Diabetes Mellitus
Manual of Clinical Nutrition Management III- 31 Copyright © 2013 Compass Group, Inc.
Table III- 8 : Human Insulins (1-3)
Insulina^ Onset (h) Peak (h) Effective
Duration (h)
Maximum
Duration (h)
Rapid-Acting:
Lispro (Humalog) 0.25-0.5 1 - 2 1 - 4 4
Aspart (NovoLog) 0.25-0.5 1 - 2 1 - 4 4
Glulisine (Apidra) 0.25-0.5 1 - 2 1 - 4 4
Short-Acting:
Regular 0.5- 1 2 - 3 6 6 - 8
Intermediate-Acting:
NPHb (Humulin N) 2 - 4 6 - 10 10 - 16 12 - 16
Long-Acting:
Glargine (Lantus) (3) 1.1 None 24 24 +
Detemir (Levemir) 1 - 2 5 - 14 14 - 23 14 - 23
Mixtures:
NPHb/ Regular: 70/30; 50/50 0.5- 1 Dual 10 - 16 14 - 18
Aspart (NovoLog Mix) 70/30
Lispro (Humalog Mix) 70/30
0.1-0.2
0.1-0.2
1 - 3
1 - 3
3 - 5
3 - 5
5
5
aGeneric names are listed first, and representative trade names are listed in parentheses. All product names are registered trademarks of
their respective companies.
bNPH (neutral protamine Hagedorn) is also called isophane insulin suspension.
Insulins
Persons with type 1 diabetes obtain the best glycemic control with replacement insulin that mimics normal
insulin action (1). The basal or background insulin dose is the amount of insulin required in the
postabsorptive state to restrain endogenous glucose output, primarily from the liver (1). The bolus
(mealtime) insulin doses mimic what happens when individuals without diabetes eat the normal physiologic
pattern of insulin secretion; the plasma glucose and insulin concentrations increase rapidly, peak in 30 to 60
minutes, and return to basal concentrations within 2 to 3 hours (1).
Insulin glargine (Lantus) is a basal insulin that is injected once a day, often at bedtime (3). However, it can
be injected at any time during the 24-hour period if it is given consistently at the chosen time. Glargine
cannot be mixed with other insulins. Insulin detemir (Levemir) has a duration of action of approximately 17
hours, and therefore may need to be given twice a day. Detemir does have a slight peak, but the peak is
extremely predictable, unlike the sometimes erratic peak of NPH (1,3). Rapid-acting insulins are given at
meals, often with the use of an insulin pen. On occasion, rapid-acting insulin may be given after meals, most
often for children with unpredictable eating habits or adults with gastroparesis (1). Insulin-pump therapy
provides basal rapid-acting or short-acting insulin pumped continuously by a mechanical device in micro
amounts through a subcutaneous catheter. In addition, bolus doses are given before meals.
Intensive insulin therapy increases the risk of hypoglycemia and weight gain in persons with type 1
diabetes mellitus (6). Skipped or delayed meals, reduced carbohydrate intake at meals, or increased physical
activity without the appropriate insulin adjustments are the major causes of hypoglycemia (6). Alcohol may
also induce hypoglycemia and mask symptoms related to hypoglycemia (6). Weight gain occurs with intensive
insulin therapy because less energy is lost from glycosuria as glycemic control improves (6). Frequency of
hypoglycemia and the extra energy used for its treatment may also contribute to weight gain (6). Strategies to
prevent weight gain include more frequent weight checks, a decreased daily energy intake, additional
physical activity, and review of the appropriate treatment of hypoglycemia.
References
- Pharmacotherapy in type 1 and type 2 diabetes. In: Nutrition Care Manual. Academy of Nutrition and Dietetics; Updated annually.
Available at: http://www.nutritioncaremanual.org. Accessed February 5, 2013. - Fonseca VA, Kulkarni KD. Management of type 2 diabetes: oral agents, insulin, and injectables. J Am Diet Assoc. 2008;108:S29-S33.
- Stuart N, ed. Medications and diabetes: new helps and old friends. On the Cutting Edge. [Diabetes Care and Education newsletter.] 2006;
27:1-32. - American Diabetes Association. Standards of medical care in diabetes–2013. Diabetes Care. 2013;36(suppl 1):11S- 66 S.
- Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B. Management of hyperglycemia in type 2 diabetes: a
consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association
and the European Association for the Study of Diabetes. Diabetes Care. 2006;29:1963-1972. - Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and
progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.