- Joined
- Aug 18, 2014
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- 10
I read a few posts on this forum (and others) about insulin that concerned me due to the misinformation they contained, and as a health professional I would like the opportunity to present some basic information to help clear up any misconceptions and prevent some of the serious consequences from improper insulin use.
** I am not condoning use of insulin or any substances regulated and described under the Federal Food Drug and Cosmetic Act for use without authorization from a licensed healthcare professional, and data presented in this post is copied and pasted from stated reference (see bottom) and for informational and research purposes only **
Regular insulin
Brands: Humulin R, Novolin R
Kinetics: Subcutaneously administered regular insulin is best given 30—60 minutes before a meal. The onset of action of unbuffered, regular insulin (100 units/ml) begins approximately 30 minutes after injection with maximal effects occurring 2.5—5 hours later. The apparent plasma half-life following SC administration is approximately 1.5 hours with a duration of action of 8—12 hours (mean 5—7 hours, actual values can widely among individuals receiving SC regular insulin).
Insulin Lispro
Brands: Humalog 100u/mL (including KwikPen)
Kinetics: Pharmacodynamically, insulin lispro has an onset of glucose-lowering activity that is 15—30 minutes, which is more rapid than regular insulin. Insulin lispro reaches mean peak plasma concentrations faster (30—90 minutes) than regular insulin (60—120 minutes) when given SC. Insulin lispro has a duration of action of roughly 3—5 hours, which is shorter than regular insulin. After subcutaneous administration, the apparent half-life of insulin lispro is 1 hour compared with 1.5 hours for regular insulin. After abdominal administration, insulin lispro concentrations are higher than those following deltoid or thigh injections. Also, the duration of action of insulin lispro is slightly shorter following abdominal injection, compared with deltoid and femoral injections. Intermittent SC injections of insulin lispro should be given within 15 minutes prior to or immediately after a meal because of the fast onset compared to regular insulin.
Insulin Aspart
Brands: Novolog 100u/mL (including FlexPen)
Kinetics: Following subcutaneous administration, insulin aspart has an onset of action of roughly 15 minutes which is quicker than the onset of regular insulin. Insulin aspart also has an earlier peak glucose lowering effect when compared to regular insulin. Insulin aspart reaches mean peak plasma concentrations faster (40—50 minutes) than regular insulin (80—120 minutes) when given SC. In addition, the mean maximum concentration of insulin aspart is 82.1 mUnits/ml compared with 35.9 mUnits/ml for regular human insulin. Insulin aspart exhibits a duration of action of roughly 3—5 hours which is shorter than the duration of regular insulin.
Isophane Insulin (NPH)
Brands: Humulin N, Novolin N
Kinetics: Neutral Protamine Hagedorn (NPH) or isophane insulin is an intermediate-acting insulin that is produced by adding zinc and protamine to regular insulin causing a delay in absorption and a prolongation of the duration of action after subcutaneous administration. After subcutaneous administration, the onset of glucose lowering activity begins approximately 1—4 hours after injection with maximal activity occurring between 4 and 14 hours (mean 5.5 hours). Roughly 14% of the total activity occurs in the first 4 hours (range 3—48%). The duration of activity ranges from 10—24 hours or longer.
Insulin Glargine
Brands: Lantus (including SoloStar Pens)
Kinetics: Insulin glargine is a long-acting insulin analog that is produced from a chemical modification of regular human insulin; the amino acid asparagine is replaced by glycine at position A21, and 2 arginines are added to the C-terminus of the B chain. Because of these changes, insulin glargine is soluble in an acidic environment; insulin glargine forms a stable hexamer precipitate in the neutral pH environment upon injection into subcutaneous tissue. The hexamer precipitate allows for a delay in the onset of action and a constant release of insulin over a 24 hour period. The onset of glucose lowering activity is 1.5 hours; insulin glargine has a constant concentration/time profile over 24 hours with no pronounced peak effect. The median duration of action of insulin glargine is 24 hours. Insulin glargine should be administered once daily, at the same time everyday.
Reference: Clinical Pharmacology, “Insulin”. Tampa, FL: Gold Standard Inc.; available online at www.clinicalpharmacology-ip.com; Accessed August 2014
With the information presented above, be mindful about meal timing and the effects of each type of insulin you choose to use (ie Lantus is VERY VERY different from Humulin and should not even be considered interchangeable in any way).
** I am not condoning use of insulin or any substances regulated and described under the Federal Food Drug and Cosmetic Act for use without authorization from a licensed healthcare professional, and data presented in this post is copied and pasted from stated reference (see bottom) and for informational and research purposes only **
Regular insulin
Brands: Humulin R, Novolin R
Kinetics: Subcutaneously administered regular insulin is best given 30—60 minutes before a meal. The onset of action of unbuffered, regular insulin (100 units/ml) begins approximately 30 minutes after injection with maximal effects occurring 2.5—5 hours later. The apparent plasma half-life following SC administration is approximately 1.5 hours with a duration of action of 8—12 hours (mean 5—7 hours, actual values can widely among individuals receiving SC regular insulin).
Insulin Lispro
Brands: Humalog 100u/mL (including KwikPen)
Kinetics: Pharmacodynamically, insulin lispro has an onset of glucose-lowering activity that is 15—30 minutes, which is more rapid than regular insulin. Insulin lispro reaches mean peak plasma concentrations faster (30—90 minutes) than regular insulin (60—120 minutes) when given SC. Insulin lispro has a duration of action of roughly 3—5 hours, which is shorter than regular insulin. After subcutaneous administration, the apparent half-life of insulin lispro is 1 hour compared with 1.5 hours for regular insulin. After abdominal administration, insulin lispro concentrations are higher than those following deltoid or thigh injections. Also, the duration of action of insulin lispro is slightly shorter following abdominal injection, compared with deltoid and femoral injections. Intermittent SC injections of insulin lispro should be given within 15 minutes prior to or immediately after a meal because of the fast onset compared to regular insulin.
Insulin Aspart
Brands: Novolog 100u/mL (including FlexPen)
Kinetics: Following subcutaneous administration, insulin aspart has an onset of action of roughly 15 minutes which is quicker than the onset of regular insulin. Insulin aspart also has an earlier peak glucose lowering effect when compared to regular insulin. Insulin aspart reaches mean peak plasma concentrations faster (40—50 minutes) than regular insulin (80—120 minutes) when given SC. In addition, the mean maximum concentration of insulin aspart is 82.1 mUnits/ml compared with 35.9 mUnits/ml for regular human insulin. Insulin aspart exhibits a duration of action of roughly 3—5 hours which is shorter than the duration of regular insulin.
Isophane Insulin (NPH)
Brands: Humulin N, Novolin N
Kinetics: Neutral Protamine Hagedorn (NPH) or isophane insulin is an intermediate-acting insulin that is produced by adding zinc and protamine to regular insulin causing a delay in absorption and a prolongation of the duration of action after subcutaneous administration. After subcutaneous administration, the onset of glucose lowering activity begins approximately 1—4 hours after injection with maximal activity occurring between 4 and 14 hours (mean 5.5 hours). Roughly 14% of the total activity occurs in the first 4 hours (range 3—48%). The duration of activity ranges from 10—24 hours or longer.
Insulin Glargine
Brands: Lantus (including SoloStar Pens)
Kinetics: Insulin glargine is a long-acting insulin analog that is produced from a chemical modification of regular human insulin; the amino acid asparagine is replaced by glycine at position A21, and 2 arginines are added to the C-terminus of the B chain. Because of these changes, insulin glargine is soluble in an acidic environment; insulin glargine forms a stable hexamer precipitate in the neutral pH environment upon injection into subcutaneous tissue. The hexamer precipitate allows for a delay in the onset of action and a constant release of insulin over a 24 hour period. The onset of glucose lowering activity is 1.5 hours; insulin glargine has a constant concentration/time profile over 24 hours with no pronounced peak effect. The median duration of action of insulin glargine is 24 hours. Insulin glargine should be administered once daily, at the same time everyday.
Reference: Clinical Pharmacology, “Insulin”. Tampa, FL: Gold Standard Inc.; available online at www.clinicalpharmacology-ip.com; Accessed August 2014
With the information presented above, be mindful about meal timing and the effects of each type of insulin you choose to use (ie Lantus is VERY VERY different from Humulin and should not even be considered interchangeable in any way).