Insulin PocketCard Updates
Effective Onset, Peak & Action Times
We love and respect our diabetes community. If someone reaches out and asks questions, we listen and investigate. Over the past few months, several of you emailed us, suggesting a needed change to the effective onset, peak and duration times for the very rapid and rapid acting analogs on our PocketCards.
Coach Beverly sprang into action and revisited the package inserts from the various insulin manufacturers in an attempt to solve the timing mystery and set things right.
After taking a closer look at the information, she realized where the confusion came in.
The effectiveness of insulin is not just based on pharmacokinetics, there is also a dose dependent response curve. In studies cited in the package inserts, there are tables with insulin timing based on different doses. In general, the larger the insulin dose, the faster the effective onset of action, but the longer duration of action (see the table for Fiasp below)
In addition, she discovered that terminology has evolved. For example, the onset of insulin (when it appears in the blood circulation) can be as short as a few minutes. However, the most important measurement for real life is time to first measurable effect (effective onset) or the amount of time it takes for the insulin to kick in and start lowering blood glucose levels. In addition, instead of using the term “duration” in the package inserts, they now use, “Time for effect to return to baseline”, which is more accurate but way too long to fit on our Pocketcard.
Called in the experts
To sort through all of this, Coach Beverly reached out to her favorite pharmacist and husband, Kristapor Thomassian, PharmD, BCPS for consultation. After reviewing all of the package inserts and online pharmacy resources, he recommended standardizing the card and using the term “effective” ranges for the action, onset and duration times of various insulins.
These updates are now posted on the latest version of our Insulin PocketCards, which are available for FREE download, or on our CDCES Coach App. You can also purchase your very own 2023 laminated version and they make perfect gifts for team members.
Insulin action has many variables
As we all know, these insulin timing charts just provide a general framework. Insulin absorption, onset, peak and duration results from a complex interplay between the insulin dose, injection site, circulating hormones, skin temperature, metabolic rate and so many other factors. The package inserts recognize that there is about at 20% day-to-day variability of insulins effectiveness and that was in a controlled research environment.
The famous chart by Adam Brown (below) and first posted on DiaTribe, clearly and succinctly highlights 42 factors that affect glucose. The bottom line is that insulin absorption timing varies within individuals. Over time, many people can determine the best time to inject the bolus of insulin or adjust their dose based on personal experience and blood glucose response.
Newly Approved Biosimilar Interchangeable Basal Insulin – PocketCard Update
Under basal insulin glargine, there are now 3 biosimilars listed; Basaglar, Semglee and Rezvoglar. The FDA just announced that Rezvoglar has also been approved as an interchangeable biosimilar along with Semglee. An “interchangeable biosimilar,” means that pharmacists can substitute a person’s Lantus prescription with these cheaper alternatives without needing to consult the healthcare prescriber.
Get Your Own PocketCard
These updates are now posted on the latest version of our Insulin PocketCards, which are available for FREE download, or on our CDCES Coach App. You can also purchase your very own 2023 laminated version and they make perfect gifts for team members.
A special thanks to those of you who alerted us to these needed updates. We love our community!
Want to learn more about this topic? Join us for our
DiabetesEd Boot Camp 2023 Updates | Level 3
$279 | 12+ CEs
Updates air live between Feb 7, 2023-March 9, 2023, at 11:30 am PST
In each webinar, Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM highlights the critical content of each topic area so you can focus your study time most efficiently. She also launches multiple poll questions that highlight key concepts to help students assess their knowledge and learn the best test-taking strategies.
2023 Webinar Dates
- February 7, 2023 – Class 1 – Diabetes – Not Just Hyperglycemia 1.5 CEs
- February 9, 2023 – Class 2 – Standards of Care & Cardiovascular Goals 1.5 CEs
- February 14, 2023 – Class 3 – Meds for Type 2 – What you need to know 1.5
- February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
- February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
- February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
- February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
- March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
- March 9, 2023 – Class 9 – Test-Taking Coach Session (48 Questions) No CE
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Coach Bev Reflects and Prepares for an Exciting 2023
Three words come to mind when I consider my family and business this year: reopening, celebration, and reflection.
From the start, my wonderful husband and boys have been amazing Diabetes Education Services cheerleaders. They are not only enthusiastic supporters, they roll up their sleeves and help package orders, stuff PocketCards, and run errands for emergency supplies. Both of my boys worked at my company throughout high school and contributed so much in terms of new ideas and products.
As I wrap up my year, I wanted to share a little about me and my family with all of you.
I am thrilled that life has opened up again. It has been so fun to go to football games to watch my high school senior, Jackson leads the marching band as drum major. Our troupe started dancing again and we were invited to perform at a local art museum for a fundraiser. Our family traveled and traipsed all around Scotland and visited family in London. Plus, for the first time in over 2 years, I taught two diabetes seminars LIVE and in person. There is nothing like the deep and profound connection made with others in a shared community.
My oldest son Robert is moving beautifully into adulthood as he studies finance and navigates college life and internships. My younger son, Jackson, loves chemistry and is busy writing essays about his goals and life experiences for college. I have so enjoyed reviewing these essays and learning new details about this wonderfully curious human. My husband continues his work as a critical care pharmacist and hopes to start a residency program at our local community hospital in the future.
Celebration and Reflection:
Diabetes Education Services Marks 25 years in 2023
I started Diabetes Education Services in May of 1998, just after the world wide web was introduced and sending messages through something called “email” was possible. At first, my one-person company only offered live courses at hospitals and meeting sites around the country. To engage new customers, I created a 2-sided Medication Post Card (see image), that we would mail out for free in exchange for an email address. My whole family helped me stuff envelopes and handwrite addresses in an effort to grow our community.
My administrative space consisted of a 10×12 foot room in our home, where I juggled writing my monthly newsletter and updating slides, all while raising two busy toddlers. In 2010, I took a leap of faith and decided to try offering courses online. In addition, I hired an amazing marketing team to redo my website and make sure it accurately reflected our company values and message of inclusion and kindness.
Fast forward to today. We have since grown our business to include an amazing team of employees and a newsletter that reaches over 37,000 online subscribers. Our Online University includes over 50 CE courses that we update yearly, plus we offer a CDCES Coach app, blogs, an 8-sided PocketCard, keynote presentations, and more. Our working space has expanded to a studio just steps from my home. This spacious office has room to store all our books and teaching tools plus offers lots of natural light, a view of my pond with abundant bird visitors, and an upstairs recording studio.
2023 is a Year of Gratitude
The truth is, we couldn’t have done any of this without YOU, our community. I am forever grateful for your willingness to support and believe in a young Diabetes Specialist who had the vision to create a company that uplifted people with diabetes through a blend of science and compassion.
To thank our amazing community of diabetes educators and advocates, we will be celebrating our 25th Anniversary throughout the year. Stay tuned. We can’t wait to see what the future holds!
FREE Resource Catalog
- Diabetes Cheat Sheets
- Diabetes Blog Bytes
- Medication PocketCards
- 10 Steps to Succeed
- CDCES Coach App
- Free Webinars hosted by Coach Beverly
- Question of the Week
- Free Diabetes Article Library
See Full Free Resource Catalog
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
![](/wp-content/uploads/2023/01/insta-png-v5.png")
