Diabetes is a chronic disease that prevents the body from properly utilizing insulin. For such people, there are several insulin substitutes which are made with the intention to fulfilling specific challenges such as How the insulin behaves inside the body, the time it takes to start working and the duration of its effects. Insulin therapy, however, remains most widely used by individuals who are diagnosed with type one diabetes but many type two diabetics also end up using insulin therapy to keep their blood sugar levels in control.
Here’s a quick synopsis of some of the basic types of insulin and their uses:
- Rapid-Acting Insulin: Insulin glulisine (Apidra), insulin aspart (NovoLog), and insulin lispro (Humalog) are examples. It usually takes about 10 to 30 minutes after injection to commence activities.
Peak: Predominantly occurs between thirty and ninety minutes duration.
It lasts approximately three to five hours.
Use: Rapid-acting insulin is most often employed prior to meals because it helps to prevent high blood sugar that typically occurs after meals. It can also be used in insulin pumps that provide insulin doses throughout the day.
- Regular Insulin, or Short-acting insulin: Humulin R, Novolin R, etc.
Onset: Works within the range of thirty to sixty minutes after being injected.
Peak: Generally peaks within two to three hours after the injection.
It lasts roughly five to eight hours.
Short-acting insulin is administered typically within 30 to 60 minutes before meals; this is usually the case as it is used to control post-prandial blood sugar excursions. The action of this kind of insulin is not very rapid like that of rapid-acting insulins.
- Intermediate-Acting Insulin: As its example, we have NPH insulin (Humulin N, Novolin N). It starts to work within one to two hours after it’s injected.
Peak: Within four to twelve hours, it has its highest concentration.
Duration: It lasts, or is effective for, twelve to eighteen hours.
Use: Usually, for about half a day or overnight insulin intermediates act to help regulate the level of blood glucose. In order to facilitate complete insulin regimens, they are typically used together with short and rapid acting insulin.
- Long-Acting Insulin: An example of this type of insulin includes insulin detemir (Levemir) and insulin glargine (Lantus, Basaglar, Toujeo). Like the previous ones, this type of insulin starts to work one to two hours after it has been injected.
Peak: The levels does not change or rather are stable which is a favorable condition for insulin therapy.
Duration: It is effective for, or lasting 24 hours and even longer.
Use: Long acting insulins keep blood glucose levels stable which is desirable for many. As a result of this, it is preferred that it is used once or twice daily dosage. It is typically used in combination with rapid-acting insulin for handling postprandial blood glucose levels.
- Ultra-Long-Acting Insulin: An example is Tresiba (insulin degludec). Insulin Degludec works about an hour right after being injected.
Peak: It is very scarce and therefore not really distinguishable.
It may last up to a maximum of 42 hours.
Use: Ultra-long-acting insulin permits additional dosage options and is administered one time a day. People whose blood sugar level requires to be kept constant for a longer duration of time can make use of it and people who are erratic in their timings.
- Humulin 70/30, Novolog Mix 70/30 and Humalog Mix 75/25 are examples (intermediate-acting 75% and rapid-acting 25%).
Onset: Ten to thirty minutes may elapse until the rapid-acting component is effective.
The peak which occurs between 1 and 4hours is determined by the intermediate acting component.
Duration: Up to 18 hours.
Use: Pre-mixed insulin is exactly what its name suggests it is an injection that contains an intermediate and a short or rapid acting insulin. For them, it is helpful who prefer to take fewer injections in the day. Normally, pre-mixed insulin is taken just before the meals to provide sufficient basal insulin to last for a longer duration preventing the rise in blood glucose levels after meals.
- Inhaled Insulin: Example: Afrezza Onset, for example, begins after 12 to 15 minutes.
Peak: It reaches its peak level in roughly thirty minutes.
About 60 to 180 minutes is the duration it lasts for.
To lower postprandial blood glucose concentrations, a device is used to deliver inhaled insulin, a rapid-acting insulin, before meals. It may be a possibility for those who do not want to take injections at lunch, although basal coverage typically requires a long-acting insulin such as Lantus.
Routes of Insulin Delivery:
Insulin Pens: These are prefilled pens that are easy to use and are effective at dispensing the desired insulin dosage. Many patients have a preference for using pens instead of vials and syringes which are more troublesome.
An insulin pump is a small electronic device implanted just under the skin that delivers insulin continuously throughout the day and provides an additional dose, called a bolus dose around mealtime. Because their goal is to achieve more stringent control of blood glucose levels, insulin pumps which automatically dispense rapid-acting insulin are quite popular.
Syringes and Vials: This is the usual method of giving insulin in which insulin stored in a vial is withdrawn and injected with a syringe.
As mentioned earlier, inhalers are used in place of needles while giving insulin during meals.
Insulin Patch: These insulins have not been widely accepted yet, but they are considered to be useful as a new and emerging technique through which insulin can be delivered consistently and through the skin.
Choosing the Best Timing for Injecting Insulin:
The choice of an insulin schedule by a patient is dependent on their lifestyle, the pattern of blood sugar changes, the type of diabetes they have, and their individual likes.
Throughout the day, people with type 1 diabetes usually utilize fast-acting insulin at mealtimes (bolus) as well as slow-acting insulin for the rest of the day (basal).
Some type 2 diabetes patients may start with oral medications and progress to insulin therapy. Long-acting insulin can be used to prevent hyperglycemia overnight, while short-acting insulin can be used during meals.
Addition of Other Medications: Most patients with type 2 diabetes who are overweight use insulin with metformin, GLP-1 receptor agonists such as liraglutide or semaglutide, and SGLT-2 inhibitors to control their blood sugar while reducing the risk of hypoglycemia.
In a nutshell, insulin is very versatile when used in the management of diabetes patients. New classes of insulin, new devices and new schedules have improved the accuracy and ease of blood glucose control. It is recommended for the diabetics to consult their health care provider to help them in determining the most appropriate insulin dosage that corresponds the blood glucose pattern controls, exercise habits and overall health targets.
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