Types of Insulin and how to start insulin in type... 1-Rapid Acting 2-Short Acting

Types of Insulin and how to start insulin in type 2 diabetics
1-Rapid Acting
e.g,Insulin Lispro ( Humalog), Insulin Aspart (Novalog, Novorapid)
2-Short Acting
Insulin Regular (Humulin R or Novolin )
3-Intermediate Acting
NPH (Humulin N, Insuget, Insulatard )
4-Long Acting
Insulin Glargine (Lantus), Detemir ( Levemir )
5-Pre-Mixed
NPH/Regular (70/30 or 50/50)
Lispro protamine/ Lispro (70/30) e.g, NovoMix 30 Flexpen
Aspart protamine/ Aspart (e.g, Novolog mix 70/30)
Type of Insulin
Rapid-acting
Short-acting
Brand Name
Generic Name
Duration
Insulin aspart
15 minutes
30 to 90 minutes
3 to 5 hours
Humalog
Insulin lispro
15 minutes
30 to 90 minutes
3 to 5 hours
Humulin R
Regular (R)
30 to 60 minutes
2 to 4 hours
5 to 8 hours
1 to 3 hours
8 hours
12 to 16 hours
1 hour
Peakless
20 to 26 hours
30 to 60 minutes
Varies
10 to 16 hours
Humulin N
NPH (N)
Novolin N
Long-acting
Peak
NovoLog
Novolin R
Intermediate-acting
Onset
Levemir
Insulin detemir
Lantus
Insulin glargine
Pre-mixed NPH
Humulin 70/30
(intermediate-acting)
and regular (shortNovolin 70/30
acting)
Humulin 50/50
70% NPH and
30% regular
30 to 60 minutes
Varies
10 to 16 hours
Pre-mixed insulin
Humalog Mix
lispro protamine
75/25
suspension
(intermediate-acting)
Humalog Mix
and insulin lispro
50/50
(rapid-acting
75% insulin lispro 10 to 15 minutes
protamine and
25% insulin lispro
Varies
10 to 16 hours
50% insulin lispro 10 to 15 minutes
protamine and
50% insulin lispro
Varies
10 to 16 hours
Pre-mixed insulin
NovoLog Mix
aspart protamine
70/30
suspension
(intermediate-acting)
and insulin aspart
(rapid-acting)
70% insulin
aspart protamine
and 30% insulin
aspart
Varies
10 to 16 hours
50% NPH and
50% regular
5 to 15 minutes
Starting Insulin in type 2 diabetes
Once daily
Start with 10 units of Lantus once daily (or Levemir twice daily) irrespective of meal but at a regular
time.Increase by 2 units every 3rd day depending upon fasting glucose.
If price is the issue,then also start with NPH (Humulin N, Insulatard) at night with 10 units and
increment of 2 unit every 3rd day.Sightly ncreased risk of hypoglycaemia and effective only for 10-12
hours.
Twice daily
Premixed insulins are twice daily (pre-breakfast and pre-evening meal),assuming that patient eats
three times a day.Nocturnal hypoglycaemia and poor glycaemic control are often the issues.
Basal-Bolus Regime
The best evidence based combination is basal+bolus regime with basal analogue at night and bolus
(Humalog or Humulin R) at meal times if HbA1c not controlled only on basal dosage only.Total
dosage would be half at night and rest of the half divided in 3 times.E.g,if a patient takes 30
units,then 15 units of Lantus and rest of 15 units as 5 units of humalog tds.