Insulin and Insulin Analogues Table

Insulin Preparation Onset of action Peak Duration of Action Essential Instructions for the Essential Instructions for the Patient on the Timing of Insulin Patients on Eating Rapid-acting insulin 5 to 15 minutes 1 to 2 hours 4 to 5 hours Take the rapid-acting insulin even if Eat a meal within 15 minutes after Lispro (Humalog) BG is well controlled taking rapid–acting insulin. Aspart (Novolog) Take the rapid-acting insulin up to 15 Glulisine (Apidra) minutes before the meal Apidra can be taken immediately after a meal

Short-acting insulin 20 to 60 minutes 2 to 4 hours 8 to 10 hours Take the Regular insulin even if BG is Eat a meal within 30 minutes after Regular well controlled taking Regular insulin (Humulin Regular) Inject 30 minutes prior to meal (Novulin Regular)

Intermediate-acting insulin 1 to 2 hours 4 to 8 hours 10 to 20 hours Take the NPH even if BG is well Eat 4 hours after taking AM NPH NPH controlled insulin. May need an HS snack if the (Humulin NPH) Take at the same times daily blood glucose is low at bedtime. (Novolin NPH)

Long-acting insulin 1 to 2 hours Relatively flat 12 to 20 hours Take the long-acting insulin even if Take the long-acting insulin even if a Detemir (Levemir) BG is well controlled person does not eat Usually administered once daily but Glargine (Lantus) can be administered twice daily (12 1 to 2 hours Relatively flat 20 to 24 hours hours apart), Take at the same time daily Pre-Mixed insulin* Onset based on the Peak based on the Duration based on the action Instruct the patient they are taking two Administer premix insulin twice daily Multiple preparations action of the action of the of the individual insulin types of insulin in a single injection before breakfast and before dinner at individual insulin individual insulin (See above) the same times each day 10 to 12 (See above) (See above) hours apart Individuals who do not have regular access to food will be at a higher risk for hypoglycemia NPH/Regular mix PreMix 70/30 (NPH/Regular) Take the pre-mix with Regular insulin Must eat ½ hour after injecting insulin Two brands available: Humulin or up to 30 minutes before breakfast and and 4-5 hours later. Novulin dinner

Refer to above Premix as: Premix Regular

NPH/Rapid Acting Insulin mix NPH/ Aspart Take the pre-mix with rapid acting Eat immediately after injecting insulin PreMix Novolog 70/30 insulin up to 15 minutes before and 4 – 5 hours later. NPH/Lispro breakfast and dinner PreMix Humalog 75/25 Refer to above Premix as: Premix Rapid acting