Insulin Actions Times And Peak Times
A good way to improve your glucose levels is to track the peaks and drops in your glucose , so you can figure out why they happened and how to correct them. Once you identify glucose patterns (they ARE there!), you also want to understand when each of your insulins is active and when they typically stop lowering your glucose. This helps you adjust your doses or food intake to stop unwanted ups and downs in your readings. The table below shows the start, peak, and end times for various insulins with some explanations and typical uses for each. When Does My Insulin Peak and How Long Does It Last? designed to peak, covers meals and lowers high BGs Humalog , Novolog and Apidra insulins currently give the best coverage for meals and help keep the glucose lower afterward. Their glucose lowering activity starts to work about 20 minutes after they are taken, with a gradual rise in activity over the next 1.75 to 2.25 hours. Their activity gradually falls over the next 3 hours with about 5 to 6 hours of activity being common with these insulins.Although insulin action times are often quoted as 3-5 hours, the actual duration of insulin action is typically 5 hours or more. See our article Duration of Insulin Action for more information on this important topic. In general, "rapid" insulins are still too slow for many common meals where the glucose peaks within an hour and digestion is complete within 2-3 hours. The best kept secret on stopping post meal spiking is to eake the injection or bolus earlier before the meal and to eat slower low glycemic carbs. Regular insulin still carries its original name of "fast insulin" but its slower action often works better for people who take Symlin or for those who have gastroparesis (delayed digestion). It is also a great choice for those who Continue reading >>
How Long Should You Keep Your Open Insulin Vials?
With so many different insulin and insulin-like products out there these days it can be hard to keep track of when your vial should be tossed. Depending on your dose, you may still have insulin left in your vial by the manufacturer-recommended time to throw it away. If this sounds like a familiar situation, know that it is important to throw away your vial regardless of whether you have any leftover. You might think it is wasteful to throw out what you may consider “perfectly good insulin,” but using the medication past the recommended time can actually do you more harm than good. You may notice that if you continue to use insulin from a vial past the manufacturers discard date, your blood glucose could be higher or a greater dose may be needed to achieve a normal blood glucose reading. There are several different types of insulin and a variety of other injectable diabetes medications, and the recommendations for how long they keep varies. For a quick overview, the different categories of insulin are: Rapid-acting Short-acting (regular) Intermediate-acting Long-acting So how long can you hold on to your insulin after you start using a vial? Rapid-acting insulin Short-acting insulin Humulin R: use within 31 days after puncturing vial Humulin R U-500 concentrated: use within 31 days after puncturing vial Intermediate-acting insulin Long-acting insulin Other injectable diabetes medications in vials A glycated hemoglobin (HbA1c) is a preferred screening test for diabetes. Done easily with a fingerstick in your physician’s office, it eliminates the need for fasting (not eating) prior to the test. The diagnosis of diabetes is confirmed if two consecutive A1c levels are greater than or equal to 6.5. What is the HbA1c? Red blood cells are permeable to glucose (sugar)—so Continue reading >>
How Long Should Insulin Be Used Once A Vial Is Started?
Editor’s comment: The commentary by Dr. Grajower has such important clinical relevance that responses were invited from the three pharmaceutical companies that supply insulin in the U.S. and the American Diabetes Association, and all of these combined in this commentary. The commenting letter and individual responses were authored separately and are completely independent of each other. Diabetic patients treated with insulin, whether for type 1 or type 2 diabetes, are prone to often unexplained swings in their blood glucose. These swings can vary from dangerously low to persistently high levels. Most diabetic patients, and most physicians, will adjust insulin regimens so as to avoid hypoglycemia at the expense of hyperglycemia. Among the “textbook” reasons for variable glucose responses to any given insulin regimen are 1) site of administration, 2) exercise, 3) bottles not adequately mixed before drawing the insulin (for NPH, Lente, or Ultralente), and 4) duration of treatment with insulin (1). A new insulin was marketed by Aventis Pharmaceuticals about 1 year ago, insulin glargine (Lantus). The manufacturer seemed to stress that patients not use a started bottle of this insulin for >28 days (2). Two patients of mine highlighted this point. L.K. is a 76-year-old woman with type 2 diabetes, diagnosed at 55 years of age, and treated with insulin since age 56. Her insulin regimen was changed to Lantus at night together with Novolog before meals. She monitors her blood glucose four times a day. She used a bottle of Lantus until it ran out; therefore, a bottle lasted for 2 months. Her recent HbA1c was 7.6%. I retrospectively analyzed her home glucose readings by averaging her fasting blood glucose levels for the first 15 days of a new bottle and the last 15 days of tha Continue reading >>
How To Store Insulin
Insulin is measured in units. Most bottles, cartridges, and pens of insulin sold in the United States have 100 units of insulin per milliliter of fluid and are labeled U-100. Different strengths, like U-500, also are available in the U.S. Different strengths are used in other countries. It's important to know the type of insulin you take and whether it should appear cloudy or clear. When you prepare to use a bottle, cartridge, or pen, check the insulin: NPH should look uniformly cloudy after you gently roll the bottle or pen. All other insulin should look clear. If your insulin doesn't look right, don't use it. Take it back to your pharmacy. Don't shake your insulin. Gently roll it. Don't toss it around or handle it roughly. If you don't handle your insulin correctly, it's more likely to clump or frost. Don't use the insulin if you can see clumps after you gently roll the bottle or pen, or if the sides look frosted. Storage Guidelines Take steps to store your insulin correctly, or it might not work. Keep your insulin away from heat and light. Any insulin that you don't store in the refrigerator should be kept as cool as possible (between 56°F and 80°F.) Never let your insulin freeze. If your insulin freezes, don't use it, even after it's thawed. Keep unused bottles, cartridges, and pens of insulin in the refrigerator (between 36°F and 46°F). If stored properly, these will be good until the expiration date listed on the insulin. Keep insulin cartridges and pens that you're currently using at room temperature (between 56°F and 80°F.) Expiration Guidelines An open insulin bottle, cartridge, or pen is only good for a limited time. Follow these guidelines for discarding insulin: Glargine (Lantus): Discard opened bottles, pens, and cartridges 28 days after you've starte Continue reading >>
Lantus glargine by Aventis long-acting analog U100 Special, pH 4 Line new molecular entity Also known as Glargine (generic) Similar to Levemir, PZI ultralente, Ultratard (duration) Action in cats varies by animal onset variable, asymmetric peak 5-14h (4-20 h as per Nelson) duration 9-24h (10-16 h as per Nelson) Action in dogs onset inconsistent, peak 0.5 to 6 hours, inconsistent, duration about 13hr but inconsistent-beef/pork PZI has longer duration (10-16 h as per Nelson) Use and Handling Type clear Shelf Life refrigerate, until date on package When opened 28 days at room temp, up to 6 months when stored in the refrigerator (2C to 8C) In pen 28 days at room temp Notes protect from light and heat do not mix with other insulins do not dilute do not prefill syringe discard if precipitate or cloudiness discard if frozen Do not use intravenously Do not use intramuscularly Lantus is the brand name for insulin glargine, an insulin analog made by Aventis. Lantus is a very long-acting insulin (lasting up to 24 hours in humans) that uses pH reactions to form micro-precipitates under the skin, which create a time-release action. Because of cats' faster metabolism, long-acting insulins like Lantus (and perhaps Levemir) are gaining a good reputation in veterinary research for regulating cats for a full 12 hours at a time, often better than some of their shorter-acting cousins. Proponents of Lantus in feline use point out that it lasts a full 12 hours in many cats, has a very gentle onset, a negligible peak, and (some claim) less chance of triggering hypo or rebound than faster-acting insulins. The famous Queensland University studies showed that a simple protocol (in a 24-hour monitored, veterinary environment, with a Low-carb diet) could bring ma Continue reading >>
Lantus Prices Squeeze Veterinarians And Owners Of Diabetic Cats
At more than $200 a 10-ml vial, the world’s most prescribed insulin is priced at or beyond the threshold of what many cat owners are able or willing to pay. Veterinarians are fielding complaints from clients, leaving some practitioners facing the delicate and time-consuming prospect of re-regulating their feline patients on other insulins. Dr. Michael Mihlfried, of Athol, Idaho, has prescribed Sanofi's Lantus (insulin glargine) for the past four years. Licensed for use in humans, a 10-ml vial of Lantus holds 1,000 units of the long-acting insulin. Many veterinarians say it can last a cat owner for months given that a moderate dosage is 2 to 3 units twice daily. “It’s the insulin I reach for when there's a diabetic cat,” Mihlfried said. “Most of my remissions have come by using Lantus. I have one particular owner who has told me he absolutely can’t afford to use it any longer. The cat is 18 years old. We’re going to try ProZinc." Manufactured by Boehringer Ingelheim, ProZinc is one of a couple of insulins licensed in the United States for use in cats. It costs about $100 for a 10-ml vial containing 400 units. Vetsulin, manufactured by Merck Animal Health, is another veterinary-specific insulin. It costs around $40 for a 400-unit, 10-ml vial. How these products compare in price to Lantus can vary depending on the patient. Diabetic cats respond differently to treatments. Some veterinarians find that Lantus, approved by the U.S. Food and Drug Administration (FDA) for use in humans, works best in their diabetic feline patients. “All of my diabetics are on it,” said Dr. William Folger, a board-certified feline specialist in Houston. “It was $82 a bottle when it came out, roughly a decade ago. Then it went to $116 and $128. Now it’s being sold at Walgreen Continue reading >>
Long-acting Insulin: How It Works
When you eat, your pancreas releases a hormone called insulin. Insulin moves sugar (glucose) from your blood to your cells for energy or storage. If you take insulin, you may need some at mealtime to help lower your blood sugar after you eat. But even between meals, you need insulin in small amounts to help keep blood sugar stable. This is where long-acting insulin comes in. If you have diabetes, either your pancreas can’t produce enough (or any) insulin, or your cells can’t use it efficiently. To control your blood sugar, you need to replace or supplement the normal function of your pancreas with regular insulin injections. Insulin comes in many types. Each type differs in three ways: onset: how quickly it starts working to lower your blood sugar peak: when its effects on your blood sugar are strongest duration: how long it lowers your blood sugar According to the U.S. Food and Drug Administration (FDA), the five types of insulin are: Rapid-acting insulin: This type starts to work just 15 minutes after you take it. It peaks within 30 to 90 minutes, and its effects last for three to five hours. Short-acting insulin: This type takes about 30 to 60 minutes to become active in your bloodstream. It peaks in two to four hours, and its effects can last for five to eight hours. It is sometimes called regular-acting insulin. Intermediate-acting insulin: The intermediate type takes one to three hours to start working. It peaks in eight hours and works for 12 to 16 hours. Long-acting insulin: This type takes the longest amount of time to start working. The insulin can take up to 4 hours to get into your bloodstream. Pre-mixed: This is a combination of two different types of insulin: one that controls blood sugar at meals and another that controls blood sugar between meals. Lo Continue reading >>
How To Inject Lantus® With A Vial And Syringe
Do not take Lantus® during episodes of low blood sugar or if you are allergic to insulin or any of the inactive ingredients in Lantus®. Do not share needles, insulin pens, or syringes with others. Do NOT reuse needles. Before starting Lantus®, tell your doctor about all your medical conditions, including if you have liver or kidney problems, if you are pregnant or planning to become pregnant or if you are breast-feeding or planning to breast-feed. Heart failure can occur if you are taking insulin together with certain medicines called TZDs (thiazolidinediones), even if you have never had heart failure or other heart problems. If you already have heart failure, it may get worse while you take TZDs with Lantus®. Your treatment with TZDs and Lantus® may need to be changed or stopped by your doctor if you have new or worsening heart failure. Tell your doctor if you have any new or worsening symptoms of heart failure, including: Sudden weight gain Tell your doctor about all the medications you take, including OTC medicines, vitamins, and supplements, including herbal supplements. Lantus® should be taken once a day at the same time every day. Test your blood sugar levels while using insulin, such as Lantus®. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Do NOT dilute or mix Lantus® with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus® must only be used if the solution is clear and colorless with no particles visible. Always make sure you have the correct insulin before each injection. While using Lantus®, do not drive or operate heavy machinery until Continue reading >>
- Caffeinated and Decaffeinated Coffee Consumption and Risk of Type 2 Diabetes: A Systematic Review and a Dose-Response Meta-analysis
- Insulin, glucagon and somatostatin stores in the pancreas of subjects with type-2 diabetes and their lean and obese non-diabetic controls
- St. Luke’s Spotlights Critical Link Between Type 2 Diabetes and Heart Disease in Partnership with Boehringer Ingelheim and Eli Lilly and Company
Can I Use My Insulin Past Its Expiration Date?
A certified diabetes educator answers whether older insulin is still safe to use. Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community. Q: Should I really worry about using insulin after its expiration date? What about using it for more than 30 days? I think the insulin companies promote that just to make us throw out good insulin. A: When it comes to insulin, we have to make darned sure that the stuff is at full potency, or blood glucose levels can go dangerously high. The insulin manufacturers are required to test their products rigorously before bringing them to market. They can more or less guarantee that their products will work as indicated if used within the expiration date and for not more than a month after the seal on the vial, cartridge, or pen is broken. This is, of course, assuming that the insulin has been stored properly and not exposed to extreme heat, freezing cold, or direct sunlight. sponsor Does this mean that insulin suddenly goes belly up at the stroke of midnight on the expiration date, or 28 days after being put into use? Hardly. Many people, including clinicians with diabetes, have used insulin beyond the “deadlines” without a hitch. It simply means that the manufacturer has not tested their product beyond the dates indicated, so there is no guarantee — no way of knowing exactly how long the insulin will remain at full strength. Read “Can I Get Insulin Over the Counter?” This is where common sense comes into play. For those with good insurance coverage and plenty of insulin on-hand, it’s best to follow the rules and discard i Continue reading >>
How Long Should You Keep Insulin Pens?
Did you read our blog on insulin vials and think to yourself, does this apply to my insulin pens too? If so, this post is for you! With so many different insulin and insulin-like products out there these days it can be hard keep track of how long each of these pens stays good. Depending on your dose, you may still have insulin left in your pen at the manufacturer-recommended time to throw it away. If this sounds like a familiar situation, know that it is important to throw away your pen regardless of whether you have any leftover. You might think it’s wasteful, but using the medication past the recommended time can actually do you more harm than good. You may notice if you continue to use insulin from a pen that’s past the manufacturers discard date, your blood glucose may be higher or a greater dose may be needed to achieve a normal blood glucose reading. There are several different types of insulin and a variety of other injectable diabetes medications, and they don’t all have the same recommendations. As a quick reminder, the different categories of insulin are: Rapid-acting. Short-acting (regular). There are no short-acting insulin pens available Intermediate-acting. Long-acting. So how long can you hold on to your insulin pen after you start to use it? Rapid-acting insulin Novolog FlexPen: use within 28 days after first use Novolog cartridge (for use in a re-useable pen): use within 28 days after first use Humalog KwikPen: use within 28 days after first use Humalog cartridge (for use in a re-useable pen): use within 28 days after in-use Apidra SoloStar: use within 28 days after first use Intermediate-acting insulin Long-acting insulin Lantus SoloStar: use within 28 days after first use Toujeo SoloStar: use within 28 days after first use Levemir FlexTouch: use Continue reading >>
Types Of Insulin For Diabetes Treatment
Many forms of insulin treat diabetes. They're grouped by how fast they start to work and how long their effects last. The types of insulin include: Rapid-acting Short-acting Intermediate-acting Long-acting Pre-mixed What Type of Insulin Is Best for My Diabetes? Your doctor will work with you to prescribe the type of insulin that's best for you and your diabetes. Making that choice will depend on many things, including: How you respond to insulin. (How long it takes the body to absorb it and how long it remains active varies from person to person.) Lifestyle choices. The type of food you eat, how much alcohol you drink, or how much exercise you get will all affect how your body uses insulin. Your willingness to give yourself multiple injections per day Your age Your goals for managing your blood sugar Afrezza, a rapid-acting inhaled insulin, is FDA-approved for use before meals for both type 1 and type 2 diabetes. The drug peaks in your blood in about 15-20 minutes and it clears your body in 2-3 hours. It must be used along with long-acting insulin in people with type 1 diabetes. The chart below lists the types of injectable insulin with details about onset (the length of time before insulin reaches the bloodstream and begins to lower blood sugar), peak (the time period when it best lowers blood sugar) and duration (how long insulin continues to work). These three things may vary. The final column offers some insight into the "coverage" provided by the different insulin types in relation to mealtime. Type of Insulin & Brand Names Onset Peak Duration Role in Blood Sugar Management Rapid-Acting Lispro (Humalog) 15-30 min. 30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- How to use long-acting insulin: Types, frequency, peak times, and duration
- Insulin pens: Types, benefits, and how to use them
How To Use The Lantus® Solostar® Pen
Please check the leaflet for the insulin for complete instructions on how to store SoloSTAR®. If your SoloSTAR® is in cool storage, take it out 1 to 2 hours before you inject to allow it to warm up. Cold insulin is more painful to inject. Keep SoloSTAR® out of the reach and sight of children. Keep your SoloSTAR® in cool storage (36°F–46°F [2°C–8°C]) until first use. Do not allow it to freeze. Do not put it next to the freezer compartment of your refrigerator, or next to a freezer pack. Once you take your SoloSTAR® out of cool storage, for use or as a spare, you can use it for up to 28 days. During this time it can be safely kept at room temperature up to 86°F (30°C). Do not use it after this time. SoloSTAR® in use must not be stored in a refrigerator. Do not use SoloSTAR® after the expiration date printed on the label of the pen or on the carton. Protect SoloSTAR® from light. Discard your used SoloSTAR® as required by your local authorities. Protect your SoloSTAR® from dust and dirt. You can clean the outside of your SoloSTAR® by wiping it with a damp cloth. Do not soak, wash, or lubricate the pen as this may damage it. Your SoloSTAR® is designed to work accurately and safely. It should be handled with care. Avoid situations where SoloSTAR® might be damaged. If you are concerned that your SoloSTAR® may be damaged, use a new one. Continue reading >>
How Long Does Insulin Last Once It's Been Opened?
A fellow caregiver asked... My mother has type 2 diabetes and needs help with her insulin injections. After I open a new bottle, how long does insulin last for, how should I store it, and how do I know whether it's gone bad? Expert Answers As a general rule, most bottles of insulin are good for 28 days once they're opened. Of course, how quickly a person goes through a vial is highly individual. Some may go through a bottle in a week or two. Others, on a lower dosage, may not use all the insulin within four weeks. But the drug's stability and potency is only guaranteed for 28 days. Opened insulin pens typically last 14 days, though some last only 10 days. If you're uncertain, check with your mother's pharmacist to find out how long her insulin should last. When either of you opens a new vial or pen, make a note on the calendar -- and note the date when you'll need to throw out any remaining insulin. It's best to store an opened bottle of insulin at room temperature, even though manufacturers often recommend refrigeration for opened containers. It's usually less painful to inject insulin when it's at room temperature than when it's cold. Store unopened insulin vials and pen cartridges in the fridge, though, where they should last until their expiration date. Insulin shouldn't be exposed to extreme temperatures, so don't leave it in the car, next to the stove, in the freezer, or in the bathroom. If the bottle freezes, it must be discarded. Two typical signs that insulin has gone bad: poor performance and unusual appearance. If your mother is following her treatment plan and her glucose levels stay stubbornly, inexplicably high, her insulin may have lost its potency. Insulin that's cloudy when it's supposed to be clear or that contains particles, crystals, or small clumps Continue reading >>
How Do I Get Lantus Insulin Less Expensively?
November 2, 2013-- How do I get Lantus Insulin Less Expensively? DCIN receives this question a few times a week from US caregivers of diabetic cats. I am often amazed by the question because of the “good” insulins for diabetic cats, Lantus can be the least expensive per unit. The problem often lies in knowing how to find the insulin inexpensively. (The hints I give also apply to Levemir, another human insulin often used by diabetic cats.) Your vet gave you a prescription that probably read “U100 Glargine/Lantus 10ml vial.” Lantus is the brand name for the generic insulin Glargine. Lantus is an insulin for humans and is only available from a human pharmacy (although some vets do hold some in stock). The company Sanofi makes Lantus, and no other companies currently make a generic Glargine because Sanofi still has an international patent on the insulin. That may change in 2014, and by then Sanofi may have developed a “second-generation” Lantus that is patent protected. Lantus is a U100 insulin, which describes the concentration of the insulin in the liquid suspension. A 10ml vial is the insulin’s containment device. It is a small glass bottle with a rubber stopper at the end that you pierce with a syringe. At a US retail pharmacy, a 10ml vial of Lantus can cost about $180 to $200. WOWZA! That does seem cause for sticker shock. A 10ml vial of U100 insulin holds 1000 units of insulin. At $200/vial, that is a price of $.20/unit. If your cat gets 2 units of insulin twice a day, that is $.80/day for its insulin (if you could completely use a vial of Lantus insulin). It would cost less each day to give your cat its life-saving medicine that to buy a soda from a vending machine. However, the problem with buying Lantus in a 10ml vial is that, properly handled, Lantus Continue reading >>
Can Insulin Go Back In The Fridge?
After removing insulin glargine (Lantus) from the refrigerator for use, can it be refrigerated over and over again after having warmed to room temperature, or does this degrade it? Continue reading >>