3. Insulin Safety know your insulins! There are many!
Humalog® Mix25
Humalog® Mix50
Humulin® I
Humulin® M3
Humulin® S
Humalog® U-100
Humalog® U-200
Abasaglar ®
Hypurin® Bovine Isophane
Hypurin® Bovine Lente
Hypurin® Bovine Neutral
Hypurin® Bovine PZI
Hypurin® Porcine 30/70
Hypurin® Porcine Isophane
Hypurin® Porcine Neutral
Actrapid®
Insulatard®
Levemir®
NovoMix® 30
NovoRapid®
Tresiba® U100 insulin
Tresiba® U200 insulin
Xultophy®
Lantus®
Apidra®
Insuman® Basal
Insuman® Comb 15
Insuman® Comb 25
Insuman® Comb 50
Insuman® Rapid
Toujeo U300
Including insulins which are more concentrated e.g. Tresiba (Insulin Degledec as U100 but also U200) and Tougeo which is Lantus U300
Biosimilar insulins too. Bovine insulin withdrawn from UK market Dec 2017.

4. Intermediate Acting insulin Neutral Protamine Hagedorn ( NPH)
Insulatard, Humulin I, & Insuman basal
Onset 2 hours
Peak 4-6 hours
Duration 8-14 hours

6. Useful in which situations?
Course of steroid therapy where the day time glucose levels rise. Overnight levels are satisfactory.
People that graze throughout the day, small frequent meals.
Can be used once a day in the evening if high fasting reading present
Bedtime administration can however lead to nocturnal hypoglycaemia

7. Short Acting Insulin Short acting regular human insulin
Actrapid, Humulin S, Insuman Rapid
Onset within 30 mins
Peak 2-4 hours
Duration up to 8 hours

8. Onset: Within 30 mins Peak: 2-4 hours Duration: Up to 8 hours
Insulin
Insulin Activity 12
Hours 6 18 24
Onset: Within 30 mins
Peak: 2-4 hours
Duration: Up to 8 hours
Short Acting Soluble Human Insulin –
Example: Actrapid, Humulin S, Insuman Rapid

9. Useful in which situations?
Can be used to address post prandial rises in blood glucose.
When given minutes pre breakfast and evening meal due to the duration of action a lunchtime dose may not be required.
Will address high post evening meal and pre bed blood glucose levels but unlikely to cause a drop in glucose levels overnight .

10. Rapid or Quick-acting Insulin
Insulin Analogues:
Prandial (mealtime insulin)
Novorapid (aspart), Humalog (lispro), Apidra (glulisine)
Onset less than 15 mins
Peak mins
Duration 2-5 hours
(Faster analogue launched in UK 2017 – Fiasp)

11. Example: Novorapid, Humalog, Apidra
Insulin Activity 6 12
Hours 18 24
Onset: Less than 15 mins
Peak: mins
Duration: 2-5 hours
Rapid Acting Analogue Insulin –
Example: Novorapid, Humalog, Apidra

12. Useful in which situations?
To cover post meal rise - inject with food
Can be administered after food if uncertainties around amount of food will be consumed, eg. elderly, children, prison setting.
Duration of rapid acting insulin useful in reducing hypoglycaemia particularly during the night-time.

13. Biphasic insulins (Pre-Mixed Insulin)
Biphasic Human-
Humulin M3, Insuman comb 15,25,50
Onset within 30 mins
Peak 2-4 hours
Duration up to 14 hours
Analogue Mix
Novomix 30, Humalog mix 25 & 50
Onset Less than 15 mins
Peak mins

14. Pre-mixed Human Insulin – Example: Humulin M3, Insuman Comb 15/25/50
Insulin Activity 6 12
Hours 18 24
Pre-mixed Human Insulin –
Example: Humulin M3, Insuman Comb 15/25/50
Onset: Within 30 mins Peak: 2-4 hours Duration: Up to 14 hours

15. Pre-mixed Analogue Insulin - 12
Hours
Insulin Activity
Hours 0 6 18 24
Pre-mixed Analogue Insulin -
Example: NovoMix 30, Humalog Mix 25/Mix 50
Onset: Less than 15 mins Peak: mins Duration: Up to 14 hours
NICE 2015 suggests considering this regime if HBA1c above 9% ( 75mmol/mol) when commencing insulin

16. Useful in which situations?
To cover post meal rise
For people who require prandial cover but only wish to inject twice a day and no more.
Appropriate if patient has regular meal pattern/lifestyle
In certain circumstances mixed insulin can be given once or 3 x a day (need to take into account the profile and individual eating pattern)

17. Long Acting Insulin Analogues
1st generation –Glargine (Lantus) Detemir (Levemir) (Biosimilar lantus = Abasaglar ) Duration- 1st generation 16 up to 24 hours 2nd generation – Toujeo (Glargine 300units) Degludec (Tresiba 100 or 200 units) 2nd generation 24 up to 42 hours – greater flexibility re injection timing. Onset for long acting analogues approx. 2 hours without a peak
Second generation LA analogues onset min so a little faster, toujeo lasting up to hours in the body

18. Long Acting Analogue Insulin –
Insulin Activity 6 12
Hours 18 24
Onset: 2 hours Peak: None
Duration: hours
Toujeo lasts longer than 24 hours, degludec can last up to 42 hours
Long Acting Analogue Insulin –
Example: Glargine, Detemir, Toujeo, Degludec*

19. Useful in which situations?
Where once daily dosing would be beneficial eg. community nurse or carer administration.
When weight gain needs to be minimised.
In those more at risk of admission (flatter profile reduces risk of hypoglycaemia)
Concentrated insulin useful in those requiring large doses.

20. Recommended reading
– for local insulin and GLP1 professional guidelines.
2nd edition. October 2016 ( currently being updated)
Valuable reference resource in respect of prescribing insulin and GLP1s
Crasto W, Jarvis J, Davies MJ ( 2016) Handbook of Insulin Therapies. Adis.
Setty SG, Crasto W, Jarvis J, Khunti K, Davies MJ (2016) New insulins and newer insulin regimens: a review of their role in improving glycaemic control in patients with diabetes. BMJ 9 Feb.