There are four main types of insulin they are short acting, rapid acting, intermediate and long acting insulin. Regular and intermediate insulin?s are referred as human insulin?s. Rapid and long acting insulin?s are chemically modified forms of human insulin.

 

 

Insulin preparations

The primary indication of insulin is in type I diabetes mellitus and gestational diabetes.

If Antidiabetic medications fail, insulin therapy may be necessary – usually in addition to oral medication therapy – to maintain normal or near normal glucose levels.

Types of insulin

Types of insulin	Examples (Brand names)	Onset in (hr)	Peak (hr)	Duration (hr)
Rapid acting insulin	Aspart, Glulisine, Lispro	0.2 - 0.5	0.5 - 2	3 - 4
Short acting insulin	Regular	0.5 - 1	2 - 3	6 - 8
Short acing insulin	Velosulin	0.5 - 1	2 - 3	2 - 3
Intermediate acting	NPH	1.5	4 - 10	16 - 24
Intermediate acting	Lente	1.5 – 3	7 – 15	16 - 24
Long acting	Ultralente	3 - 4	9 – 15	22 -24
Long acting	Levimer	1 - 2	6 – 8	Up to 24
Long acting	Lantus	1 - 2	No peak	20 – 24 P
Premixed	Humulin 70/30	0.5	2 - 4	14 – 24
Premixed	Humulin 50/50	0.5	2 - 5	18 - 24
Premixed	Humalog 75/25	0.2	0.5 – 2.5	16 – 24

Protocol for insulin therapy

Bed time NPH or Glargine insulin with anti diabetic medications, start 10- 15 units and titrate the fasting glucose to 120 mg/dl.

For twice day insulin start 0.5 U/kg with 2/3 in morning and 2/3 as NPH, to give insulin 20-30 min before meals.

For 2 or more injections daily, add Metformin or glitazone, if total insulin dosage exceeds >1-2 U/kg

Glycemic goals

• Self monitoring of glucose
• Laboratory monitoring of glucose
  

 

Test	Blood glucose (FBS, PPBS)	HbAIc	Lipid profile
DM with insulin treatment	Depends on blood glucose level	Every 3 months	yearly
DM without insulin treatment	Every 3 months	Every 3-6 months	yearly

 

Types of insulin syringes

• Normal insulin syringes: size ranging from 28-31 gauge.
• Insulin pens or pen injections: these look like pens with cartridges which are filled with insulin.
• Jet injectors: The jet injectors use high pressure air to send a find spray of insulin through the skin. These devices have no needles.
• Insulin pumps: Insulin pumps are small sized pumping devices worn outside the body.