Endocrinology Book

http://www.fpnotebook.com/

InsulinAka: Regular Insulin, Humulin, Novolog, Humalog, Aspart, Apidra, Glulisine, NPH Insulin, Lispro, Lente, Ultralente, Novolin

Advertisement

  1. See Also
    1. Insulin Dosing
    2. Insulin Simulation
    3. Glucose Metabolism
  2. Insulin Selection
    1. New insulin anologues are preferred
      1. More consistent absorption than traditional insulin
      2. Bolus analogues have more rapid onset
      3. Basal agents release at more constant rate
      4. Only disadvantage is anologues double price
    2. Combination agents are discouraged unless noncompliant
      1. Reduces flexibility in meal and activity timing
  3. Agents: Bolus Insulins (Meal-time Insulin)
    1. Traditional Insulins
      1. Regular Insulin (Novolin R, Humulin R)
        1. Onset: 15 to 30 minutes
        2. Peak: 2.5 to 5 hours
        3. Duration: 6 to 8 hours
    2. Analogue Insulins (Rapid, consistent absorption)
      1. Glulisine (Apidra)
        1. Similar to other bolus analogues
        2. FDA approved to take after meal
          1. Other analogues expected with same effect
      2. Lispro (Humalog)
        1. Onset: 5 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 4 hours
      3. Aspart (Novolog)
        1. Onset: 5 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 4 hours
  4. Agents: Basal Insulins
    1. Traditional Insulins
      1. NPH Insulin, Novolin R, Humulin R, Humulin L (Lente)
        1. Onset: 1 hour
        2. Peak: 6-8 hours
          1. Peak time is higher risk of hypoglcemia
          2. Consider snack at 6 hours after dose
        3. Duration: 10 to 16 hours (Lente slightly longer)
        4. Humulin L (Lente) discontinued in U.S. in 2006
      2. Ultralente Insulin (extended insulin zinc suspension)
        1. Discontinued in U.S. in 2006
        2. Significant inconsistent effect even in same person
        3. Onset: 6-10 hours
        4. Peak: No peak
        5. Duration: 18 to 24 hours
    2. Analogue Insulins
      1. Detemir (Levemir)
        1. Duration varies by dosage
      2. Glargine (Lantus)
        1. Onset: 1 hour
        2. Duration: 21 to 24 hours
        3. Peak: No peak
          1. Flat action profile throughout duration
          2. Mimics continuous Insulin Infusion
  5. Combination Agents (Type II Diabetes if poor compliance)
    1. NPH 50/Regular 50
    2. NPH 70/Regular 30 (Humulin R 70/30 or Novolin R 70/30)
    3. NPL 75/Lispro 25 (Humalog Mix 75/25)
    4. NPH 70/Aspart 30 (Novolog Mix 70/30)
  6. Adverse Effects
    1. Hypoglycemia
      1. Increased risk when Hemoglobin A1C <7.4%
      2. Decreased risk with analogue insulins
    2. Weight gain (Excess of 4 kg over 10 years)
      1. Countered with Metformin in type 2 diabetics
      2. Countered with diet and Exercise
      3. Benefits of glucose control outweigh weight risks
    3. Lipohypertrophy
      1. Localized fat hypertrophy when sites not rotated
      2. Prevent by rotating injection sites (see below)
      3. Medical providers should examine injection sites
    4. Variable insulin absorption
      1. Insulin absorption varies by body site
        1. Abdomen (best absorption)
        2. Arms
        3. Thigh
        4. Buttocks (least absorption)
      2. Site rotation (prevents lipohypertrophy - see above)
        1. Rotate injections within same body region
          1. Avoids insulin absorption variability
        2. Rotate to widely different sites within region
          1. Example: Abdomen rotate to LUQ, RUQ, LLQ, RLQ
  7. References
    1. Lepore (2000) Diabetes 49:2142
    2. Mayfield (2004) Am Fam Physician 70(3):489

Navigation Tree