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What Type Of Insulin Has The Most Rapid Onset Of Action?

Insulin

Insulin

Sort Mixing Compatibilities •NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30) •NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30) •insulin aspart protamine suspension 75% and insulin aspart 25% (NovoLog Mix 75/25) •insulin lispro protamine suspension 75% and insulin lispro 25% (Humalog Mix 75/25) •Premixed; do not mix with other insulins Rapid-acting o Insulin lispro (Humalog) o Insulin aspart (NovoLog) o Insulin glulisine (Apidra) •Given SC or continuous SC pump (not IV) •Most rapid onset (5-15 min) •Shorter duration •Pt must eat meal after injection oMust eat within 15min of dosage Intermediate-acting oIsophane insulin suspension oAKA NPH - Novolin •Cloudy or opaque in appearance •NPH insulin is often combined with regular insulin to reduce the number of insulin injections per day. •Slower in onset than endogenous insulin •More prolonged in duration than endogenous insulin obut not as long as those of the long-acting insulins Put the following insulins in order from shortest to longest time of onset oInsulin glargine (Lantus) oInsulin isophane suspension (NPH) oInsulin Lispro (Humalog) oRegular insulin (Humulin or Novolin R) oRegular insulin (Humulin or Novolin R) 1 oInsulin Lispro (Humalog) 2 oInsulin glargine (Lantus) 3 oInsulin isophane suspension (NPH) 4 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 >>

What Is Rapid Or Fast-acting Insulin?

What Is Rapid Or Fast-acting Insulin?

You may take rapid acting or fast acting insulin (also known as insulin analogues) for your diabetes, either through injections prior to your meals, or in your insulin pump. You may use it alone, or in combination with other insulins and diabetes medications, including injections and pills. In a person without diabetes, the pancreas puts out small amounts of insulin, continuously bringing down blood sugars to a normal level with no difficulty. When a person has diabetes, they may not make any insulin, as occurs in Type 1 Diabetes. They may make some insulin, but it’s not working well, and it’s just not enough to bring blood sugars into a normal range, as occurs in Type 2 Diabetes. When there is no insulin, or not enough insulin, the goal is to try to simulate what the body normally does to bring down blood sugars through injections of insulin, inhaled insulin, or via an insulin pump. To do this, rapid or fast acting insulin must be taken in relation to food that is eaten in many cases. Not everyone with diabetes must take insulin to control their blood sugars, though. Let’s learn how Christie uses rapid acting insulin… Christie’s story Christie has had Type 1 Diabetes for 24 years. She uses a Medtronic insulin pump. Every day, Christie’s pump gives her fast or rapid acting insulin. This is all that insulin pumps need to control blood sugar. For Christie, she uses Humalog lispro insulin. She gets a little bit of this rapid or fast acting insulin continually through her pump via a basal. She also gets some of this insulin through her pump, in a bolus dose every time she eats a meal. In a pump, the same insulin is used all the time, and it is always rapid insulin. Christie also has a new Continuous Glucose Monitor, CGM. She has found with this new technology, s Continue reading >>

Insulin Regimens

Insulin Regimens

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. The appropriate insulin regimen for each patient with diabetes will depend on their type of diabetes and their individual needs and circumstances. Regimens which attempt to improve glycaemic control will require more active involvement of the patient, both with the number of injections and with the need for close self-monitoring of blood glucose. See the separate Diabetes Education and Self-management Programmes article. Insulin regimens should be tailored to the individual, taking into account the patient's type of diabetes, previous control, age, dexterity, eyesight, and personal and cultural preferences. Insulin is usually injected into the upper arms, thighs, buttocks or abdomen. The absorption may be increased if the limb is used in strenuous exercise after the injection. Lipodystrophy can be minimised by using different injection sites in rotation. Local allergic reactions may occur but are rare.[1] Effective patient education for people using insulin treatment is essential, including 'sick day' guidance. See also the separate Diabetes and Intercurrent Illness article. Insulin Passports and patient information booklets should be offered to patients receiving insulin.[2] Insulins are classified according to their duration of action.[3] Short-acting insulins Short-acting (soluble) insulin is usually injected 15 to 30 minutes before meals. Soluble insulin is also the most appropriate form of insulin for use in diabetic emergencies - eg, diabetic ketoacidosis and at the time of Continue reading >>

What Are The Possible Side Effects Of Insulin Lispro (humalog, Humalog Cartridge, Humalog Kwikpen, Humalog Pen)?

What Are The Possible Side Effects Of Insulin Lispro (humalog, Humalog Cartridge, Humalog Kwikpen, Humalog Pen)?

HUMALOG (insulin lispro) Injection DESCRIPTION HUMALOG® (insulin lispro injection) is a rapid-acting human insulin analog used to lower blood glucose. Insulin lispro is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli. Insulin lispro differs from human insulin in that the amino acid proline at position B28 is replaced by lysine and the lysine in position B29 is replaced by proline. Chemically, it is Lys(B28), Pro(B29) human insulin analog and has the empirical formula C257H383N65O77S6 and a molecular weight of 5808, both identical to that of human insulin. HUMALOG has the following primary structure: HUMALOG is a sterile, aqueous, clear, and colorless solution. Each milliliter of HUMALOG U-100 contains insulin lispro 100 units, 16 mg glycerin, 1.88 mg dibasic sodium phosphate, 3.15 mg Metacresol, zinc oxide content adjusted to provide 0.0197 mg zinc ion, trace amounts of phenol, and Water for Injection. Insulin lispro has a pH of 7.0 to 7.8. The pH is adjusted by addition of aqueous solutions of hydrochloric acid 10% and/or sodium hydroxide 10%. Each milliliter of HUMALOG U-200 contains insulin lispro 200 units, 16 mg glycerin, 5 mg tromethamine, 3.15 mg Metacresol, zinc oxide content adjusted to provide 0.046 mg zinc ion, trace amounts of phenol, and Water for Injection. Insulin lispro has a pH of 7.0 to 7.8. The pH is adjusted by addition of aqueous solutions of hydrochloric acid 10% and/or sodium hydroxide 10%. font size A A A 1 2 3 4 5 Next What is Type 2 Diabetes? The most common form of diabetes is type 2 diabetes, formerly called non-insulin dependent diabetes mellitus or "adult onset" diabetes, so-called because it typically develops in adults over age 35, though it can develop at any age. Type 2 diabetes i 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 >>

Insulin Administration

Insulin Administration

Insulin is a protein formed by two cross-linked peptide chains. Insulin is secreted in pulses by the pancreas and reaches the liver via the portal circulation. Some 80% of the insulin reaching the liver is cleared from the circulation, which means that insulin attains much higher concentrations in the liver than in the peripheral circulation. Insulin has a short plasma half-life (3-4 minutes), and choice of the route and timing of insulin administration is a major determinant of metabolic control. Conventional insulin injections are given into the thigh, abdomen or outer side of the buttock. Standard needles range from 0.8 - 1.6 cm in length, are used with a syringe or pen device and deliver insulin into the subcutaneous fat. Too long a needle or poor injection technique can result in injection into a muscle, which is painful and results in more rapid absorption of insulin. Many alternative routes of administration have been tested, but none can match direct injection or infusion. Subcutaneous insulin injection or infusion share the disadvantages of delivery into the systemic rather than portal circulation, and rates of appearance in the blood stream which are delayed and rendered somewhat erratic by the process of absorption from subcutaneous tissues. Characteristics of an ideal insulin administration system Nature has placed the pancreatic beta cell inside a digestive gland and astride an arterial supply that continuously samples the rate of nutrient absorption from the gut. It responds instantaneously to these blood-borne signals by releasing insulin in synchronised pulses, a pattern of secretion that maximises its effect on liver cells. Furthermore, it matches this insulin secretion with reciprocal suppression or release of its partner hormone pancreatic glucagon, t 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 >>

Insulin Lispro: A Fast-acting Insulin Analog

Insulin Lispro: A Fast-acting Insulin Analog

Research has established the importance of maintaining blood glucose levels near normal in patients with type 1 (insulin-dependent) diabetes mellitus. Short-acting insulin analogs are designed to overcome the limitations of regular short-acting insulins. Compared with regular human insulin, the analog insulin lispro offers faster subcutaneous absorption, an earlier and greater insulin peak and a more rapid post-peak decrease. Insulin lispro begins to exert its effects within 15 minutes of subcutaneous administration, and peak levels occur 30 to 90 minutes after administration. Duration of activity is less than five hours. Rates of insulin allergy, lipodystrophy, hypoglycemia and abnormal laboratory test results are essentially the same in patients using insulin lispro and in those using regular human insulin. The Diabetes Control and Complications Trial (DCCT)1 established the importance of maintaining near-normal blood glucose levels in patients with type 1 (insulin-dependent) diabetes mellitus. In these patients, intensive therapeutic regimens have been found to delay the onset and reduce the progression of microvascular complications by 50 to 75 percent as compared with conventional regimens. Although no large-scale investigations have been completed, smaller studies have reported similar benefits for intensive therapeutic regimens in patients with type 2 (non–insulin-dependent) diabetes.2 Primary care physicians provide medical care for 75 percent of children and 90 to 95 percent of adults with diabetes.3 Regardless of the type of diabetes, improved glycemic control often can be achieved with individualized tools for patient self-management, carefully formulated nutrition plans and the use of alternative insulin regimens.4 Overview of Insulin Insulin is necessary Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

WARNING: RISK OF THYROID C-CELL TUMORS In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether Ozempic® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. Ozempic® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Ozempic® and inform them of symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Ozempic®. Ozempic® is not recommended as a first-line therapy for patients who have inadequate glycemic control on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans. Ozempic® has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Ozempic® is not a substitute for insulin. Ozempic® is not indicated for use in patients with type 1 diabetes mellitus or for the treatment of patients with diabetic ketoacidosis. Pancreatitis: Acute and chronic pancreatitis have been reported in clinical studies. Observe patients carefully for signs and symptoms of pancreatitis (persistent severe abdominal pain, sometimes radiating to the back with or without vomiting). If pancreatitis is suspected, discontinue Ozempic® promptly and if pancreatitis is confirmed, do not restart. Diabetic Ret Continue reading >>

Insulin Analogs: Impact On Treatment Success, Satisfaction, Quality Of Life, And Adherence

Insulin Analogs: Impact On Treatment Success, Satisfaction, Quality Of Life, And Adherence

Go to: A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns. The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile. The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure. To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment. The long-acting basal analog insulin detemir ha Continue reading >>

Rapid-acting Analogues

Rapid-acting Analogues

Rapid-Acting Analogues Short-Acting Insulins Intermediate-Acting Insulins Long-Acting Insulins Combination Insulins Onset: 12 - 18 min Peak: 1-3 hours Duration: 3-5 hours Solution: Clear Comments: NovoLog should generally be given immediately before a meal (start of meal within 5-10 minutes after injection) because of its fast onset of action. NovoLog is homologous with regular human insulin with the exception of a single substitution of the amino acid proline by aspartic acid in position B28 (beta chain). Insulin lispro (Humalog) and insulin aspart (Novolog), when administered intravenously, show pharmacodynamic parameters similar to regular insulin. Mixing NPH: If NovoLog is mixed with NPH human insulin, NovoLog should be drawn into the syringe first. The injection should be made immediately after mixing. Regular insulin: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin. Mixtures should not be administered intravenously. When used in external subcutaneous infusion pumps for insulin, NovoLog should not be mixed with any other insulins or diluent. When rapid-acting insulin is mixed with either an intermediate- or long-acting insulin, the mixture should be injected within 15 min before a meal. INDICATIONS AND USAGE Treatment of Diabetes Mellitus NovoLog is an insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus. DOSAGE AND ADMINISTRATION Dosing NovoLog is an insulin analog with an earlier onset of action than regular human insulin. The dosage of NovoLog must be individualized. NovoLog given by subcutaneous injection should generally be used in regimens with an intermediate or long-acting insulin [see package insert for Warnings and Precautions (5), How Supplied Continue reading >>

Ultrafast-acting Insulins: State Of The Art

Ultrafast-acting Insulins: State Of The Art

Go to: Background When a healthy individual is presented with a meal and begins to ingest it, a rapid release of insulin from the beta cells of the Langerhans islets in the pancreas ensues. Upon neural, hormonal, and/or metabolic stimulation, the normal mammalian islet beta cell releases preformed insulin extremely rapidly, enabling superb glucose tolerance. In comparison with the modest amounts of basal insulin secreted between meals and overnight, insulin secretion rates increase dramatically in healthy individuals, with up to 1000-fold higher rates following a carbohydrate challenge. The physiologically induced rapid increase in circulating insulin levels prepares the body for the expected influx of carbohydrates. Following a mixed meal, insulin levels circulating in blood reach half of maximal concentration in approximately 16–18 min and peaks within 30–45 min.1 The flux of glucose from the gut to the bloodstream is handled proficiently in healthy subjects by means of a very rapid reduction in hepatic glucose production (HGP), followed by an increase in peripheral cellular glucose uptake (mainly muscle and adipose tissue), with the result that only a moderate increase in postprandial glycemic excursion (PPG) is seen, even after ingestion of a large carbohydrate load. The liver is sensitive to the rate of change of the insulin concentration in blood, and thus the rapidity and extent to which the HGP is reduced depends on the insulin kinetics. This complex and highly tuned regulation system is disrupted in patients with diabetes: no insulin is secreted at all in patients with type 1 diabetes mellitus (T1DM), and in patients with type 2 diabetes mellitus (T2DM), the early phase of insulin secretion is deficient. In both cases, there are profound metabolic consequen Continue reading >>

Types Of Insulin

Types Of Insulin

Insulin analogs are now replacing human insulin in the US. Insulins are categorized by differences in onset, peak, duration, concentration, and route of delivery. Human Insulin and Insulin Analogs are available for insulin replacement therapy. Insulins also are classified by the timing of their action in your body – specifically, how quickly they start to act, when they have a maximal effect and how long they act.Insulin analogs have been developed because human insulins have limitations when injected under the skin. In high concentrations, such as in a vial or cartridge, human (and also animal insulin) clumps together. This clumping causes slow and unpredictable absorption from the subcutaneous tissue and a dose-dependent duration of action (i.e. the larger dose, the longer the effect or duration). In contrast, insulin analogs have a more predictable duration of action. The rapid acting insulin analogs work more quickly, and the long acting insulin analogs last longer and have a more even, “peakless” effect. Background Insulin has been available since 1925. It was initially extracted from beef and pork pancreases. In the early 1980’s, technology became available to produce human insulin synthetically. Synthetic human insulin has replaced beef and pork insulin in the US. And now, insulin analogs are replacing human insulin. Characteristics of Insulin Insulins are categorized by differences in: Onset (how quickly they act) Peak (how long it takes to achieve maximum impact) Duration (how long they last before they wear off) Concentration (Insulins sold in the U.S. have a concentration of 100 units per ml or U100. In other countries, additional concentrations are available. Note: If you purchase insulin abroad, be sure it is U100.) Route of delivery (whether they a Continue reading >>

Insulin Administration

Insulin Administration

Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the American Diabetes Association’s position statement “Continuous Subcutaneous Insulin Infusion” for further discussion on this subject.) INSULIN Insulin is obtained from pork pancreas or is made chemically identical to human insulin by recombinant DNA technology or chemical modification of pork insulin. Insulin analogs have been developed by modifying the amino acid sequence of the insulin molecule. Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin lispro and insulin a Continue reading >>

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