5 Types Of Insulin And How They Work
What you need to know If you have to take insulin to treat diabetes, there’s good news: You have choices. There are five types of insulin. They vary by onset (how soon they start to work), peak (how long they take to kick into full effect) and duration (how long they stay in your body). You may have to take more than one type of insulin, and these needs may change over time (and can vary depending on your type of diabetes). Find out more about the insulin types best for you. Rapid-acting insulin What it’s called: Humalog (lispro), NovoLog (aspart), Apidra (glulisine) Rapid-acting insulin is taken just before or after meals, to control spikes in blood sugar. This type is typically used in addition to a longer-acting insulin. It often works in 15 minutes, peaks between 30 and 90 minutes, and lasts 3 to 5 hours. “You can take it a few minutes before eating or as you sit down to eat, and it starts to work very quickly,” says Manisha Chandalia, MD, director of the Stark Diabetes Center at the University of Texas Medical Branch, in Galveston. Short-acting insulin What it’s called: Humulin R, Novolin R Short-acting insulin covers your insulin needs during meals. It is taken about 30 minutes to an hour before a meal to help control blood sugar levels. This type of insulin takes effect in about 30 minutes to one hour, and peaks after two to four hours. Its effects tend to last about five to eight hours. “The biggest advantage of short-acting insulin is that you don't have to take it at each meal. You can take it at breakfast and supper and still have good control because it lasts a little longer,” Dr. Chandalia says. Intermediate-acting insulin What it’s called: Humulin N (NPH), Novolin N (NPH) Intermediate-acting insulin can control blood sugar levels for about Continue reading >>
Managing diabetes often requires taking insulin shots throughout the day. Insulin delivery systems such as insulin pens can make giving insulin shots much easier. If you currently use a vial and syringe to deliver your insulin, switching to an insulin pen may make it easier to take your insulin and increase your compliance. Insulin pens do not eliminate your need to poke yourself with a needle. They simply make measuring and delivering your insulin easier. Insulin pens deliver anywhere from .5 to 80 units of insulin at a time. They can deliver insulin in increments of one-half unit, one unit, or two units. The maximum dose and the incremental amount vary among pens. The amount of total insulin units in the cartridges vary as well. The pens come in two basic forms: disposable and reusable. A disposable insulin pen contains a prefilled cartridge, and the entire pen is thrown away when the cartridge is empty. Reusable pens allow you to replace the insulin cartridge when it’s empty. The insulin pen you use depends on the type of insulin you require, the number of units you typically need per insulin shot, and the available pens for that insulin type. The needles on insulin pens come in different lengths and thicknesses, and most fit on all of the available insulin pens. Talk to your doctor or healthcare provider to decide which pen is best for you. Similar to vials of insulin, insulin pens do not require constant refrigeration once they’ve been opened. Insulin pens only require refrigeration before their first use. After its initial use, simply keep your insulin pen out of direct sunlight and in a room-temperature setting. Insulin pens typically stay good for 7 to 28 days after the initial use, depending on the type of insulin they contain. However, if the expiration da Continue reading >>
How Long Is An Open Vial Of Insulin Good For?
Once an insulin vial is punctured and open there is a limited amount of time that the vial can be stored before it becomes unsafe to use. Many people who use insulin will have left over medication in the vial because of the size of their daily dosages. Different insulin products have different time limits on being able to store it safely and it can be hard to track and remember. Not all types of glucose will have the same expiration time on open vials. They not only vary by type but also by the drug used. Here’s a help list to refer to for the proper length of time to store open (punctured) vials: Long-Acting Insulin Intermediate-Acting Insulin Humulin N: 1 month (31 days) after opening Short-Acting Insulin Novolin R: 42 days after opening Humulin R: 31 days after opening Humulin R U-500 concentrated: 31 days after opening Rapid-Acting Insulin Aspart (novolog): 28 days after opening Glulisine (apidra): 28 days after opening Lispro (humalog): 28 days after opening Other Non-Insulin Injected Medication Bydureon: use immediately once punctured and mixed. Do not store any unused portions. Helpful Tips Do not keep insulin in a hot space or overly warm room. Heat will break down the insulin and make it ineffective. Open vials can be stored at room temperature or in the refrigerator. Do not store insulin in sunlight. Direct light will also break down the insulin. Look at your insulin vial before using it after storage. Insulin should always be clear, never cloudy in appearance. There should not be any white particles or solid crystals. Insulin that is not clear or that has a smell or odor should not be used and must be thrown away. It may feel wasteful to throw away unused insulin when the recommended use time is reached. However, the medication loses its effectiveness past Continue reading >>
NovoLog® Storage Home or Away, NovoLog® Goes With You NovoLog® lasts up to 28 days without refrigeration after first use, so it can be taken almost anywhere. Once in use, NovoLog® FlexPen® must be kept at room temperature below 86°F for up to 28 days. Its ability to stand up to heat is equal to, or better than, other major fast-acting insulin brands. Here is a quick guide to NovoLog® storage: Storage for NovoLog® FlexPen® 3 mL PenFill® cartridge,a and 10mL vial: Temperature Use up to In useb,c (opened) Room temperature: up to 86°F 28 days Not in use (unopened) Room temperature: up to 86°F 28 days Not in use (unopened) Refrigerated: 36°F to 46°F Expiration date a3 mL PenFill® cartridge is available for NovoPen Echo®. bFlexPen® and PenFill® cartridges in use (opened) must NOT be stored in the refrigerator. cIn use vials (opened) may be stored in the refrigerator. Do's: Don'ts: Do store unused NovoLog® in a refrigerator between 36° to 46°F (2° and 8°C) Don’t store NovoLog® in the freezer or directly adjacent to the refrigerator cooling element Don’t freeze NovoLog® or use NovoLog® if it has been frozen Don’t draw NovoLog® into a syringe and store for later use Do keep vials at temperatures below 86°F (30°C) for up to 28 days after initial use. Opened vials may be refrigerated Do use unpunctured vials until the expiration date printed on the label if they are stored in a refrigerator Do keep unused vials in the carton so they will stay clean and protected from light Don’t expose vials to excessive heat or light Do keep NovoLog® FlexPen® at temperatures below 86°F (30°C) for up to 28 days once it is punctured Don’t store in use NovoLog® FlexPen® in the refrigerator Do keep NovoLog® FlexPen® and all PenFill® cartridges away from 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 >>
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 >>
Tracking Insulin's Health In The Summer Heat
Sunscreen: check. Water bottle: check. Beach ball: check. Insulin cooler....? Yep. For those of us who use insulin, summer heat creates an extra level of complexity and worry. The real question we all ask ourselves in the heat of the summer is whether our fun-in-the-sun will cook our insulin and leave us having-not-so-much-fun in an air conditioned ICU unit? There's a whole industry of solutions dedicated to helping us keep our insulin cool, ranging from cooling packs such as the ReliOn and others, to portable fridges, to high tech cooling crystals. Hell, we're even running a Giveaway contest this week in which our readers can win some of these products! With much of the U.S. suffering under a stifling drought-baked summer, the question of just how hot insulin can get is on all our minds. But you have to wonder if these products are serving an important need or just preying on our fears. To find out, we asked the manufacturers themselves, some leading insulin experts, and the American Diabetes Association — and guess what? The answer isn't as clear as you might like. Not Your Grandma's Insulin First, a bit of history: Didn't grandma keep her insulin in the fridge all the time? Well, only if she read the label. The original pork and beef insulin formulations were supposed to be kept cold all the time. As cold insulin stings like hell to inject, the move to being able to keep the newer human insulin and later analogs at room temperature was a great victory (!) for those of us who are human pin cushions. But wait a minute... whose room temperature are we talking about? My father used to get annoyed with me when I'd shovel ice cubes into my glass of red wine. "Wine is supposed to be consumed at room temperature," he'd huff. "Yeah, in the frickin' French Alps,where room te Continue reading >>
Beware Summer Extremes With Insulin
Living with diabetes blog With summer arriving in Minnesota and many other places, I'd like to talk about how to manage insulin storage in extreme temperatures such as this season brings. A number of years ago, I met with a client who used a rapid insulin pen for meal dosing. She shared with me a story of how she attended the county fair on an exceptionally hot day, and had placed her insulin pen in the back pocket of tight jeans and walked around the fairgrounds all day. She used the pen for covering meals eaten at the fair, and her blood sugars were running higher than normal, but she related this to all the junk food. The next day her blood sugars continued to run high and when she took her (rapid) insulin, it didn't seem to affect her blood sugar level at all; in fact, it was like she was taking water instead of insulin. She wondered if the heat had affected her insulin, so she switched to a new insulin (disposable) pen, and soon after her blood sugars started to drop. Has this or something similar happened to you? I looked at insulin manufacturers' websites and found that for the majority of all types and brands of insulin, the maximum temperatures recommended are as follows: Opened room temperature insulin should not exceed 86 F (30 C) with the exception of Lantus, which should not exceed 77 F (25 C). Most manufacturers of insulin recommend discarding insulin if it exceeds 98.6 F (37 C). Other non insulin diabetic injectable medications: Glucagon and Byetta should not exceed 77 F (25 C). Symlin should not exceed 86 F (30 C). Avoiding potential problems Temperatures exceeding manufacturer's recommendations for insulin/medications Store your insulin in the refrigerator, in an insulated case or cooler with a freezable gel pack, or use a cooling wallet. Cooling wallet 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 >>
Information Regarding Insulin Storage And Switching Between Products In An Emergency
en Español Insulin Storage and Effectiveness Insulin for Injection Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. After a disaster, patients in the affected area may not have access to refrigeration. According to the product labels from all three U.S. insulin manufacturers, it is recommended that insulin be stored in a refrigerator at approximately 36°F to 46°F. Unopened and stored in this manner, these products maintain potency until the expiration date on the package. Insulin products contained in vials or cartridges supplied by the manufacturers (opened or unopened) may be left unrefrigerated at a temperature between 59°F and 86°F for up to 28 days and continue to work. However, an insulin product that has been altered for the purpose of dilution or by removal from the manufacturer’s original vial should be discarded within two weeks. Note: Insulin loses some effectiveness when exposed to extreme temperatures. The longer the exposure to extreme temperatures, the less effective the insulin becomes. This can result in loss of blood glucose control over time. Under emergency conditions, you might still need to use insulin that has been stored above 86°F. You should try to keep insulin as cool as possible. If you are using ice, avoid freezing the insulin. Do not use insulin that has been frozen. Keep insulin away from direct heat and out of direct sunlight. When properly stored insulin becomes available again, the insulin vials that have been exposed to these extreme conditions should be discarded and replaced as soon as possible. If patients or healthcare providers have specific questions about the suitability of their insulin, they may call the respective manufacturer a 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 Does Insulin Really Last?
Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. I've seen a similar thread in the past, but now I've got my own experience to go on, and I'd like to hear about yours. Your actual experience, mind - not what you've read. Now, everybody knows what the drug companies say - 28 days after first use and then get rid of it. Yet it can stay "unopened" in the fridge for 2 years. When I was researching this (will try to give references if I can find them again) the papers I found cited several factors for length of original potency: When I was using vials, I always left them in the fridge. Injecting cold doesn't bother me, but if it bothers you, let the syringe warm up instead of the whole bottle. I could routinely go 45 days with no loss of potency (Lantus). I've never had vials of Novolog, so I can't speak to that. The pens change things, because there is no added air. They have caps, so no light. Don't carry them around, so no motion. I can see no reason why they cannot be used until their expiration date. I've got a NovoPen I've been using (from the fridge) for 2 months, and it works just fine. Also, I've still got a pen (Novolog) that I started using November 4 (it has been room temp for that time). I do carry it with me (as a backup) - mostly I 'm at home for meals. I do check for cloudiness, etc, but so far so good. Used it recently, and I did shoot 5 U, instead of the 3 U I would with fresh, and worked just as expected. Yes, after 3 months it's time to change it out. So I'm asking about two things really. One is saving money - why throw it out when it is fine if kept cold? I'm sure big Pharma likes it only good 28 days - why that magic numbe Continue reading >>
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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 >>
Insulin Pens Are Welcome Back To The Fridge!
We all know that unopened insulin must be kept in the refrigerator. But once in use can we put it back in the fridge to protect it from excessive heat? The answer to this simple question is not as easy as one might think. All manufacturers explicitly recommend to ‘Not refrigerate’ insulin pens in use. This guideline that causes confusion among users is now being revoked by one manufacturer. Let’s try to understand the reasoning behind it and what it means for users now. What? I shouldn’t put my insulin pen back in the refrigerator? When it comes to storing medications, it is recommended you follow the leaflet or packaging instructions. For insulin in particular, there are two different situations: storing and in-use. · Before Opening: When insulin is to be stored long-term and has not been opened, keeping it in the fridge ensures it lasts until expiration date. · During Use: Once a vial, a cartridge or a new disposable pen are used for the first time, the insulin can be kept at room temperature. But it needs to be used within weeks. It makes sense: higher temperatures and an open product mean a shorter shelf life. But there is one extra sentence on insulin pens packages, which has caused quite some confusion: Pens in use — ‘Do not refrigerate.’ What does ‘do not refrigerate’ mean for users? Let’s take a trip back to 2003, when the recommendation to not refrigerate opened insulin first appeared. Take Lilly’s Humalog for example, for which the label was first altered 14-years ago: What was the reason behind this? People started to speculate this warning was a result of preventing any kind of temperature extremes from affecting the insulin once it is in use. Many insulin users know from experience that high temperature can lower the effectiveness of 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 >>
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