Type/Generic Name (Brand)
Onset
Peak
Duration
Comments
Rapid-­‐Acting
5-­‐15 minutes
0.5-­‐3 hours
3-­‐5 hours
•Meal should be available before administering, ideally taking within 10 minutes of eating).
•Good in refrigerator (36-­‐46°F) until expiration date.
•Protect from light.
•May be mixed with NPH only (draw the rapid acting insulin first then NPH and use immediately).
•Should be used in regimens with intermediate or long-­‐acting insulin when giving multiple daily injections (MDI).
•Clear and colorless.
•Unless for correction, rapid-­‐acting insulin should not be taken if not eating a meal.
1-­‐3 hours
Insulin Aspart (NovoLog)
•Available in FlexPen, NovoPen Echo (delivers 0.5 units and has memory of last dose and time passed since last injection) or vial.
Novo Nordisk
•May be substituted for insulin lispro (Humalog) and glulisine (Apidra).
www.novolog.com
•Approved for use in pregnancy (category B).
•Both pen and vial good for 28 days at room temperature (<86°F).
•Pen dials up from 1 to 60 U in a single injection.
•Novo Nordisk offers instant savings card ($25 per refill for 2 years) for non-­‐government insurance payers (Medicare and Medicaid).
Type/Generic Name (Brand)
Onset
Insulin Lispro (Humalog)
Peak
Duration
30-­‐90 minutes
•Available in KwikPen or vial.
• May be substituted for insulin aspart (NovoLog) and glulisine (Apidra).
•Approved for use in pregnancy (category B).
•Both pen and vial good for 28 days at room temperature (<86°F).
•Pen dials up from 1 to 60 U in a single injection.
40-­‐120 minutes
•Available in SoloStar Pen or vial.
•May be substituted for insulin aspart (NovoLog) or lispro (Humalog).
•Not well studied during pregnancy (category C).
•Both pen and vial good for 28 days at room temperature (<77°F).
•Pen dials up from 1 to 80 U in a single injection.
Lilly
www.humalog.com
Insulin Glulisine (Apidra)
Sanofi
www.apidra.com
Short acting
30-­‐60 minutes
Comments
1.5-­‐4 hours
4-­‐8 hours
•Should be taken 30 minutes before eating.
•May be mixed with NPH (draw Regular insulin first).
•Clear and colorless.
•Approved for use in pregnancy (category B).
•Good in refrigerator (36-­‐46°F) until expiration date.
•Protect from light.
•Usually preferred in IV drip.
Type/Generic Name (Brand)
Onset
Peak
Duration
Comments
Regular 30-­‐60 minutes
1.5-­‐4 hours
4-­‐8 hours
•Only available in a vial.
Novolin R (U-­‐100)
•May be mixed with NPH (draw Regular insulin first).
Novo Nordisk
•Good for 28 days at room temperature (<86°F).
•Generic versions available (ReliOn/Novolin R)-­‐ $25 at Walmart.
•Should not be taken if not eating a meal.
Walmart (ReliOn)
Humulin R (U-­‐100)
•Only available in a vial.
Lilly
•May be mixed with NPH (draw Regular insulin first).
www.humulin.com/humulin-­‐r-­‐
u-­‐100.aspx
•Good for 31 days at room temperature (<86°F).
•Should not be taken if not eating a meal.
10 mL vial
Type/Generic Name (Brand)
Onset
Peak
Duration
Comments
Lasts up to 24 hours (chance for •Only available in a vial; use either volumetric hypoglycemia 18-­‐24 (Tuberculin) or U-­‐100 insulin syringe.
hours after injection)
•Unable to mix with other insulin.
•Five times stronger than U-­‐100 (reduces volume by 80%).
Humulin R (U-­‐500)
Lilly
www.humulin.com/
20mL vial
•Given to patients who are very insulin resistant. Patient may be appropriate if TDD >200 units/day.
(One vial of U-­‐500 contains as many units of insulin as 10 vials of U-­‐100 insulin) •Normally dose BID before breakfast & supper but may be taken before each meal.
•Action is similar to NPH.
•Good for 31 days at room temperature (<86°F).
Intermediate –Acting
1-­‐3 hours
4-­‐10 hours
10-­‐16 hours typical •Usually dosed BID but may be at bedtime only to but may last up to 20-­‐
correct FBG.
24 hours
•May be mixed with rapid-­‐acting insulin, Novolin R U-­‐
100 and Humulin R U-­‐100.
•Cloudy and milky in color; must mix before each use.
•Approved for use in pregnancy (category B); often preferred for insulin naive moms because small peak seems to better help with FBG control.
•Good in refrigerator (36-­‐46°F) until expiration date.
•Protect from light.
•Usually dosed BID but may be taken only at bedtime to correct FBG.
Type/Generic Name (Brand)
NPH (Novolin N)
Novo Nordisk
Onset
Peak
Duration
Comments
•Only available in vial.
•Good for 42 days at room temperature (<77°F).
•Generic versions available (ReliOn/Novolin N)-­‐ $25 at Walmart.
Walmart (ReliOn)
NPH (Humulin N)
•Available in KwikPen or vial.
Lilly
•Vial: good for 31 days at room temperature (<86°F).
www.humulin.com/humulin-­‐
n.aspx
•Pen: good for 14 days at room temperature (<86°F).
•Pen dials up from 1 to 60 U in a single injection.
Long-­‐Acting
•Usually taken at bedtime but can be taken in the morning if worried about nocturnal hypoglycemia or twice a day if looks like wearing off (ideal to space 12 hours between injections).
•Best to take at same time daily.
•Clear and colorless.
•Good in refrigerator (36-­‐46°F) until expiration date.
•Protect from light.
Type/Generic Name (Brand)
Onset
Peak
Duration
Comments
Insulin Glargine (Lantus)
1-­‐2 hours
None
20-­‐ 24 hours
•Available in SoloStar pen or vial.
•Both pen and vial good for 28 days at room temperature (<86°F).
•Pen dials up from 1 to 80 U in a single injection.
•Not studied for use during pregnancy (category C).
•If changing from once daily NPH to Lantus, keep dose the same; if changing from twice daily NPH to Lantus, recommend to reduce dose by 20% to reduce risk of hypoglycemia.
•Dose can be kept the same if changing from determir (Levemir) to glargine (Lantus).
Relatively flat; possible small peak 6-­‐8 hours.
12-­‐20 hours, but may •Available in FlexTouch pen (no push button last for 24 hours in extension; replacing FlexPen) or vial.
some patients.
Sanofi
www.lantus.com
Insulin Determir (Levemir) 1-­‐2 hours
Novo Nordisk
www.levemir.com
•Both pen and vial good for 42 days at room temperature (<86°F).
•Pen dials up from 1 to 80 U in a single injection.
•Approved for use during pregnancy (category B).
•If changing from once daily NPH to Levemir, keep dose the same; if changing from twice daily NPH to Levemir, recommend to reduce dose by 20% to reduce risk of hypoglycemia.
•Dose can be kept the same if changing from glargine (Lantus) to determir (Levemir).
•Novo Nordisk offers instant savings card ($25 per refill for 2 years) for non-­‐government insurance payers (Medicare and Medicaid).
Type/Generic Name (Brand)
Onset
Peak
Duration
Pre-­‐Mixed
Comments
•Usually dosed BID at breakfast and dinner. •Dual peak for action to try to control meals and overnight BG.
•Cloudy and milky in color; must mix before each use; helps to eat on schedule and time 2nd meal 4-­‐6 hours later.
•Good in refrigerator (36-­‐46°F) until expiration date.
•Protect from light.
70% NPH and 30% Regular 30-­‐60 minutes
(Novolin 70/30)
(Humulin 70/30)
2-­‐12 hours
10-­‐18 hours.
•Novolin 70/30 only available in vial; Generic versions available (ReliOn/Novolin 70/30)-­‐ $25 at Walmart.
•Good for 10 days at room temperature (<86°F).
•Take 30 minutes before eating.
•Humulin 70/30 comes in KwikPen or vial.
•Pen only good for 10 days at room temperature but vial good for 31 days at room temperature (<86°F).
•Pen dials up from 1 to 60 U in a single injection.
Lilly
•Take 30 minutes before eating.
www.humulin.com/humulin-­‐
70-­‐30.aspx
•Humulin 50/50 was discontinued in 2010.
Type/Generic Name (Brand)
Onset
70% insulin aspart protamine suspension and 10-­‐15 minutes
30% insulin aspart
Peak
Duration
Comments
1-­‐4 hours
10-­‐16 hours
•Available in FlexPen or vial.
(NovoLog Mix 70/30)
•Vial good for 28 days at room temperature (<86°F).
•Pen good for 14 days at room temperature (<86°F).
Novo Nordisk
•Pen dials up from 1 to 60 U in a single injection.
•When mixing insulin, need to have at least 12 units left in pen to mix well. If not, new pen use recommended.
www.novologmix70-­‐30.com/
•Take within 15 minutes of eating a meal.
•Novo Nordisk offers instant savings card ($25 per refill for 2 years) for non-­‐government insurance payers (Medicare and Medicaid).
70% insulin lispro protamine suspension and 10-­‐15 minutes
30% insulin lispro (Humalog 75/25)
1-­‐4 hours
10-­‐16 hours
For both Humalog 75/25 and Humalog 50/50:
•Available in KwikPen or vial.
•Take within 15 minutes of eating a meal.
50% insulin lispro protamine suspension and 50% insulin lispro (Humalog 50/50)
1-­‐5 hours
10-­‐16 hours
•Vial: good for 28 days at room temperature (<86°F).
•Pen good for 10 days at room temperature (<86°F).
•Pen dials up from 1 to 60 U in a single injection.
Lilly
www.humalog.com/humalog-­‐
kwikpen-­‐insulin-­‐pen.aspx
Type/Generic Name (Brand)
V-­‐Go®
Disposable Insulin Delivery Device
Onset
Peak
5-­‐15 minutes
No peak but have 24 hours (delivers continuous basal rate option to bolus for 24 hours)
meals in 2 Unit •V-­‐Go® is attached to the skin and whole device is increments, up to changed and disposed of daily.
36 units daily for each V-­‐Go®
(Uses vials of rapid-­‐
acting insulin; tested with Humalog and NovoLog; not tested with Apidra)
Duration
Comments
•Comes in different delivery options but patient must be able to tolerate minimum basal rate of 20 units/day since unable to adjust basal rate:
•V-­‐Go® 20 (basal rate 20 units/day (0.83 U/hr) and bolus up to 36 units in 2-­‐unit increments).
Valeritas
www.go-­‐vgo.com/
•V-­‐Go® 30 (basal rate 30 units/day (1.25 U/hr) and bolus up to 36 units in 2-­‐unit increments).
•V-­‐Go® 40 (basal rate 40 units/day (1.67 U/hr) and bolus up to 36 units in 2-­‐unit increments).
•Insulin is filled into each separate V-­‐Go® delivery device through the EZ Fill product (transfers insulin from the vial into the V-­‐Go®); patient gets new EZ Fill with each 30-­‐day V-­‐Go® supply.
•Uses U-­‐100 fast-­‐acting insulin and ordered for a 30-­‐
day supply (patient needs 2 vials each month for V-­‐
Go® 20 and 3 vials each month for V-­‐Go® 30 and 40).
•May be beneficial for patients on <100 units insulin daily (usually recommended patient's total daily dose of insulin is reduced by 25-­‐30%).
•May be beneficial for patients that do not want hassle of multiple injections and are not well controlled on basal insulin (at 50+ Units) and oral meds.
•Can be worn on abdomen or back side of the arm.
Type/Generic Name (Brand)
Onset
Peak
Duration
Comments
Afrezza
5-­‐15 minutes
0.5-­‐3 hours
3-­‐5 hours
•Inhaled insulin taken at the beginning of a meal.
(insulin human) inhalation powder
•Dispensed in 4 unit (blue) and 8 unit (green) cartridges; able to take maximum 24 units per meal (3 cartridges per use).
•This is a rapid-­‐acting insulin and needs to be paired with long-­‐acting (basal) insulin.
Inhaled insulin approved by FDA but not available to market yet.
•Lung function needs to be assessed before starting (spirometry, a physical and medical history); Not recommended for those who have chronic lung disease (asthma or COPD) or people who smoke or recently stopped smoking.
MannKind looks to be partnering with Sanofi for marketing.
•Not studied with pregnancy (category C).
•Inhaler can be stored in refrigerator or at room temperature (30-­‐77°F) but needs to be at room temperature before use.
•Inhaler must be replaced every 15 days.
•Cartridges are sold in foil package with 2 sealed blister cards that contain 5 strips of 3 cartridges (i.e. 30 cartridges per foil package).
•Unopened foil packages are good in refrigerator (36-­‐
46°F) until expiration date but cartridges being used need to sit at room temperature at least 10 minutes before use.
•Unopened blister card and strips good for 10 days at room temperature (<77°F). •Opened strips good for 3 days at room temperature (<77°F). Type/Generic Name (Brand)
Onset
Peak
Duration
Comments
Special Notes: Pen Needles: Syringes:
Injection Tips:
Insulin's mechanism of action:
•Most vials of insulin contain 1000 Units (10 mL).
The primary activity of insulin is the regulation of glucose metabolism. Insulin exert their specific action through binding to insulin receptors. This •The higher the gauge lowers blood glucose by facilitating cellular uptake of for pen needle, the •1/3 mL syringe = •Always wash hands glucose into receptor-­‐bound insulin skeletal muscle thinner the pen 30 units
and injection site.
and adipose tissue and by inhibiting the output of needle.
glucose from the liver. Insulin inhibits lipolysis in the adipocyte, inhibits proteolysis, and enhances protein synthesis.
•Most pens contain 300 units (3 mL) and 5 pens come to a box (pharmacy cannot split boxes).
•Needle length: 31G and either 4 or 5 mm appropriate for most patients using insulin.
•Pen needles and insulin syringes need to be ordered separately from prescription.
•Rotate injection sites to prevent •1/2 mL syringe = lipodystrophy, which 50 units
may interfere with insulin absorption
•Most people do not need to pinch skin unless •1 mL syringe = thin and worried about 100 units
going into muscle.
•Can be injected in fatty tissue in abdomen, outer thighs, upper arm •Discuss appropriate sharps disposal.
and in buttock; may see better absorption in abdomen.
•Prime insulin pen before each use (2 unit air shot).
Last Revised: 10/2014
•For safety, patients starting insulin should notify the department of motor vehicles about insulin use and should start carrying rapid-­‐acting source of glucose and medical ID at all times incase of hypoglycemia.
•New needle for each injection; do not store with needle.