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A Choice of Insulins

In addition to rapid-acting insulin, we now have “ultra rapid” insulins with onset and peak that are even earlier than traditional rapid insulins. These insulins combine traditional rapid-acting insulin with additives that stimulate more rapid absorption by the blood vessels below the skin, thereby producing an earlier onset and peak. Studies have shown that ultra-rapid insulin taken at mealtimes can produce a marked reduction in the post-meal glucose spike.


Fiasp, Lyumjev

(insulin + vasodilator)

5-10 min earlier onset & peak
50% greater activity during first 30-60 min

Speeding Insulin 2: Timing of Bolus Insulin

Even when using rapid-acting or ultra-rapid insulin, it is usually necessary to dose 10-15 minutes before the onset of a meal in order to prevent a significant postprandial glucose peak.  The higher the premeal glucose, and the more rapidly the meal digests, the earlier the insulin should be taken.  For example, when the glucose is above-target and a high-glycemic index meal (one that digests rapidly) is planned, it is best to give the insulin dose 30 to 40 minutes before the meal.  This helps bring the glucose down a bit before the meal kicks in.  At the opposite extreme, when the glucose is near a hypoglycemia threshold and the meal consists of slowly-digesting foods, it is best to give the insulin dose 15-20 minutes AFTER the onset of the meal.


High GI

Moderate GI

Low GI

BG Above Target Range


30-40 min. prior


20-30 min. prior


10-15 min. prior

BG Within Target Range

20-30 min. prior

10-15 min. prior

0 min. prior

BG Below Target Range


0 min. prior


5-10 min. after


15-20 min. after


Does Timing Matter?

Looking back at the top graph which we saw earlier, showing my post-meal peaks when I took my insulin right before my meals, you can see the improvement made when I started taking my insulin 15 minutes before eating. The post-meal rises are barely noticeable.


Bolus with meal




Bolus pre-meal

Research has shown that taking insulin prior to eating can reduce the net glucose rise by approximately 40 mg/dl in people with insulin-requiring type-2 diabetes.



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