A 31-year-old woman with type 1 diabetes presents to her dentist for periodontal and prosthodontic care. A fixed partial denture is needed to replace tooth #4. Teeth #3 and #5 require crown lengthening procedures.
The patient was diagnosed with type 1 diabetes mellitus at the age of 15. Medical management of her diabetes is with a multiple-dose insulin regimen, consisting of insulin glargine 16 units hs (long-acting insulin, see Table 1) and insulin aspart (rapid-acting insulin, Table 1) before meals. The dose of insulin aspart is calculated based on the carbohydrate content of the planned meal and the blood glucose level as determined by a fingerstick test. Her most recent hemoglobin A1c (HbA1c) was 6.8%, indicating excellent metabolic control. She has no history of severe hypoglycemic events. She takes no other medications.
|Insulin preparation||Onset of action||Peak||Duration of action|
|Lispro (Humalog ® )||< 15 minutes||1–2 hours||3–6 hours|
|Aspart (Novolog ® )||< 15 minutes||1–2 hours||3–6 hours|
|Glulisine (Apidra ® )||< 15 minutes||1–2 hours||3–6 hours|
|Regular (Novolin ® R, Humulin ® R)||30–60 minutes||2–4 hours||6–10 hours|
|Humulin ® R Regular
|30–60 minutes||2–4 hours||Up to 24 hours|
|NPH (Novolin ® N, Humulin ® N, ReliOn ® )||2–4 hours||4–8 hours||10–18 hours|
|Glargine (Lantus ® )||1–2 hours||Usually no peak||Up to 24 hours|
|Determir (Levemir ® )||1–2 hours||Usually no peakb||Up to 24 hours b|
|Premixed insulins c||Onset of action||Peak/>|