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Nadir peak

Illustration of blood glucose curve noting blood glucose nadir occurs at the same time as insulin peak effect.

The peak of any insulin means when it is strongest, or working the hardest; charts and graphs like this refer to the level of insulin in the bloodstream. At this time, your pet's blood glucose levels will be at their lowest, or at their nadir. The term "peak" always refers to insulin action, while "nadir" always refers to blood glucose levels. At the time the insulin is at peak, it's exerting the maximum effect on blood glucose levels. This produces the nadir, or lowest point of blood glucose levels-both happen at the same time. A high level of insulin in the blood means a low level of glucose in it. [1]

Let's look at some graphs of insulin activity by way of explanation. The Lente activity profile shows when the insulin is working at its hardest (highest level of insulin in the blood)-the "bump" seen at 8-10 hours. When the insulin is peaking (working hardest), it's bringing the blood glucose levels down to their lowest point.

Lentetap

Time activity profile for lente insulin. This is the same graphic shown on our Lente page.

Lentetapflip

Graph from our Lente page turned upside-down and rotated horizontally; it mirrors the blood glucose pattern.


Now we'll take the Lente activity profile, turn it upside down and rotate it horizontally. The second image would then reflect the blood glucose levels, with the nadir, (lowest blood glucose levels)-the "valley" seen at 8-10 hours, which is the same time the insulin's at peak. When insulin levels are high, blood glucose levels are low and vice-versa.

Once you know this time for your pet on a particular insulin, you know the ideal time for a peak blood test. (While regulating it's often helpful to frequently take a mini-curve, a set of three blood glucose level readings at shot times and peak.)

Generally, the longer acting an insulin is, the longer it takes to reach peak. So it would take insulins like Ultralente and PZI longer to peak than intermediate-acting ones like Lente and NPH or short-acting ones like R/neutral.

Peak times are also determined by an insulin's suspension. Even though Lente and NPH are in the intermediate-acting class, NPH, with its isophane suspension, peaks before Lente and its zinc suspension.

The strength of an insulin formulation also can play a part in when an insulin peaks, with U 100 insulins having more duration than U 40 ones, this means they will go to work slower, peak slower and last longer overall than a U 40 preparation; origin or species may also be a factor.

Intermediate acting

This is a time activity profile for intermediate-acting insulins. The darker green portion of the graph shows the average time that it will be peaking, or working hardest.

Looking at an insulin's time-activity profile will give you the average time it peaks. However, this is only an average--it varies from individual to individual because of absorption and other unique factors. In some cases, pets and people rapidly metabolize the insulin. This speeds the time activity profile up for the person or pet. The onset (average time after injection the insulin begins working), the peak and the time the insulin becomes inactive (leaves the system) are much sooner than the time activity profile indicates.

The only presently available insulins "without a peak" are Lantus and Levemir, when working correctly for the pet or person. They are then often used as a basal insulin to provide a virtually "flat response", and with a bolus insulin at mealtimes to provide extra insulin action.

See also onset, duration, and carryover. I16

ReferencesEdit

  1. Bruyette, David. Blood glucose curve: interpretation. VetStream Canis.

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