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Let’s Talk About Insulin Pt. 2: Supplemental Insulin

An overview of the five types of supplemental insulin

In the previous post, I discussed the role of insulin and glucagon, as well as the two main types of insulin, basal and bolus. In this post, I will discuss supplemental insulin, how each type works and insulin brands.

There are more than 20 brands of supplemental insulin available in the United States. There are five types of brands: rapid acting, short acting, intermediate-acting, long-acting, and ultra long-acting. In addition to these categories, you can get premixed insulin or inhaled insulin as well.   

Rapid-acting Insulin & Short-acting Insulin

To replace the natural bolus insulin produced by the pancreas, rapid-acting and short-acting insulins are used. These types of insulin are administered just before a meal or snack to counteract sugar spikes that are caused by eating.   

In the medical world, short acting insulin is known as regular bolus insulin. Short-acting insulin begins to work within 30 minutes, reaches its peak between 2 and 3 hours, and lasts for 3 to 6 hours.   

Examples of short-acting insulin:

  • Humulin R
  • Novolin R
  • Velsulin R

Rapid-acting insulin, however, works the fastest of all types of supplemental insulin. In the case of rapid-acting insulin, onset occurs after 15 minutes, peak within an hour, and then lasts 2-4 hours.   

Examples of rapid-acting insulin:

  • Apidra (glulisine)
  • Admelog
  • Humalog (lispro)
  • Fiasp (insulin aspart)
  • Novolog (insulin aspart)

Intermediate-acting Insulin

Intermittent-acting insulin replaces basal insulin. Only one type of intermediate insulin exists, Hagedorn or NPH. Within 2-4 hours, the onset occurs. Peak hours are between 4 and 12 hours and the duration varies from 12 to 18 hours. As a result, some people use short-acting or rapid-acting insulin to cover meals.  

Examples of intermediate-acting insulin:

  • Humulin N
  • Novolin N
  • ReliOn (NPH)

Long-acting Insulin & Ultra Long-acting Insulin

The long-acting and ultra-long-acting insulins are used to replace basal insulin by maintaining glucose levels throughout the day and night. They begin around four to six hours apart, but the duration is at least 24 hours. This type of insulin doesn’t have any peak points as it is designed to remain in the system for longer.

Examples of long-acting insulin:

  • Toujeo (glargine u-300)
  • Levemir (detemir)
  • Basaglar
  • Lantus (glarine)

Example of ultra long-acting insulin:

  • Tresiba (degludec)

Premixed Insulin

In a premixed insulin injection, varying amounts of intermediate-acting insulin are combined with short-acting or rapid acting insulin. Depending on the mix, onset can take between 15 minutes and an hour. It peaks at varying times and lasts for up to 24 hours.  

Examples of premixed insulin:

  • Humulin 70/30, Novolin 70/30 and Humulin 50/50 are mixtures of intermediate and short acting insulin.
  • Humalog Mix 75/25 and Novolog Mix 70/30 are mixtures of intermediate and rapid-acting insulin.

Inhaled Insulin

As far as we know, Afrezza is the only rapid-acting insulin that is inhaled. As soon as Afrezza is inhaled, it begins to take effect within 12 to 15 minutes, peaks in around 30 minutes, and dissipates around 3 hours after taking it.   

SOUND OFF: What type of insulin are you currently using? Let’s have a conversation and comment below!

Until Next Time,

The Genetic Diabetic

References:

American Diabetes Association: Insulin Basics

https://www.diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics

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Let’s Talk About Insulin

The role of insulin and the two basic types

You just returned from your follow up doctor’s appointment, and it didn’t go quite as well as expected. While you’ve followed the recommended diet, exercised, improved your sleep and implemented some stress management strategies, your A1C has increased. Your doctor is strongly considering adding insulin therapy to your treatment plan.  

The stigma attached to injecting insulin has caused you to try very hard to avoid using it. However, it seems that there is no alternative for you.   

Feelings of guilt and failure begin to creep in. As a result of the failure of your current treatment, you feel that you failed.   

Taking insulin is not a sign of failure, my friend.  

When insulin therapy is used properly, you can still live a long and healthy life. There is a good deal of planning, organizing and a lot of math skills required (no kidding!), but once you understand the role insulin plays in our bodies, you will discover that insulin therapy is a life-saving tool for managing diabetes.  

The Role of Insulin

Insulin is a hormone that aids in lowering the level of glucose in the blood. In response to a rise in glucose level, such as when eating, this hormone is released into the bloodstream. In the body, glucose enters cells where it can be used for energy or stored to use later.  

Any excess sugar is stored in the liver, muscles, and fat cells. In the cells, glucose reaches its normal level once it enters the cells.   

The presence of low blood glucose stimulates the release of another hormone called glucagon by cells of the pancreas. Glucagon activates the liver to release the stored glucose known as glycogen from the liver into your bloodstream. Throughout the day, insulin and glucagon alternate their release in order to keep blood glucose levels stable.  

A person with type 1 diabetes needs insulin therapy to replace the insulin that is not produced by the body.  

The insulin therapy is sometimes necessary for people with type 2 diabetes or gestational diabetes when other treatments have not controlled blood glucose levels. Maintaining a target blood glucose level prevents complications.  

Basal & Bolus

Insulin comes in two basic forms: basal and bolus.   

Basal insulin is a long-acting type of insulin, also known as a “background”. Basal insulin boosts activity for about 24 hours at a time. High resting blood glucose levels can be brought down with basal insulin by providing a continuous supply of throughout the day. Basal insulin is usually taken once or twice a day to maintain consistent levels. By using basal insulin, glucose levels can remain steady even when individuals are not eating, allowing the cells to use energy more efficiently.

Bolus insulin is a more powerful, but shorter-lasting type of insulin. It is commonly taken before meals and during periods of higher blood sugar. Bolus insulin is taken at mealtimes to maintain a healthy level after eating. It is also known as “rapid-acting” insulin because it needs to work fast. Bolus insulin usually works around 15 minutes, peaks after an hour, and lasts for 2-4 hours. Bolus insulin is affected by the amount of food a person eats during a meal; therefore, it’s necessary that a person with diabetes knows how many carbohydrates they consume so that they can adjust how much insulin they need. Many people using bolus insulin use carb counting and carb-to-insulin ratios as tools.      

Basal-bolus insulin therapy is an intensive insulin treatment that involves taking basal and bolus insulin simultaneously.  This means that some people takes basal insulin once or twice a day and use bolus insulin at mealtime. In addition to insulin, people with type 2 diabetes may need to take oral, non-insulin medications. 

Did you know that there are over 20 different types of insulin on the market in the United States? Tomorrow, I will share the five types of supplemental insulin and how each of them work.

Until Next Time,

The Genetic Diabetic