This
graph shows an approximation of insulin response to
meals in patients without diabetes. Insulin therapy
is intended to mimic these responses to keep blood
glucose under control.
Types of
insulin available include rapid-acting,
short-acting, intermediate-acting, long-acting, and
pre-mixed. This graph shows the approximate action
on insulin levels of several insulin medications.
The bolus, or quick-acting insulin is given at
mealtimes and offsets the effects of dietary
carbohydrates. The basal or longer-acting insulins
offset hepatic glucose secretion, meeting the body’s
basic metabolic energy needs. Rapid-acting works has
an onset of 10-30 minutes and peaks between 30-90
minutes. Variations are seen in duration from 1-2.5
or 3-5 hours. Short-acting, shown here as “regular”,
have and onset of ˝ to 1 hour, a peak of between 2-5
hours, and varied durations from 2-3 hours or 5-8
hours. Intermediate-acting insulin, such as NPH or
Lente, have onsets between 1-2.5 hours, a peak
between 3-12 hours, and a duration of 18-24 hours.
Long-acting includes ultralente, lantus, and levemir
or detemir. The onset ranges from ˝ to 2 hours, peak
levels are varied from 6-8 hours or 10-20 hours,
except for lantus, which is delivered at a steady
level. The duration ranges from 20-36 hours. This
type of insulin is often combined with rapid or
short-acting insulin therapy. Pre-mixed include
products such as humulin, novolin, novolog, and
humalog. These mixes have both a quick onset and a
long duration.