Table 2 |
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|
Currently Available Insulin Formulations |
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|
Insulin Formulation |
Coverage |
Duration of Action |
Dosing |
Special Considerations |
|
|
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|
NPH insulin [69] |
Basal |
13 hours |
Twice daily |
Nocturnal hypoglycemia; morning hyperglycemia; intersubject variability |
|
Insulin glargine [69,70] |
Basal |
24 hours |
Once daily |
Less risk of hypoglycemia (overall and nocturnal) compared with NPH insulin; once-daily dosing |
|
Insulin detemir [38,45,71] |
Basal |
14 hours |
Once or twice daily |
Less nocturnal hypoglycemia and less weight gain compared with NPH insulin; most patients require twice-daily dosing |
|
RHI [40] |
Prandial |
6–8 hours |
30 minutes premeal |
Limited mealtime flexibility |
|
Insulin lispro [42,72] |
Prandial |
3–4 hours |
Up to 15 minutes premeal or immediately postmeal |
Pregnancy category B rating |
|
Insulin aspart [40,44] |
Prandial |
3–4 hours |
Up to 15 minutes premeal or immediately postmeal |
Pregnancy category B rating. |
|
Insulin glulisine [72,73] |
Prandial |
3–4 hours |
Up to 15 minutes premeal or up to 20 minutes after start of meal |
Only rapid-acting agent evaluated in conjunction with a dosing algorithm |
|
Premix (human) 70% NPH, 30% RHI 50% NPH, 50% RHI |
Basal-prandial |
16–24 hours |
Prebreakfast and presupper |
Short- and long-acting components in fixed ratio; difficult to titrate, increased risk of hypoglycemia |
|
Premix (insulin analogs) 75% NPL, 25% lispro 50% NPL, 50% lispro 70% protamine aspart, 30% aspart |
Basal-prandial |
16–24 hours |
Prebreakfast and presupper |
Short- and long-acting components in fixed ratio; difficult to titrate, increased risk of hypoglycemia |
|
|
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NPH = neutral protamine Hagedorn; NPL = neutral protamine lispro; RHI = regular human insulin. |
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Valitutto Osteopathic Medicine and Primary Care 2008 2:4 doi:10.1186/1750-4732-2-4 |
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