Thursday’s Daily Piece: New Faster Acting Insulin Lispro and Next Generation Freestyle Libre 2

What an exciting week in the world of the diabetes with the ADA Virtual Scientific Sessions, FDA approval of a new faster acting insulin lispro and the next generation Freestyle Libre 2 continuous glucose monitoring system. Lilly has received FDA approval for their new faster acting insulin lispro (Lyumjev) available in U-100 and U-200 formulations. This new insulin will be available through Lilly Insulin Value Program ($35/month copay). More details are provided in link below.

https://www.healio.com/news/endocrinology/20200616/fda-approves-novel-fasteracting-insulin-lispro-injection?M_BT=4557970002905

FDA approves Lyumjev, Lilly's new rapid-acting insulin – PharmaLive

Secondly, the next generation of the Free Style Libre has been approved. Freestyle Libre 2 integrated continuous glucose monitoring system now has optional, real time alarms (which Freestyle Libre 14 day lacked). Similar to Freestyle Libre 14 day, this new generation integrated is placed on the upper arm for 14 days. Abbott (maker of Freestyle Libre) is still working to bring apps for Libre to U.S. Please click on link below for additional details.

https://www.healio.com/news/endocrinology/20200615/fda-clears-nextgeneration-integrated-continuous-glucose-monitor?M_BT=4557970002905

Abbott's Freestyle Libre 2 Advanced Wearable Glucometer FDA ...
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#FDA #Lyumjev #Libre2 #next generation

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Saturday’s Daily Piece: FDA Updates on Insulin Glargine and Metformin ER

FDA has approved insulin glargine (Semglee, U-100) manufactured by Mylan Pharmaceuticals this week. We now have 3 insulin glargine U-100 (Lantus, Basaglar and Semglee) formulations available. Semglee is approved for use in adults and pediatrics with type 1 diabetes and adults with type 2 diabetes.

FDA announces additional companies to being asked to voluntarily recall metformin extended release due to elevated levels of NDMA. Additional details in link below.

https://www.medpagetoday.com/endocrinology/generalendocrinology/87035?xid=nl_mpt_DHE_2020-06-13&eun=g1137305d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202020-06-13&utm_term=NL_Daily_DHE_dual-gmail-definition

Semglee® | Insulin glargine injection|HCP Website
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#FDA #Semglee #metformin #NDMA

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Tuesday’s Daily Piece: Caution When Switching from Humulin R U-500 KwikPen and Vial

Recently, I had an experience that made the hair on my head stand up. A patient was switched from Humulin R U-500 KwikPen to Humulin R U-500 vial. While on the surface, this is no big deal except that patient was given U-100 insulin syringes without any instructions on how to divide his U-500 dose by 5 when determining how many units to draw up in the U-100 syringe. Look to hear more about safe use of Humulin R U-500 in the June blog for Reece’s Pieces in a Diabetes World.

Using U-500 Insulin | Clinical Diabetes

FDA Approves First U-500 Insulin Pen Device
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#U-500 #dosing #safety

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Thursday’s Daily Piece: Out of Pocket Costs for Diabetes Beyond Insulin

For persons living with diabetes, they know first hand that diabetes is expensive. Much talk and advocacy efforts around the cost of insulin driving up the overall cost of insulin is happening. Recent research letters in JAMA Internal Medicine took a deep dive into the out of pocket costs for insulin. The findings revealed out of pocket costs are high for supplies including insulin pump supplies, glucose meters and continuous glucose monitors. We must look beyond insulin alone when considering the out of pocket costs for diabetes. For more details, please click on link below.

https://www.medscape.com/viewarticle/931631

Out-of-pocket costs | Wellmark
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#costs #supplies #diabetes

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Tuesday’s Piece: FDA Recalls Certain Versions of Extended Release Metformin Due to NDMA Levels

Due to the increased levels of N-nitrosodimethylamine (NDMA) found in extended release metformin, FDA recommends a voluntary recall of certain extended release versions of metformin. NDMA exposure at higher levels for long periods of time is associated with potential for causing cancer. Please click below for additional details.

https://www.medscape.com/viewarticle/931361?nlid=135750_3901&src=wnl_newsalrt_200529_MSCPEDIT&uac=293412PG&impID=2399725&faf=1

Online pharmacy finds high levels of NDMA in metformin
FDA releases updated COVID-19 food safety guidelines | New Hope ...

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#metformin #FDA #recall

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Thursday’s Piece: Insulin Copays Capped at $35/Month for Most Medicare Beneficiaries

In the upcoming Medicare enrollment beginning October 15, monthly insulin copays will be capped at $35 per month for more than 1,750 Medicare Part D plans and Medicare Advantage plans in 50 states, Washington, D.C. and Puerto Rico. Currently, monthly insulin copays are $50 – $150 for many Part D plans so this is a potential savings of $446 per year. Please make sure to check Part D or Medicare Advantage Plans that you consider this fall to see if this new reduced insulin copay is included. For more information, please click below.

https://www.medpagetoday.com/primarycare/diabetes/86706?xid=nl_mpt_DHE_2020-05-28&eun=g1137305d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202020-05-28&utm_term=NL_Daily_DHE_dual-gmail-definition

Tuesday’s Piece: Summertime: Diabetes Medications with Higher Risk for Hypoglycemia

We are at the end of May and summertime activities have begun. Swimming and lots of fun outdoor activities (with social distancing of course) means many of us are now more active. If you are taking a diabetes medications with higher risk for causing hypoglycemia (low blood glucose), increased activity could mean increased risk for hypoglycemia. So what diabetes medications have a higher risk for causing hypoglycemia?

-Sulfonylureas (glipizide, glyburide, glimepiride)

-Insulin

While these particular classes of diabetes medications have a higher risk, other classes of diabetes medications could potentially cause hypoglycemia if a person goes long periods without eating or significantly increases their activity level without potentially adding a small snack. So what step can be taken to decrease risk of hypoglycemia if you find yourself significantly more active in the summer?

-Check your blood sugar before engaging activities such as hiking, swimming, long walks, running

-Incorporate protein into your meals and snacks as this will help stabilize your glucose

-Pack 15 gram carbohydrate with protein snack (i.e. apple and almonds; peanut butter crackers) in your bag

-Watch for patterns in your glucose for specific days or activities that consistently cause hypoglycemia (I highly encourage to see if a flash or continuous glucose monitor is option)

-Discuss with your provider potential decrease in medication dose if you see a pattern of hypoglycemia

Low Blood Sugar (hypoglycemia)|Columbus Regional Health
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#hypoglycemia #summertime #medications

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Saturday’s Piece: Don’t Forget to Remove Second Cap on Insulin Pen Needle

Recently, when working with a person with diabetes taking insulin, he and I discovered that the reason his glucose was not lowering with insulin therapy is he removed the first but not the second cap on the insulin pen needle. You might be tempted to think, “really, are you serious?” Yes, I am serious. The underlying reason for this happening is he was not taught how to use the insulin pen when he first began taking insulin. I reassured him that he was not the first nor the last for this happen, and to not feel bad as he simply did not know. Guidance on how to use insulin pens is key prior to the first dose.

Pen Needles | Alpine Health
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#guidance #education #insulin #pens

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Saturday’s Daily Piece: Cardiovascular Benefit with Liraglutide Likely Mediated by A1c

Liraglutide (Victoza), GLP-1 receptor agonist, is known for its ability to lower cardiovascular risk in persons with type 2 diabetes who have blood glucose values consistently above target range and who at high risk for a cardiovascular event (i.e. heart attack). What exactly mediates this benefit? Buse and colleagues uncovered that this benefit most likely is mediated by hemoglobin A1c. Please click below for additional details on this exploratory analysis.

https://www.healio.com/endocrinology/diabetes/news/online/%7B09ebef6b-62b1-42d0-bbf0-3c2ed5e6b68c%7D/hba1c-likely-mediates-liraglutides-cv-benefit?M_BT=4557970002905

When Changing from Daily to Weekly GLP-1, Make Sure Patient is Clear
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#A1c #liraglutide #CV #benefit

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Thursday’s Daily Piece: Greater Benefits with Higher Doses of Dulaglutide

A recent study (AWARD 11) by Dr. Frias in adults with type 2 diabetes currently on metformin without achieving target glucose goals were assigned to dulaglutide 1.5 mg, dulaglutide 3 mg and dulaglutide 4.5 mg. A stepwise dose escalation every 4 weeks to doses of dulaglutide 1.5 mg, 3 mg or 4.5 mg was completed. Dulaglutide 3 mg and 4.5 mg produced greater improvements in glycemia and body weight reduction however only dulaglutide 4.5 mg was superior to dulaglutide 1.5 mg. The results are promising for higher doses of dulaglutide however time will tell whether FDA approves these higher doses. Please click on link below for additional details.

https://www.healio.com/endocrinology/diabetes/news/online/%7B52416ea4-897f-46b7-9c8c-982afa65b7d7%7D/higher-dose-dulaglutide-reduces-hba1c-body-weight-in-type-2-diabetes?M_BT=4557970002905&page=2

Trulicity (dulaglutide) for the Treatment of Type 2 Diabetes ...
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#dulaglutide #AWARD11 #diabetes #medication

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