Table 3. Insulins use in advanced CKD.
O: onset of action; P: peak of action; E: effective duration.
Stage 3 = eGFR 30–60 ml/min, Stage 4 = eGFR 15–30 ml/min, Stage 5 = eGFR less than 15 ml/min.
All % mentioned in the above table are % dose reduction of the suggested initial dose that may be used to start treatment, and titration may be needed [34-38].
| Categories of insulin | Drugs name | Pharmacology | CKD3 | CKD 4 | CKD 5 | HD | PD |
| Rapid-acting | |||||||
| Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. It may usually be used with longer-acting insulin. | Lispro (Humolog) | O: 15–30 min; P: 30–90 min; E: 3–5 hours | Yes | Yes | Yes | Yes | Yes |
| Aspart (Novolog) | O: 10–20 min; P: 40–50 min; E: 3–5 hours | Yes | Yes | Yes | Yes | Yes | |
| Glulisine (Apidra) | O: 20–30 min; P: 30–90 min; E: 1–2 1/2 hours. | Yes | Yes | Yes | Yes | Yes | |
| Short-acting | |||||||
| Short-acting insulin covers insulin needs for meals eaten within 30–60 minutes. | Regular (R) or (Novolin) | O: 30 min; −1 hour; P: 2–5 hours; E: 5–8 hours | Yes | 25% | 50% | 50% | 50% |
| Velosulin (Insulin pump- based on Insulin used) | O: 30 min; −1 hours; P: 1–2 hours; E: 2–3 hours | Yes | 25% | 50% | 50% | 50% | |
| Intermediate-acting | |||||||
| Intermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with a rapid- or short-acting type. | NPH (N) | O: 1–2 hours; P: 4–12 hours; E: 18–24 hours | Yes | 25% | 50% | 50% | 50% |
| Long-acting | |||||||
| No peak effect delivered at a steady level. Long-acting Insulin covers insulin needs for about one full day. This type is often combined, when needed, with rapid- or short-acting insulin. | Insulin Glargine (Basaglar, Lantus, Toujeo) | O: 1–1 1/2 hours; P: No peak time; E: 20-24 hours | Yes | 25% | 50% | 50% | 50% |
| Insulin Detemir (Levemir) | O: 1–2 hours; P: 6–8 hours; E: Up to 24 hours | Yes | 25% | 50% | 50% | 50% | |
| Insulin Degludec (Tresiba) | O: 30–90 min; P: No peak time; E: 42 hours | Yes | 25% | 50% | 50% | 50% | |
| Premixed* | |||||||
| These products are generally taken two or three times a day before mealtime. *Premixed insulins combine specific amounts of intermediate-acting and short-acting Insulin in one bottle or an insulin pen. (The numbers following the brand name indicate the percentage of each type of insulin.) | Humulin 70/30 | O: 30 min; P: 2–4 hours; E: 14–24 hours | Yes | 25% | 50% | 50% | 50% |
| Novolin 70/30 | O: 30 min; P: 2–12 hours; E: Up to 24 hours. | Yes | 25% | 50% | 50% | 50% | |
| Novolog 70/30 | O: 10–20 min; P: 1–4 hours; E: Up to 24 hours | Yes | 25% | 50% | 50% | 50% | |
| Humulin 50/50 | O: 30 min; P: 2–5 hours; E: 18–24 hours | Yes | 25% | 50% | 50% | 50% | |
| Humalog mix 75/25 | O: 15 min; P: 30 min to 2 1/2 hours; E: 16–20 hours | Yes | 25% | 50% | 50% | 50% | |