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Insulin Types Rapid-Acting Insulins are rapid-acting, short-acting, intermediate-acting, long-acting, and combination preparations. The brand names are in parentheses; and not all the brand names are listed. It’s interesting to note that insulin preparations available now do not include an oral preparation. This is because biochemical and physical barriers, and manufacturing challenges have prevented their development.
Rapid-acting insulins include: Insulin lispro (Admelog® and Humalog®): Onset of action, 0.25-0.5 h; peak glycemic effect, 0.5-2.5 h; duration, ≤ 5 h. Insulin aspart (Novolog® and Fiasp®): Onset of action, 0.2-0.3 h; peak glycemic effect, 1-3 h; duration of action, 3-5 h. Insulin glulisine (Apidra®): Onset of action, 0.2-0.5 h; peak glycemic effect, 1.6-2.8 h; duration, 3-4 h.
Short-Acting Short-acting insulins include the following as see on this slide: Insulin, regular U-100 (Humulin® R, Novolin® R): Onset of action, 0.25-0.5 h; peak glycemic effect, 2.5-5 h; duration, 4-12 h. Insulin, regular U-500 (Humulin®): Onset of action, 0.25-0,5 h; peak effect, 4-8 h, duration of action 13-24 h.
Intermediate-Acting Intermediate-acting insulins generally have an onset approximately 2-4 hours after injection with a peak from 4-12 hours. These usually clear after 12-18 hours. Examples include insulin NPH as Humulin® N, Novolin® N, and ReliOn™.
Long-Acting Long-acting insulins have an onset that is usually a few hours after injection. They continue to lower blood glucose fairly evenly after onset. These medications generally clear from the body within 24 hours. Examples include: Insulin degludec (Tresiba®), Insulin detemir (Levemir®), and Insulin glargine (Basaglar®, Lantus®). The most commonly observed side effect is hypoglycemia.
Ultra Long-Acting Ultra long-acting insulins provide clinically significant glucose-lowering effect beyond 24 hours after injection. These products Insulin, regular U-100 (Humulin® R, Novolin® R): Onset of action, 0.25-0.5 h; peak glycemic effect, 2.5-5 h; duration, 4-12 h. Insulin, regular U-500 (Humulin®): Onset of action, 0.25-0,5 h; peak effect, 4-8 h, duration of action 13-24 h.
Combination Products Insulin aspart protamine suspension (Novolog® Mix 70/30): Onset of action, 10-20 minutes, peak glycemic effect, 1-4 h; duration of action, 18-24 h. Insulin aspart (Novolog®): Onset of action, 0.3-0.3 h, peak effect, 1-3 h. duration of action, 3-5 h. (Note: Aspart is used in combination with a longer-acting insulin). Insulin lispro protamine and insulin lispro (Humalog® Mix 75/25, Humalog® Mix 50/50): Insulin lispro is a rapid-acting insulin, and lispro protamine is an intermediate-acting insulin. Onset of action, 0.25-0.5 h; peak glycemic effect of 50/50 is 0.8-4.8 h, peak glycemic effect of 75/25 is 1-6.5 h, duration of action for both is 14-24 h. Insulin NPH suspension and regular insulin (Humulin® 70/30, Novolin® 70/30): Onset of action, 0.5 h; Peak glycemic effect, 2-12 h; Duration, 18-24 h.
Inhaled Insulin There is also another form of insulin, one that is inhaled. The lone option is ‘Afrezza’, and it is used adjunctively for hyperglycemic control in patients with type 1 or type 2 diabetes. Comparisons of the efficacy of inhaled insulin and injected insulin have mixed results, but a lack of patient acceptance, and patient discontinuation of the inhaled variant may have limited its popularity.
Alfrezza is a rapid-acting insulin. Its method of action is through specific membrane-bound receptors which regulate the metabolism of the macronutrients carbohydrate, protein, and fats. The onset and time to peak is approximately 10-20 minutes with a duration of between 90 and 270 minutes, depending on dose. |
