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What Kind Of Insulin Is Nph

Types Of Insulin

Types Of Insulin

Topic Overview Insulin is used to treat people who have diabetes. Each type of insulin acts over a specific amount of time. The amount of time can be affected by exercise, diet, illness, some medicines, stress, the dose, how you take it, or where you inject it. Insulin strength is usually U-100 (or 100 units of insulin in one millilitre of fluid). Short-acting (regular) insulin is also available in U-500. This is five times more concentrated than U-100 regular insulin. Long-acting insulin (glargine) is also available in U-300. This is three times more concentrated than U-100 long-acting insulin. Be sure to check the concentration of your insulin so you take the right amount. Insulin is made by different companies. Make sure you use the same type of insulin consistently. Types of insulinfootnote 1 Type Examples Appearance When it starts to work (onset) The time of greatest effect (peak) How long it lasts (duration) Rapid-acting Apidra (insulin glulisine) Clear 10-15 minutes 1-1.5 hours 3-5 hours Humalog (insulin lispro) Clear 10-15 minutes 1-2 hours 3.5-4.75 hours NovoRapid (insulin aspart) Clear 10-15 minutes 1-1.5 hours 3-5 hours Short-acting Humulin R, Novolin ge Toronto (insulin regular) Clear 30 minutes 2-3 hours 6.5 hours Intermediate-acting Humulin N, Novolin ge NPH(insulin NPH) Cloudy 1-3 hours 5-8 hours Up to 18 hours Long-acting Lantus (insulin glargine) Clear 1.5 hours Does not apply Up to 24 hours Levemir (insulin detemir) Clear 1.5 hours Does not apply 16 to 24 hours Toujeo (insulin glargine U-300) Clear Up to 6 hours Does not apply Up to 30 hours Rapid-acting insulins work over a narrow, more predictable range of time. Because they work quickly, they are used most often at the start of a meal. Rapid-acting insulin acts most like insulin that is produced by Continue reading >>

Insulin Use And Exercise, Part 1: Faster And Intermediate-acting Insulins

Insulin Use And Exercise, Part 1: Faster And Intermediate-acting Insulins

When you don’t have diabetes and you start any activity, your body increases the release of glucose-raising hormones to prevent falls in your blood glucose levels. At the same time, your pancreas releases less insulin during exercise. But what about your patients who have diabetes? Sheri Colberg, Ph.D., FACSM, discusses how you can help your patients in this week’s feature Insulin Use and Exercise, Part 1: Faster and Intermediate-Acting Insulins By Sheri Colberg, Ph.D., FACSM At the start of any activity, your body increases the release of glucose-raising hormones to prevent falls in your blood glucose levels. At the same time, your pancreas releases less insulin (if you still make any) during exercise. But if you have to depend on insulin by injections or pump or if you use certain other medications, your body may not be able to respond normally. You can’t turn off insulin from an injection site, and exercise can sometimes speed up its absorption by increasing blood flow to your muscles and skin. As a result, instead of having less insulin circulating around your bloodstream during exercise, you may end up with more than normal, which can easily lower your blood sugars too much. Similarly, certain oral diabetic medicines can also augment the effects of insulin during exercise or cause greater release, also potentially resulting in hypoglycemia. Insulin Use: Effect on Spontaneity and More Have you ever felt like jumping on your bike and going for a ride without giving any thought to where you’re going or how long you’ll be gone? When you have diabetes and you use insulin, the problem with such spontaneity is that your insulin levels during an activity can greatly affect your blood sugar response to exercise (refer to figure 2.6 in chapter 2). To predict your r Continue reading >>

Insulin (and Other Injected Drugs)

Insulin (and Other Injected Drugs)

Diabetes is a disease affecting the body's production of insulin (type 1) or both the body's use and its production of insulin (type 2). Injectable insulin is a lifesaver for people who can no longer produce it on their own Continue reading >>

Selecting An Insulin For Treating Diabetes Mellitus In Dogs And Cats

Selecting An Insulin For Treating Diabetes Mellitus In Dogs And Cats

Richard W. Nelson, DVM, Dipl ACVIM University of California Davis, California From: The 30th Annual Royal Canin/Ohio State University Symposium for the treatment of small animal diseases: Endocrinology, October 2006, Veterinarians often ask which insulin is the best for treating diabetes mellitus in dogs and cats. Unfortunately, this question is difficult to answer. All insulin types currently on the market have the potential to work well in some diabetic dogs and cats but not in others. Recommendations regarding the insulin of choice for treating diabetic dogs and cats are based on personal experiences and vary between clinicians. Some clinicians prefer NPH insulin while others prefer lente insulin for treating diabetic dogs. Some clinicians prefer PZI, some NPH, some lente, and some insulin glargine for treating diabetic cats. Which insulin is ultimately effective in a diabetic is unpredictable. The clinician’s role is to identify which type of insulin works best in the diabetic dog or cat currently being treated. Success with insulin therapy requires knowledge of currently available insulin preparations - their intended use, potency, trends regarding duration of effect, and potential impact of species of insulin origin on diabetic control. Overview of Insulin Types. Commercial insulin is categorized by promptness, duration, intensity of action, and origin. Short-acting prandial insulins include regular crystalline (Humulin R®, Eli Lilly, Indianapolis, IN), insulin lispro (Humulog®, Eli Lilly) and insulin aspart (Novolog®, Novo Nordisk, Princeton, NJ). Regular crystalline insulin is a recombinant human insulin while insulin lispro and insulin aspart are insulin analogs. Recombinant DNA technology has been used to alter the amino acid sequence of the insulin molec Continue reading >>

Short-acting Insulins

Short-acting Insulins

Rapid-Acting Analogues Short-Acting Insulins Intermediate-Acting Insulins Long-Acting Insulins Combination Insulins Onset: 30 minutes Peak: 2.5 - 5 hours Duration: 4 - 12 hours Solution: Clear Comments: Best if administered 30 minutes before a meal. Mixing NPH: If Regular insulin is mixed with NPH human insulin, the Regular insulin should be drawn into the syringe first. Aspart - Novolog ®: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin. Lispro - Humalog ®: Compatible - but NO support clinically for such a mixture. Draw up Humalog first before drawing up Regular Insulin. Mixtures should not be administered intravenously. When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Novolog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin. CLINICAL PHARMACOLOGY Insulin is a polypeptide hormone that controls the storage and metabolism of carbohydrates, proteins, and fats. This activity occurs primarily in the liver, in muscle, and in adipose tissues after binding of the insulin molecules to receptor sites on cellular plasma membranes. Insulin promotes uptake of carbohydrates, proteins, and fats in most tissues. Also, insulin influences carbohydrate, protein, and fat metabolism by stimulating protein and free fatty acid synthesis, and by inhibiting release of free fatty acid from adipose cells. Insulin increases active glucose transport through muscle and adipose cellular membranes, and promotes conversion of intracellular glucose and free fatty acid to the appropriate storage forms (glycogen and triglyceride, respectively). Although the liver does not require active glucose transport, insulin increases hepatic gl Continue reading >>

Selecting An Insulin Program For Type 1 Diabetes

Selecting An Insulin Program For Type 1 Diabetes

For people with Type 1 diabetes, is there really anything more personal and significant in your life than your insulin program? In a way, your insulin program defines your lifestyle. It can either dictate your meal, sleep, and activity schedules, or it can set you up for successful control of your diabetes. Unfortunately, most people are given little choice or education on how to select the insulin program that best meets their needs. As a matter of fact, many people probably put more thought and effort into choosing a car — perhaps because they have a better idea of what they’re looking for. So what should you look for in an insulin program, and how do you know if the one you’re following is really the best one for you? Read on for some tips on this important decision. What’s in an insulin program? Every insulin program for people with Type 1 diabetes should include a basal, or “background,” insulin. Basal insulin is necessary to cover the liver’s secretion of glucose throughout the day and night, which provides the cells with a continuous supply of glucose to burn for energy. Insufficient basal insulin at any time will result in a sharp rise in blood glucose level and can also lead to the buildup of ketones, acidic by-products of fat-burning that can accumulate in large amounts if no glucose is being burned simultaneously. If high blood glucose and ketones are not treated promptly, a life-threatening condition called diabetic ketoacidosis can develop. Each person’s basal insulin requirements are unique, but typically they are higher during the early morning and lower in the middle of the day. This is due to the nighttime production of blood-sugar-raising hormones and to the enhanced insulin sensitivity that comes with daytime physical activity. Basal i Continue reading >>

Types Of Insulin And How They Work

Types Of Insulin And How They Work

Insulin is a hormone the body makes to control the level of glucose (sugar) in the blood. It lowers blood sugar by allowing glucose to leave the bloodstream and enter body cells. Without enough insulin, the level of glucose in the bloodstream can become too high. Everyone needs insulin to use food properly. People without diabetes make enough of their own insulin to keep their blood sugar at healthy levels all the time. People with type 1 diabetes no longer make insulin of their own. Instead, they need to take shots of one or more types of insulin to keep their blood sugars close to normal. Between 75 and 90 percent of people with type 2 diabetes need to take insulin shots to help them get the best control of their blood sugar levels. Deciding How Much Insulin to Take The amount of insulin a person needs depends on: Body weight Percentage of body fat Activity level Diet Other medicines Emotions and stress General health Type of insulin When you first start taking insulin shots, your doctor might ask you to change the amount you take or the time you take it several times. You and your doctor will base these changes on the results of your blood sugar tests. You'll need to make adjustments until you find the dose and schedule that work best for you. Each person's need for insulin is different: Some people can control their blood sugar with one shot of insulin a day. Most people need more than three shots every day. Many people need more than one type of insulin. If you take several insulin shots a day or use more than one type of insulin, it doesn't mean your diabetes isn't in good control. Your blood sugar, not the amount or type of insulin you take, is the best way to judge how well you are doing. If you take three shots a day and your blood sugar is near normal, that's Continue reading >>

Insulin Actions Times And Peak Times

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? Action Times for Insulins Insulin Starts Peaks Ends Low most likely at: Usage Hum/Nov/Apidra 10–20 m 1.5–2.5 h 4.5–6 h 2–5 h designed to peak, covers meals and lowers high BGs Regular 30–45 m 2–3.5 h 5–7 h 3–7 h NPH 1–3 h 4–9 h 14–20 h 4–16 h intermediate, less peaking, larger action Lantus 1–2 h 6 hr 18–26 h 5–10 h designed for flatter and longest action, background insulin action for keeping your BG flat when fasting Levemir 1–3 h 8–10 18–26 h 8–16 h Rapid Insulins 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 mea Continue reading >>

Intermediate Acting Insulin

Intermediate Acting Insulin

Tweet Intermediate acting insulins are often taken in conjunction with a short acting insulin. Intermediate acting insulins start to act within the first hour of injecting, followed by a period of peak activity lasting up to 7 hours. After this, the activity starts to tail off. Are intermediate acting insulins known by any other names? Intermediate acting insulins may also be referred to as ‘isophane’or ‘NPH’ (Neutral Protamine Hagedorn) insulins. Those who inject intermediate acting insulins should be aware of the risk of hypoglycemia, and particularly the risk of night time hypoglycemia. Hypurin isophane Hypurin is based around the active ingredient isophane insulin, and is an intermediate-acting insulin. It usually starts working approximately two hours after injection and will work for between 18 and 24 hours. This helps to regulate blood sugars throughout the day. Commonly used in conjunction with short-acting insulin, isophane insulin such as Hypurin is administered before meals to control blood glucose levels after eating. Hypurin isophane is available in bovine (beef insulin) and porcine (pork insulin) forms. Hypurin porcine 30/70 insulin is also available. This is a premixed insulin made up of 30% short acting (neutral) insulin and 70% intermediate acting (isophane) insulin. Humulin I Humulin I is a human isophane insulin made by Eli Lilly & Co. It can be taken with shiort acting insulin before a meal, or without short acting insulin before bed. Humulin I has a peak activity between 1 and 8 hours after injecting with a duration of activity lasting as much as up to 22 hours. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produc Continue reading >>

Insulin For Gestational Diabetes

Insulin For Gestational Diabetes

Examples Rapid-acting Generic Name Brand Name insulin aspart NovoLog insulin lispro Humalog Short-acting Intermediate-acting Long-acting Mixtures Generic Name Brand Name 50% lispro protamine and 50% lispro Humalog Mix 50/50 50% NPH and 50% regular Humulin 50/50 70% aspart protamine and 30% aspart NovoLog Mix 70/30 70% NPH and 30% regular Humulin 70/30, Novolin 70/30 75% lispro protamine and 25% lispro Humalog Mix 75/25 Insulin normally is made by the pancreas, a gland behind the stomach. The medicine form of insulin helps the body use glucose. Insulin cannot be taken as a pill, because stomach acid destroys insulin before it can enter the blood. Insulin is categorized according to how fast it starts to work and how long it continues to work. The types of insulin available include rapid-, short-, intermediate-, and long-acting insulin. See types of insulin for more information. Packaging Insulin is packaged in small glass bottles that are sealed with rubber lids. One bottle of U-100 insulin holds 1,000 units, which is many doses of insulin. It is also packaged in small cartridges used in pen-shaped devices (insulin pens) attached to disposable needles. Insulin bottles and cartridges are labeled with important information you should read, such as the expiration date. How insulin is taken Insulin usually is given as a shot under the skin. It can also be given through an insulin pump or a jet injector, a device that sprays the medicine into the skin. Some insulins can be given in a vein, but this is only done in a hospital. How It Works Insulin reduces blood sugar levels by helping sugar (glucose) enter the cells to be used for energy. Sometimes women who have gestational diabetes need to take two types of insulin, usually a rapid- or short-acting and an intermediate-acting Continue reading >>

Insulin A To Z: A Guide On Different Types Of Insulin

Insulin A To Z: A Guide On Different Types Of Insulin

Elizabeth Blair, A.N.P., at Joslin Diabetes Center, helps break down the different types of insulin and how they work for people with diabetes. Types of Insulin for People with Diabetes Rapid-acting: Usually taken before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin. Short-acting: Usually taken about 30 minutes before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin. Intermediate-acting: Covers the blood glucose elevations when rapid-acting insulins stop working. This type of insulin is often combined with rapid- or short-acting insulin and is usually taken twice a day. Long-acting: This type of insulin is often combined, when needed, with rapid- or short-acting insulin. It lowers blood glucose levels when rapid-acting insulins stop working. It is taken once or twice a day. A Guide on Insulin Types for People with Diabetes Type Brand Name Onset (length of time before insulin reaches bloodstream) Peak (time period when insulin is most effective) Duration (how long insulin works for) Rapid-acting Humalog Novolog Apidra 10 - 30 minutes 30 minutes - 3 hours 3 - 5 hours Short-acting Regular (R) 30 minutes - 1 hour 2 - 5 hours Up to 12 hours Intermediate- acting NPH (N) 1.5 - 4 hours 4 - 12 hours Up to 24 hours Long-acting Lantus Levemir 0.8 - 4 hours Minimal peak Up to 24 hours To make an appointment with a Joslin diabetes nurse educator, please call (617) 732-2400. Continue reading >>

5 Types Of Insulin And How They Work

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 >>

Nph Insulin

Nph Insulin

Neutral Protamine Hagedorn Insulin. Neutral protamine Hagedorn (NPH) insulin is a crystalline suspension of insulin with protamine and zinc, providing an intermediate-acting insulin with onset of action in 1 to 3 hours, duration of action up to 24 hours, and peak action from 6 to 8 hours. NPH insulin usually cannot be administered once daily in the setting of T1DM, at least in combination with rapid-acting monomeric analogue insulin. In the preanalogue era, NPH insulin was used successfully in combination with regular insulin, although this human insulin-based regimen has now been largely supplanted by analogue insulin because of a perceived lower risk of hypoglycemia.310 6.19.6.5.3.3 Intermediate-acting insulins Neutral Protamine Hagedorn ((NPH), lente, and insulin detemir) Neutral Protamine Hagedorn (NPH) and insulin zinc (lente) are different types of intermediate-acting insulins. NPH is a suspension of medium-sized crystals, which include zinc and protamine. Lente is a suspension of large, zinc-containing crystals that have been precipitated in an acetate buffer. These crystals dissolve slowly after subcutaneous injection. NPH and lente have similar pharmacodynamic profiles, with an onset of action approximately 2 h, a peak effect 6–14 h, and duration of action up to 24 h following subcutaneous injection. Intermediate-acting insulins can provide basal and/or prandial insulin, depending on dose and time of administration. Insulin detemir is an acylated insulin analog with threonine removed at position B30, and lysine at position B29 is acylated with a 14-carbon myristoyl fatty acid acylation, resulting in delayed action due to increased binding to albumin. It has a longer duration of action (20 h) than NPH or lente insulins, and less intradose pharmacokinetic varia Continue reading >>

Basal Insulin Types, Benefits, Dosage Information, And Side Effects

Basal Insulin Types, Benefits, Dosage Information, And Side Effects

The primary job of basal insulin is to keep your blood glucose levels stable during periods of fasting, such as while you’re sleeping. While fasting, your liver continuously secretes glucose into the bloodstream. Basal insulin keeps these glucose levels under control. Without this insulin, your glucose levels would rise at an alarming rate. Basal insulin ensures that your cells are fed with a constant stream of glucose to burn for energy throughout the day. Here’s what you need to know about basal insulin medication and why it’s important for managing diabetes. Types There are three main types of basal insulin. Intermediate-acting insulin, NPH Brand-name versions include Humulin and Novolin. This insulin is administered once or twice daily. It’s usually mixed with mealtime insulin in the morning, before your evening meal, or both. It works hardest in the 4 to 8 hours after injection, and the effects start waning after about 16 hours. Long-acting insulin Two types of this insulin currently on the market are detemir (Levemir) and glargine (Lantus). This basal insulin begins working 90 minutes to 4 hours after injection and remains in your bloodstream for up to 24 hours. It may start weakening a few hours earlier for some people or last a few hours longer for others. There isn’t a peak time for this type of insulin. It works at a steady rate throughout the day. Ultra-long acting insulin In January 2016, another basal insulin called degludec (Tresiba) was released. This basal insulin begins working within 30 to 90 minutes and remains in your bloodstream for up to 42 hours. As with the long-acting insulins detemir and glargine, there isn’t a peak time for this insulin. It works at a steady rate throughout the day. Insulin degludec is available in two strengths, 1 Continue reading >>

Why Walmart Insulins Aren’t The Answer To High Insulin Prices

Why Walmart Insulins Aren’t The Answer To High Insulin Prices

A diabetes advocate contrasts the performance of generic insulins versus the more popular brands. Commentary Some people don’t understand why people with diabetes get upset at the price of insulin. They see insulin for sale at a relatively reasonable price in Walmart and don’t see the problem. What they don’t know is that these Walmart insulins just don’t perform nearly as well as the more expensive insulins, and that gap in performance can have a very negative effect on the health of people with diabetes. There are three insulins available at Walmart for the price of $25 – NPH, Regular, and 70/30 (a mix of the two). NPH was first approved by the FDA in 1950, Regular was approved in 1982, 70/30 in 1989. That means NPH has been around for 66 years, Regular for 33 years, 70/30 for 27 years. Take a moment and think about what healthcare was like in 1950. Now, I’m sure someone is saying, “Well, they must still work if they are still being sold.” And they do, but they don’t work in the same way. These insulins are not interchangeable. If a person with Type 1 diabetes were to switch from a Humalog/Lantus insulin regimen to Regular and NPH, it would drastically alter their lifestyle, making blood sugar control more irregular and raising A1C scores. The biggest issue is that whereas Lantus is steady, NPH peaks. A person using NPH must keep a very set dietary schedule, making sure to eat meals and snacks at certain times to correspond with peak times of an insulin dose. The strict schedule is difficult for everyone, but especially for children. They are unable to alter their daily schedules and must always be sure to eat at specific times. Even if they’re not hungry, they must eat to avoid low blood sugar. And if they are hungry, they often cannot have more t Continue reading >>

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