Subcutaneous insulin is the mainstay of treatment for the type 1 diabetes mellitus. But there are different types of insulin available depending on their onset of action and the duration of the action. These types of insulins are as follows:
1. short acting insulin
2. intermediate acting insulin
3. long acting insulin
4. mixtures
Short acting insulin
Rapid- and short-acting insulins have the most rapid onsets of action and are used whenever quick glucose utilization is needed
There are two types;
1. soluble insulin
2. rapid acting insulin analogue
Soluble insulin
Human insulin currently is the best species of insulin available, and it is less antigenic than previously used animal-derived varieties. It can be given subcutaneous, intravenous and intramuscular routes.
Rapid acting insulin analogue
Rapid-acting insulins include regular insulin, lispro, and aspart insulin. Regular insulin is a preparation of zinc insulin crystals in solution. Its onset of action is 0.5-1 h, it peaks at 2.5-5 h, and duration of action is 6-8 h. Lispro insulin is a form of regular insulin that is genetically engineered with the reversal of the amino acids lysine and proline in the B chain. Aspart insulin has aspartic acid substituted for proline in position 28 of the B chain. Both of these insulins are absorbed more quickly and have a rapid onset (5-10 min), peak (1 h), and duration (4 h) of action. Therefore, they have the advantage that they may be administered shortly before eating. Semilente insulin is like regular insulin and is slightly slower rapid-acting insulin. It contains zinc insulin microcrystals in an acetate buffer and is not readily available.
Intermediate acting insulin
Intermediate-acting insulins have slower onsets of action and longer durations of action and are usually administered in combination with faster-acting insulins to maximize benefits of a single injection.
Intermediate-acting insulins include neutral protamine Hagedorn (NPH) insulin, which contains a mixture of regular, and protamine zinc insulin, and lente insulin, which contain 30% semilente insulin and 70% ultralente insulin in an acetate buffer.
Long acting insulin
These insulins offer a very long duration of action and, when combined with faster-acting insulins, offer better glucose control for some patients.
Long-acting insulins include ultralente insulin, containing large zinc insulin crystals in an acetate buffer, and glargine insulin, newer long-acting insulin that has no peak and produces a relatively stable level lasting more than 24 hours. Both insulins can supply basal 24-hour insulin with a single daily injection.
Mixtures
Mixtures of insulin preparations with different onsets and durations of action frequently are administered in a single injection by drawing measured doses of 2 preparations into the same syringe immediately before use. The exception is glargine insulin, which should not be mixed with any other form of insulin. Preparations that contain a mixture of 70% NPH and 30% regular human insulin (ie, Novolin 70/30, Humulin 70/30) are available, as is Humulin 50/50, but the fixed ratios of intermediate-acting to rapid-acting insulin may restrict their use. In addition, a 25/75 mixture of NPH and lispro insulin is available.
1. short acting insulin
2. intermediate acting insulin
3. long acting insulin
4. mixtures
Short acting insulin
Rapid- and short-acting insulins have the most rapid onsets of action and are used whenever quick glucose utilization is needed
There are two types;
1. soluble insulin
2. rapid acting insulin analogue
Soluble insulin
Human insulin currently is the best species of insulin available, and it is less antigenic than previously used animal-derived varieties. It can be given subcutaneous, intravenous and intramuscular routes.
Rapid acting insulin analogue
Rapid-acting insulins include regular insulin, lispro, and aspart insulin. Regular insulin is a preparation of zinc insulin crystals in solution. Its onset of action is 0.5-1 h, it peaks at 2.5-5 h, and duration of action is 6-8 h. Lispro insulin is a form of regular insulin that is genetically engineered with the reversal of the amino acids lysine and proline in the B chain. Aspart insulin has aspartic acid substituted for proline in position 28 of the B chain. Both of these insulins are absorbed more quickly and have a rapid onset (5-10 min), peak (1 h), and duration (4 h) of action. Therefore, they have the advantage that they may be administered shortly before eating. Semilente insulin is like regular insulin and is slightly slower rapid-acting insulin. It contains zinc insulin microcrystals in an acetate buffer and is not readily available.
Intermediate acting insulin
Intermediate-acting insulins have slower onsets of action and longer durations of action and are usually administered in combination with faster-acting insulins to maximize benefits of a single injection.
Intermediate-acting insulins include neutral protamine Hagedorn (NPH) insulin, which contains a mixture of regular, and protamine zinc insulin, and lente insulin, which contain 30% semilente insulin and 70% ultralente insulin in an acetate buffer.
Long acting insulin
These insulins offer a very long duration of action and, when combined with faster-acting insulins, offer better glucose control for some patients.
Long-acting insulins include ultralente insulin, containing large zinc insulin crystals in an acetate buffer, and glargine insulin, newer long-acting insulin that has no peak and produces a relatively stable level lasting more than 24 hours. Both insulins can supply basal 24-hour insulin with a single daily injection.
Mixtures
Mixtures of insulin preparations with different onsets and durations of action frequently are administered in a single injection by drawing measured doses of 2 preparations into the same syringe immediately before use. The exception is glargine insulin, which should not be mixed with any other form of insulin. Preparations that contain a mixture of 70% NPH and 30% regular human insulin (ie, Novolin 70/30, Humulin 70/30) are available, as is Humulin 50/50, but the fixed ratios of intermediate-acting to rapid-acting insulin may restrict their use. In addition, a 25/75 mixture of NPH and lispro insulin is available.
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