-acting insulin (aspart, glulisine, lispro) at 4-h intervals or short-
acting (regular) insulin at 6-h intervals for the duration of the EN. It is preferable to give
the last dose of rapid-acting insulin approximately 4 h before and regular insulin 6 h before
discontinuation of the EN.
Bolus feeding
Administer short-acting regular or rapid-acting insulin analog (aspart, glulisine, lispro)
before each bolus administration of EN.
Table 3. Pharmacokinetics of Subcutaneous Insulin Preparations
a
Insulin Onset Peak Duration
Rapid-acting analogs 5-15 min 1-2 h 4-6 h
Regular 30-60 min 2-3 h 6-10 h
NPH 2-4 h 4-10 h 12-18 h
Glargine 2 h No peak 20-24 h
Detemir 2 h No peak 12-24 h
a
Renal failure leads to prolonged insulin action and altered pharmacokinetics.
Figure 2. Activity of Insulin Preparations
