COMMONLY USED INSULIN PREPARATIONS

All patients who are new to insulin are generally started on human or analogue insulins.

 

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All patients who are new to insulin are generally started on human or analogue insulins.
NAME TYPE SOURCE ONSET DURATION OF ACTION
Rapid
Lispro Analogue A 10 - 20 min 3 - 5 hrs
Insulin Aspart Analogue A 10 - 20 min 3 - 5 hrs
Intermediate
Insulatard
Humulin-I
Insuman Basal
Hypurin Isophane

Monotard
Hypurin Lente
Humulin Lente
 Isophane
Isophane
Isophane
Isophane

Ins. Zinc Susp.
Ins. Zinc Susp.
Ins. Zinc Susp.
 P or H
H
H
B or P

H
B
B
 1-2 hrs 8 - 12 hrs or longer
Long
Ultratard
Humulin - Zn

Glargine 		ns Zinc Susp.(Crystalline)-
ns Zinc Susp.(Crystalline)-

Analogue
 H
H

A
4 - 8 hrs

1.5 hrs
24 hrs

20-24 hrs
Examples of fixed mixtures
NAME TYPE SOURCE ONSET DURATION OF ACTION
Mixtard "30" Or
Humulin M3 Or
Hypurin 30/70

Biphasic Insulin Aspart(NovoMix "30")

Biphasic Insulin Lispro (Humalog Mix "25") 		A pre-mixed combination of 30% soluble & 70% Isophane


30% Insulin Aspart & 70% Insulin Aspart Protamine

25% Insulin Lispro & 70% Insulin Lispro Protamine
H
P/H

A


A
30-60 mins

0 - 5 mins

0 - 5 mins
8-12 hrs or longer


8-12 hrs


8-12 hrs

Rapid Acting Insulin Analogues

  • Rapid-acting analogues of insulin (e.g. Lispro or Insulin Aspart) may be used in both twice daily and basal bolus regimens
  • For some patients on rapid acting insulin analogues, monitoring of post-prandial (2 hours) glucose may sometimes be required to assist with dosage adjustment.

Glargine (Lantus)

  • Glargine is a long-acting human insulin analogue designed to have a flat release profile to mimic natural insulin release. It provides good background insulin (basal) cover over a 24 hour period.
  • Due to this profile, it is suitable for basal bolus regimens. However unlike isophane insulin, it does not need to be taken at bed-time, but it does need to be taken at the same time each day. For this reason, it may suit some shift-workers better than isophane insulins.
  • Glargine shows similar efficacy as isophane insulin in terms of glycosylated haemoglobin (HbA1c) levels. A lower incidence of symptomatic nocturnal hypoglycaemia has been demonstrated in some trials.
  • Unlike isophane insulin, Glargine appears "clear" rather than "cloudy"
  • Due to its physical properties, Glargine is not suitable for "free-mixing" in a syringe with other insulins

 

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Summary of Scottish Medicines Consortium(SMC) advice on Glargine - Recommended for restricted use

Insulin glargine is an acceptable treatment for patients with diabetes mellitus. Pending further studies, its use should be targeted on patients who are at risk or experience unacceptable frequency and/or severity of nocturnal hypoglycaemia on attempting to achieve better glycaemic control during treatment with established insulin. It is also acceptable as a once daily insulin therapy for patients who require carer administration of their insulin. At present the evidence does not support its routine use in patients with type 2 diabetes unless they suffer from recurrent episodes of hypoglycaemia or require assistance with their insulin injections.

In the light of SMC advice, consideration should be given to following:

  • Insulin glargine should be considered second-line to established insulins.
  • A trial of insulin glargine is appropriate for patients who are unable to achieve optimal glycaemic control with established insulins, due to risk of hypoglycaemia.
  • The efficacy and safety of insulin glargine has not been assessed in children

Regimens using Glargine

  • Usually basal bolus regimen, especially in type 1 patients, combined with rapid-acting analogue or soluble insulins.
  • Occasionally used as a single injection regimen for housebound elderly or nursing home patients, to minimise input from Community Nurses.
  • Glargine can be used in combination with oral hypoglycaemic agents, in patients with type 2 diabetes. At present, this regimen has not been endorsed by the Scottish Medicines Consortium
  • Glargine doses, regardless of the time that the injection is administered, are titrated against the fasting blood glucose value. See table below for guidance, but if in doubt, contact a Diabetes Specialist Nurse

 

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