Table 3.
Currently Available Insulin Formulations[31,68]
| Insulin, Generic Name (Brand) | Onset | Peak | Effective Duration |
|---|---|---|---|
| Rapid-acting | |||
| Insulin aspart injection (NovoLog) | 5-15 min | 30-90 min | < 5 hr |
| Insulin lispro injection (Humalog) | 5-15 min | 30-90 min | < 5 hr |
| Insulin glulisine (Apidra) | 5-15 min | 30-90 min | < 5 hr |
| Short-acting | |||
| Regular human (Humulin R by Eli Lilly and Co., Novolin R by Novo Nordisk Pharmaceuticals) | 30-60 min | 2-3 hr | 5-8 hr |
| Intermediate-acting, basal | |||
| NPH insulin (Humulin N by Eli Lilly and Co., Novolin N by Novo Nordisk Pharmaceuticals) | 2-4 hr | 4-10 hr | 10-16 hr |
| Long-acting, basal | |||
| Insulin glargine injection (Lantus)*,† | 2-4 hr‡ | No pronounced peak | 20-24 hr |
| Insulin detemir injection (Levemir)*,†;[69,70] | 2-4 hr | No pronounced peak | 6-23 hr |
| Premixed§ | |||
| 75% insulin lispro protamine suspension, 25% insulin lispro injection (Humalog Mix 75/25)∥ | 5-15 min | Sustained, unimodal, skewed | 10-16 hr |
| 70% insulin aspart protamine suspension, 30% insulin aspart injection (NovoLog Mix 70/30) | 5-15 min | Sustained, unimodal, skewed | 10-16 hr |
| 70% NPH insulin, 30% regular human insulin (Humulin 70/30 by Eli Lilly and Co., Novolin 70/30 by Novo Nordisk Pharmaceuticals) | 30-60 min | Sustained, unimodal, skewed | 10-16 hr |
NPH = neutral protamine Hagedorn
May require 2 daily injections in patients with type 1 diabetes mellitus
Assumes 0.1-0.2 U/kg per injection. Onset and duration may vary by injection site; in addition, for insulin detemir the duration of action has been reported to be dose-dependent (ranging from 6 hours at 0.1 U/kg to 23 hours at 1.6 U/kg).
Time to steady state
Contrary to popular belief, the premixed insulin formulations do not result in 2 discrete peaks of insulin activity separated by a nadir; there is only a single skewed, asymmetric peak located between that of the peaks that would be expected for rapid-acting insulin analogs and intermediate-acting insulin. The peak is asymmetric, with a skewing toward the longer time.[63,64]
A mixture of 50% insulin lispro and 50% lispro protamine suspension is also available.