Insulin is the primary medication used to treat type 1 diabetes.
Pramlintide has recently been approved for the treatment of type 1 and type 2 diabetes.
The information provided here is meant to give you a general idea about each of the types of insulin listed below. Only the most general instructions are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.
For proper diabetes control, insulin is administered, either by injection or inhalation, several times throughout the day to replace the insulin that the pancreas is unable to produce. Insulin must be taken as an injection or inhalation because if it were taken by mouth, it would be digested by the enzymes in the stomach before it reached the bloodstream.
The amount of insulin you take must be balanced with the amount and type of food you eat and the amount of exercise you do. If you change your diet, your exercise, or both without changing your insulin dose, your blood glucose level can drop too low or rise too high.
Before getting insulin, you should check your blood glucose level with a blood glucose meter. This will help you to determine how much insulin you need. Most individuals with type 1 diabetes will need two to four insulin administrations daily. Current insulin treatment regimens usually employ some combination of rapid-acting and long or very long-acting insulins. Insulin is most commonly administered before meals and at bedtime.
The three characteristics of insulin are:
Onset
—the length of time it takes for the insulin to reach the bloodstream and begin lowering blood glucose after it is injected.
Peak Time
—the time during which insulin is at its maximum strength in terms of lowering blood glucose levels.
Duration
—how long the insulin continues to lower blood glucose
Main Types
The main types of insulin available are:
| Type of insulin |
Onset* |
Peak time* |
Duration* |
Notes on use |
|
Rapid-acting
|
10-30 minutes |
0.5-3 hours |
3-5 hours |
Inject immediately before a meal. |
|
Regular or short-acting
|
0.5-1 hour |
2-5 hours |
5-8 hours |
|
Intermediate-acting
(NPH and lente)
|
1-2 hours |
3-12 hours |
18-24 hours |
This is often used in combination with short-acting insulin. |
Long-acting
Ultralente–absorption varies; this kind can be either intermediate- or long-acting
|
0.5-3 hours |
10-20 hours |
20-36 hours (nearly a continuous insulin release) |
A long-acting can be combined with a short-acting to provide proper peaking of insulin at mealtimes. |
Very long-acting
Insulin glargine (Lantus)—enters the body quickly, and its effects are long lasting
|
1 hour |
n/a |
20-24 hours (continuous insulin release) |
This may not be mixed with other types of insulin. |
*Each person has a unique response to insulin, so the times mentioned here are approximate.
Pre-Mixed
Premixed insulins are a mixture of short-acting and intermediate-acting insulins.
|
Type of insulin
|
Onset
|
Peak time
|
Duration
|
| Humulin (50/50) |
30 minutes |
2-5 hours |
18-24 hours |
| Humalog mix
(75/25) |
15 minutes |
0.5-2.5 hours |
16-20 hours |
| Humulin (75/30) |
30 minutes |
2-4 hours |
14-24 hours |
| Novolin (75/30) |
30 minutes |
2-12 hours |
up to 24 hours |
| Novolog (75/30) |
10-20 minutes |
1-4 hours |
up to 24 hours |
Common Brands
The table below show types of insulin and common brand names.
| Type of insulin |
Brand names |
| Rapid-acting |
Humalog (insulin lispro)
NovoLog Cartridge (insulin aspart)
*both require a prescription
|
| Regular or short-acting |
Humulin R (regular)
Iletin II Regular
Novolin R
ReliOn/Novolin R
|
| Intermediate-acting |
Humulin L (lente)
Humulin N (NPH)
Iletin II Lente
Iletin II NPH
Novolin L (lente)
Novolin N (NPH)
ReliOn/Novolin N (NPH)
|
| Long-acting |
Humulin U (ultralente)
|
| Very long-acting |
Lantus (insulin glargine) |
In the recent past for insulin to be used by the body, it must be moved through the outermost layer of skin and into fatty tissue before it gets into the bloodstream. As of September 2005, the Food and Drug Adminsitration (FDA) has approved a breakthrough delivery system with inhaled insulin.
The following lists wasy of getting insulin through the skin.
Syringe
—The syringes you will use are small and have fine points and special coatings that help make injections as easy and painless as possible. When insulin injections are done properly, most people find that they are relatively painless.
Insulin is usually given as a
subcutaneous injection
. This means that the needle goes into the fat layer between the skin and the muscle to deliver a certain amount of medicine.
Pump
—This is a computerized device about the size of a beeper that is worn on the belt or in a pocket. It delivers a steady, measured dose of insulin through a flexible plastic tube called a cannula. With the aid of a small needle, the cannula is inserted through the skin, usually in the abdominal region, and is taped in place. In some products, the needle is removed and only a soft catheter remains in place. Based on your meals and your blood sugar level, you control the release of insulin from the pump.
Because the pump continuously releases tiny doses of insulin, this delivery system most closely mimics the body's normal release of insulin. Also, pumps can deliver very precise insulin doses for different times of the day, which may be necessary to correct the dawn phenomenon—the rise of blood sugar that occurs in the hours before and after waking.
Pen
—The insulin pen looks very much like an old-fashioned cartridge pen, except that it has a needle and holds a cartridge of insulin. Pens are particularly useful for people who travel frequently, or whose coordination is impaired.
- Check your insulin's expiration date. If you haven't finished it before then, throw the rest away.
- Store unopened bottles of insulin in the refrigerator. Do not store your insulin at extreme temperatures.
- Keep the bottle of insulin you are using at room temperature. Injecting cold insulin can sometimes make the injection more painful. (Most doctors believe that insulin kept at room temperature will last 1-2 months.)
- If your treatment requires that two different insulins be mixed, be sure that you understand which of the two should be drawn into the syringe first. If you change the mixing pattern you may change the dose you receive. Some insulins cannot be mixed together. Do not mix insulins together in one syringe unless you have been instructed to do so.
Common name: Pramlintide (Symlin)
Amylin is a hormone produced by the same beta cells which produce insulin. In fact, amylin is released into the bloodstream at the same time as insulin. Amylin reduces glucagons release and ehances a sense of fullness after ingesting a meal. Together with insulin, it lowers blood glucose. Pramlintide is chemically related to amylin.
This new drug was approved by the FDA in March 2005 for the treatment of type 1 and type 2 diabetes together with insulin treatment. It is given to patients who fail to achieve the optimal blood glucose levels despite getting the right dose of insulin. This drug is given by injection immediately before meal. It should be used with care in the elderly.
Pancreatic transplantation is performed only in a few medical centers in the US. This procedure is an acceptable alternative in the following situations:
- Patients who develop severe renal disease especially those contemplating kidney transplantation
- Patients in whom insulin treatment consistently fails to prevent the acute complications such as ketoacidosis
- Patients in whom insulin treatment causes severe emotional problems which interfere with his/her daily life
- Patients who have frequent, potentially life-threatening complications, such as repeated pneumonias
