Table 2.

Currently Available Insulin Formulations

Insulin Formulation	Coverage	Duration of Action	Dosing	Special Considerations
NPH insulin [69]	Basal	13 hours	Twice daily	Nocturnal hypoglycemia; morning hyperglycemia; intersubject variability
Insulin glargine [69,70]	Basal	24 hours	Once daily	Less risk of hypoglycemia (overall and nocturnal) compared with NPH insulin; once-daily dosing
Insulin detemir [38,45,71]	Basal	14 hours	Once or twice daily	Less nocturnal hypoglycemia and less weight gain compared with NPH insulin; most patients require twice-daily dosing
RHI [40]	Prandial	6–8 hours	30 minutes premeal	Limited mealtime flexibility
Insulin lispro [42,72]	Prandial	3–4 hours	Up to 15 minutes premeal or immediately postmeal	Pregnancy category B rating
Insulin aspart [40,44]	Prandial	3–4 hours	Up to 15 minutes premeal or immediately postmeal	Pregnancy category B rating.
Insulin glulisine [72,73]	Prandial	3–4 hours	Up to 15 minutes premeal or up to 20 minutes after start of meal	Only rapid-acting agent evaluated in conjunction with a dosing algorithm
Premix (human) 70% NPH, 30% RHI 50% NPH, 50% RHI	Basal-prandial	16–24 hours	Prebreakfast and presupper	Short- and long-acting components in fixed ratio; difficult to titrate, increased risk of hypoglycemia
Premix (insulin analogs) 75% NPL, 25% lispro 50% NPL, 50% lispro 70% protamine aspart, 30% aspart	Basal-prandial	16–24 hours	Prebreakfast and presupper	Short- and long-acting components in fixed ratio; difficult to titrate, increased risk of hypoglycemia

NPH = neutral protamine Hagedorn; NPL = neutral protamine lispro; RHI = regular human insulin.