Type of Insulin

1 Human Insulin 1 2 ( Insulin analogue) (rapid acting) (prandial Insulin ) Insulin Lispro ( .. 1996) Insulin Aspart ( .. 2000) 24 basal Insulin Insulin Glargine( .. 2000) Insulin Detemir (.)

2 2005) delivery system Insulin pump inhale Insulin 4 ( 1 2) 1. rapid-acting Insulin ( Insulin analogue) amino acid Insulin lispro( proline lysine 28 29 carboxy terminal B-chain) Insulin aspart ( aspartic acid proline 28 B-chain) Insulin glulisine ( ) - 15-30 15 15 prandial Insulin - IV, SC.

3 , IM, CSII(continuous subcutaneous Insulin infusion or Insulin pump therapy) - Insulin lispro Insulin aspart > 2 - early postprandial hyperglycemia late postprandial hypoglycemia HA1C regular Insulin 2. Short-acting Insulin regular Insulin 30-60 3. Intermediate-acting Insulin 2 NPH (Neutral Protamine Hagedorn Isophane Insulin ) protamine 2-4 Lente Insulin (Zinc)

4 NPH Insulin 3-4 1 Preparation Trade name Timing of Action Onset Peak Duration Rapid-acting Insulin Lispro Aspart Humalog Novorapid 15-30 30-90 3-5 Short acting Insulin Regular Humulin R Actrapid HM 30-60 1-2 5-8 Intermediate acting Insulin NPH (isophane) Lente ( Insulin zinc suspension) Humulin Insulatard Monotard 2-4 3-4 6-10 6-12 10-16 12-18 Long acting Insulin Glargine Detemir Lantus Levemir 1-2 1-2 Less peak Less peak 24 20-22 Pre-mixed Insulin 70%NPH / 30%Regular 75% protaminated Lispro / 25% Lispro 70% Protaminated aspart / 30% aspart Humulin 70/30 Mixtard30 Humalog mix 25 Novomix 30 30-60 15-30 15-30 Dual Dual Dual 10-16 10-16 10-16 2 time-action profiles (subcutaneous injection)

5 Insulin aspart, Insulin lispro, regular Insulin , NPH Insulin , Insulin detemir Insulin glargine 4. Long-acting Insulin ultralente ( ) 24 24 Insulin glargine Insulin detemir - 24 Insulin glargine asparagines 21 A chain glycine arginine 2 carboxyl terminal B chain isoelectric point pH ( ) physiologic pH (pH )

6 Insulin detemir threonine 30 B chain myristic fatty acid carbon 14 amino group Lysine 29 B chain Insulin detemir albumin long-chain fatty acid binding site albumin pH neutral - basal Insulin NPH - NPH (symptomatic nocturnal hypoglycemia) (symptomatic overall hypoglycemia) HbA1C (severe hypoglycemia) - conventional basal Insulin (NPH) - Insulin detemir basal Insulin - Insulin glargine IGF1 receptor human Insulin 6-8 5.

7 Premixed Insulin regular Insulin NPH Insulin , lispro neutral protamine lispro(NPL) aspart neutral protamine aspart 70:30 premixed analogue nocturnal hypoglycemia HbA1C premixed human Insulin 2 ( Insulin analogue) 2 ( 4) 3 1. basal Insulin intermediate-acting Insulin : NPH lente continuous subcutaneous Insulin infusion (CSII) long-acting Insulin analogue: Insulin glargine detemir 1-2 2.

8 Prandial Insulin prandial Insulin regular Insulin , Insulin lispro Insulin aspart 3. correction-dose Insulin steroid 2 1. Once daily Insulin regimen ( 2 ) intermediate-acting Insulin (NPH) long acting Insulin ( Insulin glargine detemir) pre-mixed Insulin 70/30 2.

9 Flexible multiple- Insulin regimen multiple dose Insulin injection (MDI) regular Insulin Insulin analogue intermediate-acting Insulin 3. Split-and-mixed Insulin regimen 2 (conventional Insulin treatment) intermediate-acting Insulin regular Insulin Insulin analogue 4. Split-and-mixed Insulin program with bedtime intermediate Insulin ) intermediate-acting Insulin regular Insulin Insulin analogue regular Insulin Insulin analogue intermediate-acting Insulin 5.

10 Continuous subcutaneous Insulin infusion (CSII) Insulin pump therapy basal prandial Insulin rapid acting Insulin analogue 6. Intravenous Insulin infusion Insulin analogue 1. organ transplantation 2. Acute diabetic complication DKA, hyperosmolar hyperglycemic state 3. septic shock, acute myocardial infarction, stroke 4.