TYPE OF INSULIN BRAND NAMES ONSET OF ACTION PEAK ACTION EFFECTIVE
DURATION OF
ACTION
Rapid-acting
insulin
Short-acting
insulin
Intermediate-
acting insulin
Long-acting
insulin
Pre-mixed
insulins
NovoRapid
(insulin aspart)
Humalog
(insulin lispro)
Apidra
(insulin glulisine)
Actrapid
Humulin R
Hypurin Neutral
Humulin NPH
Lente
Protaphane
HypurinIsophane
Lantus
(insulin glargine)
Levemir
(insulin detemir)
Humalog Mix 25
Humalog Mix 50
NovoMix 30
Mixtard 30/70
Humulin 30/70
Mixtard 50/50
5-15 mins
30-60 mins
2-4 hrs
3-4 hrs
1.5 hrs
2-4 hrs
2- 4 hrs
2-4 hrs
10-15 mins
10-15 mins
5-15 mins
30-60 mins
30- 60 mins
30-60 mins
30-90 mins
2-3 hrs
4-10 hrs
4-12 hrs
3-12 hrs
6-12 hrs
peakless
6-14 hrs
varies
varies
varies
2-8 hrs
varies
4-8 hrs
3-5 hrs
5-8 hrs
10-16 hrs
12-18 hrs
Up to 24 hrs
Up to 18 hrs
20-24 hrs
16-20 hrs
10-16 hrs
10-16 hrs
10-16 hrs
Up to 24 hrs
10-16 hrs
Up to 24 hrs
AVAILABLE FORM OF INSULIN
The onset, peak and duration of action are varies depending on the type of insulin. Insulin pharmacodynamics refers to the metabolic effect of insulin. Commercially available insulin can be divided into rapid-acting, short-acting, intermediate-acting, long-acting and pre-mixed insulin
Rapid-acting insulins, they worked efficiently in controlling post-prandial glycemic excursions with the absence of the risk of delayed hypoglycaemia. Thus, this type of insulin can be injected immediately before taking meal. They are genetically engineered analogues of human insulin. They aim to work like the insulin normally produced with a meal.
Subcutaneous injections of short-acting insulins are advisably taken at 30-40 minutes before meals in order to match the peaks of glucose and insulin.This will improved their influence on post-prandial hyperglycaemia but, the delayed risk of hypoglycaemia will still be remained. Short-acting insulins may also be given intravenously by pump. If used intravenously, the half-life is very short and the insulin disappears by 30 minutes.
Intermediate-acting insulins, they are mostly taken at bedtime in order to control the fasting blood sugar. However, the risk of nocturnal hypoglycaemia which also called as dawn phenomenon is present.
Long-acting insulins are designed for an attempt in achieving a stable basal insulin level without the presence of peak and they are taken as a single dose. The insulin glargine had improved the diabetes treatment in both type 1 and type 2 patients with a low risk of nocturnal hypoglycaemia. Meanwhile, insulin detemir is able to give a more predictable glycaemic control with a significant reduction of hypoglycaemia in a smoother plasma glucose profile.
The pre-mixed insulins are suitable for type 2 diabetes patients that are on split mix regime and the regime is set up in approximately similar proportion for both types of insulin used.
TAKE NOTE !
**The standard intermediate-acting insulin is isophane insulin - also known as neutral protamine Hagedorn (NPH).