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Two highly conserved glutamate residues (205 and 206) within the glycosylated region are essential for the activity of DPP4 (12)

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Premixed regimen Split mix regimen Basal bolus regime (multidose) Bedtime dosing alone (NPH/Lente/Glargine) Infusion Premixed insulin Premixed(30/70): Regular: 30 % NPH : 70% Premixed (50/50): Regular 50% NPH 50% Premixed Analogs Biphasic insulin aspart (30/70) 30% : Aspart 70% : protaminated aspart Insulin Therapy Regimens Usual starting dose: 0.5-1.0 unit/kg/day Premixed insulin Dose adjustment: The fasting sugar depends on the night dose of insulin The post breakfast sugar depends on the morning dose of insulin Rough calculation increase the insulin by one unit to reduce the sugars by 25mg/dl Self Monitoring is crucial Glucometers At least 6-8 times a week ideally Premixed insulin Advantages more accurate dosing lesser injections Pen devices administer premixedforms Disadvantages Fine tuning may not be possible Strict meal pattern Nocturnal hypoglycemia May need diet changes for insulin rather than insulin changes fordiet Split-mixed insulin Common combinations: Short acting plus intermediate acting in a syringe:- Regular + NPH How to adjust insulin doses in a split mix Regular meal Regular NPH Increase regular insulin How to adjust insulin doses in a split mix Regular meal Regular NPH Reduce regular insulin How to adjust insulin doses in a split mix

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