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Insulin

Insulin is the only medication used to treat type 1 diabetes. The use of insulin in managing diabetes not only helps to prevent hyperglycemic emergencies, but is also the best safeguard to prevent the long-term complications of diabetes by correcting fasting and postprandial hyperglycemia.

Newer forms of insulin, known as insulin analogs, have been available since 1995, and have allowed improved control of blood glucose level. Human insulin analogs, which are manufactured by recombinant technology, allow more physiological patterns of insulin replacement. These insulins are no longer classified as "long-acting" or "short-acting", but rather are made to mimic the action of the body's natural (endogenous) insulin and are classified as basal (fasting) or bolus (mealtime) insulins. Each type of insulin has distinct advantages and disadvantages.

Providing continuous basal insulin throughout the day and night with boluses of insulin at mealtimes may be used for persons with either type 1 or type 2 diabetes. If regular insulin is used, injections are given approximately 30-45 minutes before meals. However, this often results in suboptimal control because the postprandial glucose will rise before the insulin peaks. In addition, when the insulin peaks later, hypoglycemia can ensue. Therefore, the shorter acting analogs are preferred for pre-meal administration and work better for persons who may have variable mealtimes.

Most children on insulin injections receive three injections per day. Traditional insulin regimens for children consist of two-thirds of the daily insulin dose given in the morning before breakfast and one third in the evening. The morning injection typically consists of rapid-acting and intermediate-acting insulin which covers breakfast, lunch, and the afternoon. The dinner injection consists of rapid-acting insulin to cover the evening and the bedtime injection of intermediate-acting insulin to cover hormone surges during the sleeping hours.

Most basal insulins can be mixed in the same syringe with short-acting insulins, allowing fewer injections. The notable exceptions, however, are Insulin Glargine and Insulin Detemir which cannot be mixed in the same syringe with other insulins.

Types of Insulin

• Rapidly acting insulins - takes effect rapidly and can last 4-12 hours

  • Regular insulin - Onset 30-60 minutes; Peaks in 2-4 hours; Duration 6-8 hours

  • Insulin lispro (Humalog by Eli Lilly) - Onset 15-30 minutes; Peaks in 1-2 hours, Duration 3-5 hours

  • Aspart (Novolog by Novo Novodisk) - Onset 5-10 minutes; Peaks in 1-2 hours; Duration 3-4 hours

  • Glulisine (Apidra by Sanofil-Aventis) - Onset 10-15 minutes; Peaks in 1-1.5 hours; Duration 3-5 hours

• Intermediate-acting insulins

  • NPH insulin - usually given twice daily (before breakfast and before dinner or at bedtime): Onset 1 hour; Peaks in 6-8 hours; Duration 12 hours

  • Lente Insulin - Onset 1-3 hours; Peaks in 6-8 hours; Duration 12-20 hours

• Long-acting or Basal insulins - These are released slowly and can last up to 24 hours

  • Ultralente insulin - Onset 2-4 hours; Peaks in 8-14 hours; Duration 18-30 hours