How Insulin Works:
Each type of insulin has an onset, a peak, and a duration time.

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Onset is the length of time before insulin reaches the bloodstream and begins lowering blood
glucose.
Peak is the time during which insulin is at maximum strength in terms of lowering blood
glucose.
Duration is how long insulin continues to lower blood glucose, how long it lasts.
Summary on Types of Insulin:

Rapid-acting insulin, begins to work about 5 minutes after injection, peaks in about 1 hour,
and continues to work for 2 to 4 hours. Types: Insulin glulisine (Apidra), insulin lispro
(Humalog), and insulin aspart (NovoLog)

Regular or Short-acting insulin usually reaches the bloodstream within 30 minutes after
injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3
to 6 hours. Types: Humulin R, Novolin R

Intermediate-acting insulin generally reaches the bloodstream about 2 to 4 hours after
injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours. Types: NPH
(Humulin N, Novolin N)

Long-acting insulin reaches the bloodstream several hours after injection and tends to lower
glucose levels fairly evenly over a 24-hour period. Types: Insulin detemir (Levemir) and insulin glargine
(Lantus)

Long acting and Pre-mixed insulin’s should never be mixed or diluted with any other
insulin or solutions.
Fun ways to learn about insulin and diabetes:
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www.globalrph.com/insulin_mixing.htm
quizlet.com/11903163/mnse-nclex-pn-review-insulin-flash-cards/
quizlet.com/1176546/
l s
dex
n e m
insulin
www.studystack.com/flashcard-123034
www.studystack.com/flashcard-38176
flashcarddb.com/cardset/50409-insulin-flashcards
FYI: (Acceptable range for blood glucose usually 70-110 mg/dL. know your
institutions policy.)
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HYPOglycemia: can occur during peak time. Sweating, weakness, dizziness, chills, confusion,
headache, nausea, rapid/weak pulse, fatigue, tachycardia, change in LOC, slurred speech,
staggering gait, anxiety, tremors, hunger,
Unconsciousness, insulin shock
DEATH
HYPERglycemia: fatigue, polyuria, polydipsia, flushed dry skin, change in LOC
acetone
breath (fruity breath) DKA
Diabetic coma & death
The onset, peak and duration times shown in the chart are estimates based on ADA and pharmaceutical
inserts. Patient onset, peak, and duration times may vary slightly per patient.
Type of
Insulin &
Brand
Names
Onset
Peak
Duration
Role in Blood Sugar Management
Rapid-Acting
Humalog or
lispro
5 -15
min.
30-90 min
3-5 hours
Novolog or
aspart
5 - 15
min.
40-50 min.
3-5 hours
Apidra or
glulisine
5 - 15
min.
30-90 min.
1-2½
hours
Rapid-acting insulin covers insulin needs for meals eaten within 10
minutes or at the same time as the injection.
This type of insulin is used with scheduled longer-acting insulin.
If mixing with NPH, rapid acting insulin, clear, should be drawn into
syringe first. Mixture should be given immediately to avoid effects on
peak action.
Short-Acting
Regular (R)
Humulin or
Novolin
30 min.
2-5 hours
-1 hour
Short-acting insulin covers insulin needs for meals eaten within 3060 minutes of injection.
5-8 hours May be mixed with NPH in same syringe. Mixing order should be
e le
e ul d
n up i s , en e l udy NPH (ie “ le
l udy”)
Intermediate-Acting
Intermediate-acting insulin covers insulin needs for about half the
day or overnight. This type of insulin is often combined with rapidor short-acting insulin. NPH by itself should be given regardless of
meal time.
Available as pen or in vial to be used with syringe.
1-2
hours
4-12 hours
18-24
hours
Lantus
1-1½
hour
No peak time;
insulin is
delivered at a
steady level
20-24
hours
Levemir or
detemir
1-2
hours
6-8 hours
Up to 24
hours
Injections of long-acting insulin are not "timed" to mealtime because
of their long duration of action Levemir is taken once or twice a day
irrespective of mealtime. Lantus is only administered once a day
(and should be administered at the same time each day). Keep in
mind that these long-acting insulins may need to be given with
shorter-acting insulin products --depending on patient situation.
14-24
hours
These products are generally taken twice a day before mealtime.
70% NPH +30% regular insulin.
Novolin 70/30 30 min. 2-12 hours
Up to 24
hours
Novolog Mix: aspart protamine 70% + aspart 30%
Novolog
70/30
10-20
min.
Up to 24
hours
Humalog
50/50
30 min. 2-5 hours
Humalog mix
75/25
15 min.
NPH (N)
Long-Acting
Pre-Mixed*
Humulin
70/30
30 min. 2-4 hours
1-4 hours
30 min.-2½
hours
18-24
hours
16-20
hours
Humalog 50/50: 50% lispro protamine suspension + 50% lispro
protamine injection rDNA origin
Humalog mix 75/25: 75% lispro protamine suspension +
25% lispro protamine injection rDNA origin
*Premixed insulins are a combination of specific proportions of intermediate-acting and a rapid or short-acting insulin in
one bottle or insulin pen (the numbers following the brand name indicate the percentage of each type of insulin). Insulin
action includes 2 peaks (1 from each formulation). Depending on mixture they should be given between 10-45 minutes
before the meal.
= may be infused subcutaneously by external insulin infusion pumps.
Oral Hyperglycemic Pills
Biguanides
Metformin (Glucophage)
Metformin liquid ( Riomet)
Metformin extended
release (Glucophage XR,
Fortamet, Glumetza)
How to Take
Metformin: usually
taken twice a day with
breakfast and evening
meal.
Metformin extended
release: usually taken
once a day in the
morning.
Sulfonylureas
Take within 15-30
Glimepiride (Amaryl)
minutes of a meal or with
Glyburide (Diabeta, Micronase)
meals once or twice a
Glipizide (Glucotrol, Glucotrol XL) day.
Micronized glyburide (Glynase)
Meglitinides
Repaglinide (Prandin)
D-Phenylalanine Derivatives
Nateglinide (Starlix)
Thiazolidinediones
Pioglitazone (TZDs)
Pioglitazonen (Actos)
DPP-4 Inhibitors
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin ( Tradjenta)
Alpha-glucosidase Inhibitors
Acarbose (Precose)
Miglitol (Glyset)
Bile Acid Sequestrants
Colesevelam (Welchol)
How They Work
Decreases amount of glucose
released from liver.
Side Effects
Of Note
Bloating, gas, diarrhea, upset stomach, loss of
appetite (usually within the first few weeks of
Always tell healthcare providers that it may need
starting). Take with food to minimize symptoms.
to be stopped when you are having a dye study or
Metformin is not likely to cause low blood
surgical procedure.
glucose. In rare cases, lactic acidosis may occur
in people with abnormal kidney or liver function.
Stimulates the pancreas to
release more insulin, both right Low blood glucose, occasional skin rash,
after a meal and then over
irritability, upset stomach
several hours
Both of these
medications should be Stimulate the pancreas to
Effects diminish quickly and they must be taken
taken with meals. If you release more insulin right after
with each meal; may cause low blood glucose.
skip a meal, skip the
a meal.
dose.
Because these medicines can cause low blood
glucose, always carry a source of carbohydrate
with you.
Follow your meal plan and activity program. Call
your healthcare provider if your blood glucose
levels are consistently low. If there is an increase
in your activity level or reduction in your weight or
calorie intake, the dose may need to be lowered.
These work quickly when taken with meals to
reduce high blood glucose levels.
However, they are less likely than sulfonylureas to
cause low blood glucose.
May cause side effects such as swelling (edema) Increases the amount of glucose taken up by
muscle cells and keeps the liver from
or fluid retention.
overproducing glucose; may improve blood fat
Usually taken once a
Makes the body more sensitive Does not cause low blood sugar when used
levels.
day; take at the same
to the effects of insulin.
alone.
Talk with your healthcare provider if you have the
time each day.
following symptoms: nausea, vomiting, fatigue,
Increased risk of congestive heart failure in those loss of appetite, shortness of breath, severe
at risk.
edema or dark urine.
Can be taken alone or with metformin, a
Improves insulin level after a
Stomach discomfort, diarrhea, sore throat, stuffy
Take once a day at the
sulfonylurea or Actos.
meal and lowers the amount of nose, upper respiratory infection.
same time each day.
Tell your healthcare provider if you have any side
glucose made by your body.
Does not cause low blood glucose.
effects that bother you or that don’t go away.
Take with meals, to limit the rise of blood glucose
Take with first bite of the Slows the absorption of
that can occur after meals; these do not cause low
meal; if not eating, do not carbohydrate into your
Gas, diarrhea, upset stomach, abdominal pain
blood glucose.
take.
bloodstream after eating.
Take once or twice a
day with a meal and
liquid.
Works with other diabetes
medications to lower blood
glucose.
Constipation, nausea, diarrhea, gas, heartburn,
headache (may interact with glyburide,
levothyroxine and contraceptives)
Primary effect, when used either alone or with a
statin, is to lower LDL cholesterol; has blood
glucose-lowering effect when taken in
combination with certain diabetes medications.
Before taking this medication, tell healthcare
provider if pt. has high triglycerides (blood fats) or
stomach problems, takes thyroid medication or
glyburide (take them 4 hours before taking
Welchol.)
Combination Pills
Pioglitazone & metformin)
(Actoplus Met)
Glyburide & metformin
(Glucovance)
Side effects are the same as those of each pill
used in the combination.
Glipizide & metformin (Metaglip)
Sitagliptin & metformin (Janumet)
Saxagliptin & metformin
(kombiglyze )
Repaglinide & metformin
(Prandimet)
Pioglitazone & glimepiride
(Duetact)
Check with your
provider; usually taken
once a day.
Combines the actions of each
pill used in the combination.
Some combination pills may lead to low blood
glucose levels if one of the medications contained
in the combination has this effect.
May decrease the number of pills you need to
take.