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Hyperglycemia

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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

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