INSULIN Rapid-Acting
Short-Acting
IntermediateActing
Long-Acting
Insulin IV (regular insulin only)
Isophane insulin suspension (NovoLIN NPH, HumULIN N)
Insulin glargine (Lantus)
Insulin detemir (Levemir)
30 min – 1hr
10-30 min
1- 2 hr
3 - 4 hr
3-4 hr
1 – 3 hr
2 – 4 hr
15-30 min
4 – 12 hr
Plateau
3-14 hr
6-8 hr
3-5 hr
5-7 hr
30 min -1 hr
18-24 hr
24 hr
6-24 hr
Clear
Clear
Clear
Clear
Clear
Cloudy
Clear
Clear
When given -meals should occur when insulin is at peak effect
15 min before or within 20 after start of meal
Within 15 min before or immediately after a meal
5-10 min before meals
15-30 minutes prior to a meal
30 minutes prior to a meal
Within 30-60 min before a meal
One daily at the same time every day.
Once daily with evening meal or bedtime
Compatibility
NPH
NPH
NPH
NPH
Regular, HumALOG, NovOLG, Apidra
None
None
• MUST NOT BE
With 2 daily Detemir, with evening meal, bedtime or 12 hrs after morning dose.
Type
Insulin glulisine (Apidra)
Insulin lispro (HumALOG)
Onset (hr)
Within 15 min
Within 15 min
10 – 20 min
Peak effect (hr)
1 hr
1 - 1.5 hr
Duration (hr)
2-4 hr
Appearance
Special Considerations
Insulin aspart (NovOLOG)
Insulin injection SQ (NovoLIN R, HumULIN R U500, HumULIN R)
•Best mimics the body’s release of pre-meal insulin when given at right time.
•Hypoglycemia less likely
than with Regular due to timing of insulin administration
•More likely to occlude continuous subcutaneous insulin infusion CSII cannula than Regular Insulin
•Can be used for CS II (insulin pump)
*Regular (concentrate d) insulin U500 should not be given IV
(think even 2,12,24)
MIXED WITH ANY OTHER INSULIN OR SOLUTION
• Injection site pain more likely since Lantus is made to precipitate in the SQ tissue.
Combinations – None have Compatibility Type
Isophane human insulin (70%) & regular human insulin (30%) (HumULIN 70/30, NovOLIN 70/30)
Insulin lispro protamine/insulin lispro (HumALOG Mix 75/25)
Insulin aspart protamine/insulin aspart (NovOLOG Mix 70/30))
Onset
30 min
15 min
15 min
Peak effect (hr)
2-12 hr
2.8 hr
1-4 hr
Duration (hr)
24 hr
24 hr
18-24 hr
Appearance When given
Cloudy Once or Twice Daily
Give within 15 minutes of meals
Within 15 minutes of meals
Hypoglycemia: anxiety, restlessness, tingling in hands, feet, lips, tongue, chills, cold sweats, confusion, cool pale skin, difficulty concentrating, drowsiness, nightmares or trouble sleeping, excessive hunger, headache, irritability, nausea, nervousness, tachycardia, tremor, weakness, unsteady gait. Hyperglycemia: confusion, drowsiness, flushed dry skin, fruit like breath odor, rapid deep breathing, polyuria, loss of appetite, nausea, vomiting, and unusual thirst.