Types of insulin

  There are main types of insulin which are rapid-acting insulin regular insulin intermediate-acting insulin long-acting insulin and pre-mixed insulin the type of insulin is chosen based on the alignment between the individual needs of the patient and the properties of the types of insulin the main properties of insulin taken into consideration for choosing the appropriate type are the following

Onset time representing the duration it takes for insulin to start reducing blood glucose levels Peak time representing the time when insulin is at its maximum effectiveness in reducing blood glucose levels Duration of action representing the duration for which the effect of insulin continues in reducing blood glucose levels

Rapid-acting insulin Rapid-acting insulin starts its effect within less than 15 minutes of injection reaches its peak effect within 30-90 minutes and continues to affect for 2-4 hours examples include insulin aspart insulin lispro and insulin glulisine these types were manufactured by modifying the chemical composition of natural insulin hence they are called insulin analogs their effect is faster than regular insulin and they are highly effective in preventing hyperglycemia after meals they are safe to use as their mechanism of action is very close to that of natural insulin it is important to eat immediately after taking a rapid-acting insulin injection as it can cause a sharp drop in blood sugar levels if meals are not consumed in appropriate quantities immediately rapid-acting insulin is given by injection except for a type called inhalable insulin which lasts for 2-3 hours and reaches its peak effect within 15-20 minutes of use its use has been approved by the food and drug administration for patients with type 1 diabetes in conjunction with long-acting insulin it can also be used for patients with type 2 diabetes as deemed appropriate by the doctor

Regular or short-acting insulin Regular insulin also known as short-acting insulin starts to reduce blood glucose levels within 30 minutes of injection it takes longer than rapid-acting insulin to start working thus it is necessary to take it 30 minutes before eating its effect lasts for 6-8 hours with its peak effect occurring 2-3 hours after injection

Intermediate-acting insulin Intermediate-acting insulin is more effective in controlling blood sugar levels at night and between meals it starts working within one to two hours of injection and its effect lasts for more than 12 hours in some cases it takes 4-6 hours to reach its peak effect taking a large dose may increase the duration of effectiveness and the time needed to reach peak effect while a very small dose may shorten the time needed to reach peak effect examples include neutral protamine hagedorn NPH

Long-acting insulin Long-acting insulin has no peak time it mimics the natural insulin produced by the pancreas starting its effect two hours after entering the bloodstream and lasting for 14-24 hours examples include insulin glargine and insulin detemir there is also an ultra long-acting insulin with no peak time and a longer duration of effect an example is insulin degludec which starts working one hour after injection and lasts for about 42 hours or more

Pre-mixed insulin This type is prepared by mixing two types of insulin in one injection one being intermediate-acting insulin and the other either rapid-acting or short-acting to facilitate injection the insulin appears cloudy this type starts its effect depending on the faster-acting insulin between the two and its effect continues based on the longer-acting insulin it is important to follow the preparation instructions that come with the product

Choosing the appropriate type of insulin The specialist doctor chooses the appropriate type of insulin based on several factors including how the patient responds to insulin the duration it takes for the body to absorb insulin varies from person to person and the duration insulin remains effective in the body the patient's ability to take multiple insulin injections per day the age of the patient lifestyle factors such as the type of food the patient eats and their physical activities the frequency of the patient's blood sugar level measurements the goals of blood sugar level control

Storing insulin The American diabetes association recommends storing unused insulin in the refrigerator for insulin vials in use they can be stored at room temperature not exceeding 26 degrees celsius for up to 30 days provided the vial is kept away from direct sunlight the rule is if the room temperature is comfortable for the person insulin is safe it is generally recommended to keep an extra vial of insulin used by the patient in the refrigerator and take it out the night before the day of intended use as cold insulin is believed to cause noticeable pain at the injection site be careful not to allow insulin to freeze rapid-acting regular and some long-acting insulin types should be clear while other types are cloudy without clumps it is important to check this before using the vial it should be noted not to shake the vial whether intentionally or unintentionally as it can form air bubbles that affect the amount of insulin to be drawn from the vial

When using insulin pens follow the storage instructions that come with the product the same applies to inhalable insulin which must be kept in the refrigerator until use or used within 10 days if kept outside the refrigerator the open vial can be stored in the refrigerator but should be left to warm to room temperature before use