Meal Time Insulin – Bolus:
- Humulin® R, Novolin® R, ReliOn R – Human regular insulin – Once open can be used for 42 days
- Humalog - lispro - Once open can be used for 28 days
- Novolog - aspart - Once open can be used for 28 days
- Apidra - glulisine - Once open can be used for 28 days
- Afrezza – insulin human [rDNA origin
Timing of these insulins are usually before meals. Regular (R) insulin is the slowest onset in this group. Regular insulin is taken 20-30 min before meals. The other 3 humalog, novolog, and apidra are all taken within 5-15 minutes before the meal. This group of insulins are ONLY taken with food.
Afrezza an inhalable insulin that is taking at the beginning of the meal and peaks much faster than other insulins. A peak level is achieved within 12-15 minutes while injectable insulins do not peak for about 90 minutes for rapid acting insulin such as Humalog, Novolog or Apidra.
Regular insulin often peaks at 3-4 hours after you inject and can last up to 6 hours. Humalog, novolog, apidra peak in about 90 minutes and last only about 3 hours.
Main side effect: hypoglycemia
Storage: un-open insulin vials/pens should be refrigerated
Open vials: can be kept out of the refrigerator for approximately 28 days for Lantus, Novolog, Humalog and Apidra. Levemir, Regular and NPH can be used up to 42 days once open.
Insulin should NOT be exposed to temperatures above 87 degrees. Insulin should also be protected from cold, freezing and bright lights. All can affect the strength and action of insulin.
- NPH - neutral protamine Hagedorn
NPH is the only remaining cloudy insulin in use today. The NPH can be mixed with any of the fast/rapid acting insulins. NPH often starts to work in about 90 minutes and is strongest or peaks at 4-10 hours and can last up to 18 to 24 hours.
NPH must be gently rolled before each use. NEVER shake insulin.
Storage: same as fast/rapid acting insulin
Main Side Effect: low blood sugar
Long acting - Basal insulin:
- Lantus - glargine
- Levemir - detemir
- Phase 3 trials U300 lasting 40 hours - has not been submitted to FDA
Both are considered 24 hour insulins. Both should always be clear just like water. There should NEVER be any flakes, clumps or cloudiness with these insulins. Often given at bedtime although Lantus and Levemir may be given in the morning.
- NEVER MIX with any other insulins.
- Lantus once open can be used up to 28 days
- Levemir once open can be used up to 42 days
Main side effects: low blood sugar - the risk is less than meal time insulin
Storage: unopened insulin should be refrigerated.
Open insulin can be kept out of the refrigerator as long as the insulin is stored properly.
- Avoid bright light
- 70/30 NPH/Regular insulin mix - insulin isophane and insulin regular
- 70/30 Humalog/Novolog mix - insulin lispro and insulin lispro protamine and insulin aspart protamine and insulin aspart rdna origin
- 75/25 Humalog mix - insulin lispro and insulin lispro protamine
Any pre-mixed insulin must be gently rolled before each use. NEVER shake insulin. The pre-mixed insulin is taken before meals from 1-3 times a day depending on your treatment plan.
The 25-30% part of the insulin is to cover the food you are eating, while the 70% is your back ground or basal insulin that works to control sugars between meals and during the night.
Mixed insulins do not work for all people. If your routine and food intake is stable from day-to-day the pre-mixed may be an option.
Inhaled Insulin: is not currently available in the U.S.
Afreeza is an inhaled insulin that takes advantage to the lungs ability to deliver insulin directly into the blood in place of injections.
There is concern about possible side effects on of the lungs including lung cancer. An FDA advisory panel voted overwhelmingly to give to go ahead to marketing Afrezza. The panel also recommended more long term studies on lung problems from the inhaled insulin.
The panel approved Afrezza for adults with type 1 and 2 diabetes. The FDA as delayed a final decision until later this year.
Previous attempts to use inhaled insulin were unsuccessful.
May 27, 20145:24:28 PM