Diabetes Self-Management Articles

These articles cover a wide range of subjects, from the most basic aspects of diabetes care to the nitty-gritty specifics.

Links not loading properly?

Some of our pages use Portable Document Format (PDF) files, which require Adobe Acrobat Reader. To download Acrobat Reader for free, visit www.adobe.com.

Sign up for our weekly e-mail newsletter and receive a FREE GIFT! Enter your e-mail below.

Learn more

Learn more about diabetes

Links to help you learn more about diabetes.

Ask a diabetes expert
Other diabetes resources
Browse article topics

 

Type 2 Diabetes and Insulin
Getting Started

by Christin Snyder, MD, and Irl B. Hirsch, MD

Injected insulin that functions as basal insulin is called “long-acting” and provides a relatively low level of insulin for a long period. Insulin that functions as bolus insulin is called “short-acting” or “rapid-acting” and provides a higher level of insulin that is used quickly.

Three types of long-acting insulin are commonly used: NPH (brand name Humulin N), insulin glargine (Lantus), and insulin detemir (Levemir). NPH insulin lasts 10–16 hours in the body. It may initially be taken as a single daily injection, but eventually it usually needs to be taken twice a day. The main advantage of NPH insulin is that it is inexpensive. Its main drawback is that the timing of its peak of action is unpredictable, which can lead to hypoglycemia (low blood glucose) if meals are not timed with injections properly. (An insulin’s “peak” is when it is most active in the body. It varies by type of insulin, and ideally injections are timed so that the insulin’s peak coincides with the rise in blood glucose that follows a meal.)

Insulin glargine is a long-acting insulin that can last up to 24 hours and has little peak in its action, which reduces the risk of hypoglycemia. Another advantage of insulin glargine is that it only requires one injection each day for the vast majority of people with Type 2 diabetes.

The newest long-acting insulin, insulin detemir, usually lasts 16–20 hours. In general, it has less of a peak than NPH but is not as “flat” as glargine. Insulin detemir tends to be the most predictable of the long-acting insulins. It has also consistently been shown to cause less weight gain than the other insulins (or even mild weight loss). Detemir and glargine cost about the same, but both are more expensive than NPH. They cannot be mixed with other insulins in the same syringe, while NPH can. All three basal insulins are available in prefilled pens that do not require syringes or vials. Doses of insulin can be dialed into the pen, and the pens can be carried conveniently in a coat pocket, purse, or knapsack.

The oldest type of short-acting insulin is Regular insulin (brand names Humulin R and Novolin R). It lasts about 6–8 hours and has its peak about 2 hours after injection. It does not start working (lowering blood glucose) until about 30–60 minutes after injection, so it can be difficult to coordinate the timing of injections with meals. For example, if you take an injection of Regular insulin right before you eat lunch, your lunch will likely raise your blood glucose level before your insulin starts working to lower it. You would need to inject the insulin 30–60 minutes before eating lunch to match the rise in blood glucose with the action of the insulin. In spite of this inconvenience, Regular insulin is still widely used because it is very inexpensive, and because many physicians have years of experience prescribing it.

Three other forms of short-acting insulin (considered “rapid-acting”) are insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra). These insulins each have a slightly different chemical structure, but all last less than 5 hours and start to work within 15 minutes. They are all relatively expensive but are easier to coordinate with meals than Regular insulin. In general, these three rapid-acting insulins match up better with the body’s release of glucose into the blood after eating, resulting in a lower risk of hypoglycemia, but are no better than Regular insulin at lowering the HbA1c level. All short-acting insulins are available in easy-to-use insulin pens.

Long- and short-acting insulins are also available in premixed combinations such as 70% NPH and 30% Regular, also known as “70/30.” Although premixes may initially appear to be more convenient, they are difficult to tailor to individual needs due to the fixed proportions of the combinations. A person who needs, for example, more short-acting insulin but not more long-acting insulin is out of luck when using a premix. For more information on the different types of insulin, see “Insulin Action times.”

Page    1    2    3    4    Show All    

Also in this article:
Adjusting Bedtime Insulin
Insulin Action Times
Correction Doses

 

 

More articles on Insulin & Other Injected Drugs

 

 


Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

 

 

Computer-Aided Diabetes Care? Why Not?
"What did we ever do without computers?" I asked myself, both rhetorically and somewhat sarcastically... Blog

Diabetes Health Fair in Raleigh
If you'll be in the area of Raleigh, North Carolina, on May 17, be sure to check out the... Blog

Cats and Dogs Get Diabetes, Too!
We may not think about it much, but our pets can get diabetes. In fact, diabetes is pretty... Blog

Roughly how many calories a day will nursing my baby require? Get tip


Carbohydrate Restriction: An Option for Diabetes Management
Some people find that decreasing the amount of carbohydrate they eat can help with blood glucose control. Here’s what to know about this approach.

Insulin Patch Pumps: A New Tool for Type 2
Patch pumps are simpler to operate than traditional insulin pumps and may be a good option for some people with Type 2 diabetes who need insulin.

How Much Do You Know About Vitamins?
Learn what these micronutrients can and can’t do for you.

Complete table of contents
Get a FREE ISSUE
Subscription questions