Insulin is classified as:
All insulin prescribed in the U.S. is chemically similar to human insulin. Human insulin is manufactured using recombinant DNA technology and has replaced insulin derived from pork
and beef organs. Beef insulin differed from human insulin at 3 amino acid sites and pork
insulin differed at one site. As a result, beef and pork insulin caused more allergic
reactions and are no longer sold in the U.S.
Each insulin preparation has a different pharmacokinetic profile, i.e., onset, peak effect, and duration. To further complicate things, dosage can significantly modify the profile even within the same commercial product.
Therefore replacing one insulin product with another is not a simple substitution. Changing an insulin medication should only be
done under the supervision of a health professional with expertise in diabetes
management. If a patient is admitted to the hospital, the type of insulin he
or she has been using should not be changed indiscriminately. In all instances
of insulin use, dosages must be individualized and balanced with medical nutrition
therapy and exercise.
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Ultra-rapid insulin - Afrezza is an inhaled human insulin, recently approved by the FDA, for use by adult patients with diabetes mellitus (DM). In patients with type 1 DM (T1D), Afrezza must be used in conjunction with a long-acting insulin. Afrezza is rapidly absorbed with a peak serum concentration occurring within 12-15 minutes and a half-life of ≈28-39 minutes. Peak action occurs in about 60 minutes and a duration of about 160 minutes. Afrezza is intended to be taken just before meals. Afrezza appears to improve glycemic control for type II DM patients compared with bolus subcutaneous insulin. Because Afrezza is cleared rapidly from the body, there appears to be less weight gain than that associated with the longer half-life of the rapid-acting insulin analogs. The short half-life is also believed to be responsible for lower incidence of hypoglycemic events.
Rapid-acting insulin analogs are similar to human insulin with minor structural or amino acid changes. They include lispro, aspart and glulisine. They are the fastest acting injectible insulins, used for bolus therapy at mealtime and to correct hyperglycemia. They reach the bloodstream in ≈15 minutes or less after subcutaneous injection, peak
action between 30 and 180 minutes, and a maximum duration of action between
2 and 6 hours. They should be injected 5-10 minutes before a meal.•
Short acting or Regular insulin usually reaches the blood within 30 minutes after injection, peaks in 2 to 5 hours and stays in the bloodstream for 4 to 12 hours, (Humulin R and Novolin R). Because of its short and predictable peak action, regular insulin is the insulin product routinely used for intravenous administration. Insulin concentrations currently available in the U.S. are U-100 and U-500, indicating 100 units or 500 units per milliliter. U-500 is only used in rare cases of insulin resistance when the patient requires extremely large doses. Travelers should be aware that insulin is available in a U-40 strength outside the U.S. To avoid dosing errors, syringes that match the concentration of U-40 insulin must be used.
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Intermediate acting (NPH) insulins are human insulin isophane suspensions. They are loudy/ milky suspension of human insulin with protamine and zinc. The addition of protamine or zinc delay relay availability of the insulin, resulting in slower onset, slower peak effect and longer duration. They reach the bloodstream1 to 2 hours after injection, peak within 4 to 12 hours and stay in the bloodstream for 14 to 24 hours. (Humulin N and Novolin N)
Long Acting Insulins• These insulins have no peak or a very small peak effect 10 to 16 hours after injection. Depending on dose they can remain active in in the bloodstream for 22-24 hours or longer.
Insulin Inhaled | Brand/generic name | Onset in minutes |
Peak |
Duration |
Administer |
Ultra-Rapid insulin• |
Afrezza/ rDNA Human powder | 12 -14 min. |
≈1 hour |
180 min. |
Beginning of meal |
Insulin (SubQ) | Brand/generic name | Onset in minutes |
Peak effect |
Duration |
Administer |
Rapid-acting • (insulin analogs) |
Novolog/insulin aspart | 12 - 18 min. |
1-3 hours |
2 - 5 hours |
5-10 min. before meal |
Humalog/ insulin lispro | 15 - 30 min. |
.5 - 2.5 hours |
2 - 4 hours |
<15 min. before meal |
|
Apidra/insulin gluisine | 12 - 30 min. |
1.6 - 2.8 hours |
3 - 4 hours |
15 min. before meal |
|
Short-acting • |
|
30 min. |
2.5 - 5 hours |
4 - 12 hours |
30 min. before meal |
Intermediate-acting • |
|
1-3 hours |
8 hours |
12 to 16 hours |
|
Long-acting (insulin analogs) |
|
3-4 hours |
3-9 hours |
5.7-24 Hrs |
|
|
3-4 hours |
No peak |
≈ 24 Hrs |
||
Pre-mixed Insulins | Brand/generic name | Onset in minutes |
Peak |
Duration |
Administer |
Novolin® 70/30 - Humulin® 70/30 |
30-60 min |
2-12 hours |
18 - 24 hours |
30 min. between doses 30 min. before meals |
|
Novolog® Mix 70/30 |
10 - 20 min | 1-4 hours | 18 - 24 hours | 10-20 min. between doses and before meals |
|
Humalog® Mix 75/25 |
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