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 Preparationsa Insulin
Onset
Rapid-acting analogs Regular NPH
Glargine Detemir
5-15 min 30-60 min 2-4 h 2 h 2 h
Peak 1-2 h 2-3 h
4-10 h
No peak No peak
a Renal failure leads to prolonged insulin action and altered pharmacokinetics. Figure 2. Activity of Insulin Preparations
Duration 4-6 h
6-10 h
12-18 h 20-24 h 12-24 h
