Outline of Various Types of Insulin Type of Insulin
Rapid-acting insulin analogues
Aspart Lispro Glulisine
Aspart + aspart-protamine Lispro + lispro-protamine
NovoLog Humalog Apidra
Premixed insulin/protamine
NovoLog Mix Humalog Mix
Long-acting insulin analogues Glargine
Detemir
Usually used twice a day before breakfast and dinner; provides postprandial coverage with 2 injections per day; less flexible than use of basal-bolus therapy with a combination of rapid-acting and long-acting analogues
Lantus Levemir
Can be used with 1 injection per day in patients with type 2 diabetes
Can be used with 1 injection per day in patients with type 2 diabetes; excellent reproducibility of absorption profile within individuals; possibly less weight gain than with other insulins
Not recommended
Regular human insulin Humulin R Novolin R
NPH insulin
Humulin N Novolin N
Onset of action is too slow and persistence of effect is too long to mimic a normal prandial physiologic profile; the result is impaired efficacy and increased risk of delayed hypoglycemia
Does not provide a sufficiently flat "peakless" basal insulin; highly variable absorption even within individuals; increased risk of hypoglycemia compared with the long-acting insulin analogues glargine or detemir
Summary of Insulin Regimens
Insulin Regimen
Basal
Premixed Prandial
Basal-bolus (multiple daily injections)
Continuous subcutaneous insulin infusion
Components and Frequency of Administration Glargine or detemir (daily or twice a day)
NovoLog Mix or Humalog Mix (usually twice a day; occasionally used daily or 3 times a day)
NovoLog, Humalog, or Apidra (usually 3 times a day)
NovoLog, Humalog, or Apidra (usually 3 times a day) in combination with glargine or detemir (daily)
NovoLog, Humalog, or Apidra
Injections per day
1 or 2 2
3 4
Continuous
Superior to regular human insulin in terms of more rapid action profile with reduced risk of hypoglycemia 2-5 hours aſter a meal or overnight
Trade Name Comment
