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Insulin Basics: The Types of Insulin

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Rapid-acting, long-acting, pre-mixed and more.

 

Written By: ADCES clinical staff

Updated: December 8, 2023

 

Understanding Insulin Types & Administration Options

Before getting into the details of technology-based insulin delivery devices, it's important to have a firm understanding of all insulin options. There are different types of insulin to help keep blood glucose levels within an optimal range. And there are a number of different ways in which insulin can be administered including injected with a syringe, insulin pen or connected pen, inhaled or delivered through a pump, as part of an automated insulin delivery (AID) device, or through a simple patch.

Insulin availability and brand names can differ by country. In the United States, there are many types of insulin available to treat people with diabetes, and even more are on the horizon. While the choices can seem complex and overwhelming, they're a little easier to understand once you realize that the category descriptors were originally created based on 2 things: the speed at which the insulin works and how long the insulin continues to be effective after it’s administered.

Since insulin action times can vary by individual, the onset, peak and duration times are only guidelines. As you and those you work with know well, so many things in diabetes including insulin action time can feel more like an art than an exact science.

 

Comparison of Human Insulin Preparations and Analogs

Rapid-acting Insulin: This type of insulin starts to work within 15 minutes of injection and peaks between 1 to 3 hours after injection. Duration can be anywhere from 3 to 7 hours. Some resources further divide them into very rapid acting with an onset between 15 to 20 minutes from injection and rapid acting with an onset of action between 15 to 30 minutes.

Examples include insulin lispro, (brand names: Admelog, Humalog), lispro-aabc (brand name: Lyumjev), insulin aspart (brand names: Fiasp, NovoLog), and insulin glulisine (brand name: Apidra).

In this list, Fiasp and Lyumjev are considered very rapid-acting insulins.

A very rapid-acting inhaled insulin is also available. It starts to work within 10 to 15 minutes, has a peak within 35 to 45 minutes, and its duration is between 1.5 to 3 hours. This rapid acting inhaled insulin, known by the brand name Afrezza, is a human insulin inhaled power form of regular human insulin.

Short-acting Insulin: This type of insulin takes about 30 minutes to start working and peaks at about 2 to 3 hours after injection. The effective duration is approximately 5 to 8 hours.

Examples include regular insulin (brand names: Humulin R, Novolin R).

Intermediate-acting Insulin: This type of insulin takes about 2 to 4 hours to start working and peaks at about 4 to 12 hours after injection. The effective duration is 12 to18 hours.

Examples include NPH insulin (brand names: Humulin N, Novolin N).

Long-acting Insulin: This type of insulin starts working several hours after injection and can last up to 24 hours or more. Examples include insulin glargine (brand name: Lantus), insulin detemir (brand names: Levemir), and insulin degludec (brand name: Tresiba).

Longer duration, long-acting insulins are on the horizon, including a weekly long-acting insulin.

Combination Insulin/Pre-Mixed/Fixed Combination: This type of insulin combines different types of insulin into 1 injection. It starts working within 5 to 60 minutes. The peaks vary and the duration is anywhere from 10 to 24 hours.

Examples include the brand names: Humalog Mix 75/25, Humalog Mix 50/50, NovoLog Mix 70/30, and Novolin 70/30.

 

Insulin Concentrations

Insulin also comes in different concentrations. The concentration of insulin identifies the number of units of insulin in 1 milliliter (mL). The most commonly used concentration in the United States is U-100. The higher concentrations are used to decrease the volume of injection needed to administer an insulin dosage and are used when larger amounts of insulin are required for glucose management.

Insulin delivery devices including smart pens, insulin pumps and insulin patch devices are approved for use with certain insulins. Consult the manufacturer's website for the most up-to-date list of approved insulins for a particular device. 

Insulin Types At-A-Glance

Insulin Types

 

ONGOING EVALUATION AND ADJUSTMENTS ARE NEEDED

It is important to remember that a set it and forget it approach to insulin does not work for an individual on insulin therapy. It's necessary to continually evaluate a person’s insulin plan over time based on data on the effectiveness of their insulin plan. Using the published information on onset, peak and duration of action (see table above) is a useful starting point that will need to be adjusted based on the numerous factors that will continually impact the lives of people with diabetes. 

 

References

1. Cornell S, Halstenson C, Miller D. The Art and Science of Diabetes Care and Education. 5th edition. Association of Diabetes Care & Education Specialists; 2020 .2. Skyler JS. Weekly insulin becoming a reality. Diabetes Care.2021;44(7):1459–1461. https://doi.org/10.2337/dci21-0011 3. ElSayed NA, Aleppo G, Gabbay RA, et al; on behalf of the American Diabetes Association. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S140–S157. https://doi.org/10.2337/dc23-S009 4. Safe at School®: Overview of Insulin Concentration for School Nurses. American Diabetes Association. Published August 11, 2022. Accessed March 1, 2023. https://diabetes.org/sites/default/files/2022-08/SAS-overview-of-insulin-8-11-22.pdf


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DISCLAIMERS:

This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or health care provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit the ADCES finder tool.

ADCES and danatech curate product specifics and periodically review them for accuracy and relevance. As a result, the information may or may not be the most recent. We recommend visiting the manufacturer's website for the latest details if you have any questions.