The document discusses insulin therapy, outlining its characteristics including onset, peak time, and duration. It details various types of insulin such as rapid-acting, short-acting, intermediate-acting, long-acting, ultra long-acting, and pre-mixed options, along with specific examples and their administration methods. Additionally, it mentions the approval of inhaled insulin and provides information on insulin strength.

1. INSULIN Therapy
Ahmed Khairi Mshari
Consultant Family Physician
Basic Information
INSULIN Therapy

2. Characteristics of Insulin
Insulin has three characteristics:
● Onset: is the length of time before insulin
reaches the bloodstream and begins
lowering blood glucose.
● Peak time: is the time during which
insulin is at maximum strength in terms
of lowering blood glucose.
● Duration: is how long insulin continues to
lower blood glucose.

3. Types of Insulin
● Rapid-acting insulin
● Short-acting insulin
● Intermediate-acting insulin
● Long-acting insulin
● Ultra long-acting
● Pre-Mixed Insulin

4. Rapid-acting Insulin (analogues)
● Onset 5-15 minutes after injection, peaks in
about 1-2 hours after injection, and last
between 2-4 hours.
● It usually taken right before a meal.
● It is typically used to control blood sugar
levels during meals or to correct high blood
sugar.
● Examples:
 Insulin lispro (Humalog)
 insulin aspart (NovoRapid)
 insulin glulisine (Apidra)

5. Short-acting Insulin
● Also called; Regular, Soluble, Neutral
● Onset within 30 minutes after injection,
peaks 1-3 hours after injection, and is effective
for approximately 3-6 hours.
● Usually taken 30-60 minutes before a meal.
● It is the only type given IV in diabetic
emergencies.
● Example:
– Actrapid
– Humulin R
– Novolin R

6. Intermediate-acting Insulin
● Also called Isophane (NPH).
● Onset about 2-4 hours after
injection, peaks 4-12 hours later,
and is effective for about 12-18
hours.
● Covers insulin needs for half a
day or overnight. Often used with
rapid- or short-acting insulin.
● Example: Humulin N, Novolin N

7. ● Onset about 1-2 hours, it doesn’t peak and
lasts for up to 24 hours or more.
● It is used to provide a consistent basal
insulin level throughout the day and night.
● The are usually taken once/day.
● Often used, when needed, with rapid- or
short-acting insulin.
● Examples:
– glargine (Lantus)
– detemir (Levemir)
– degludec (Tresiba)
Long-acting Insulin

8. Ultra Long-acting
● Onset in 6 hours,
doesn’t peak, and
lasts about 36 hours
or longer.
● Examples: glargine
U-300 (Toujeo)

9. Pre-Mixed Insulin (Biphasic)
● It combines 2 types of insulin (rapid- or
short-acting + intermediate-acting).
● Usually taken 10 to 30 minutes before
breakfast and dinner.
● They provide rapid onset with prolonged
duration (12-16 h).
● They are usually injected twice/day.
● Examples:
 Human Mixtard 30/70,
 Humalog Mix 75/25,
 NovoLog Mix 70/30,
 Humulin 70/30.

10. Administration Methods
● Insulin Syringe.
● Insulin Pen.
● Insulin Pump.
● Inhaled Insulin.

11. Inhaled Insulin
● The FDA approved an inhaled insulin
product, Afrezza, in 2015.
● Afrezza is a rapid-acting inhaled insulin.
● It is taken at the beginning of each meal
● It can be used by adults with type 1 or 2 DM.
● It must be used in combination with
injectable long-acting insulin.
 Onset within 10-15 minutes
 peaks by 30 minutes
 Last for 3 hours

12. Insulin strength
● All insulins come dissolved or suspended in liquids.
● The standard and most commonly used strength is U-100,
which means it has 100 units of insulin per milliliter of
fluid.
● U-500 insulin is available for patients who are extremely
insulin resistant.
● U-40, which has 40 units of insulin per milliliter of fluid,
has generally been phased out around the world, but it is
still used in veterinary care.

13. Thank
You
Thank
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