What Are the Different Types of Insulin?
Insulin is the hormone normally made in the pancreas that stimulates the flow of sugar – glucose – from the blood into the cells of the body.
Glucose provides the cells with the energy they need to function. There are two main groups of insulins used in the treatment of diabetes: human insulins and analog insulins, made by recombinant DNA technology. The concentration of most insulins available in the United States is 100 units per milliliter. A milliliter is equal to a cubic centimeter. All insulin syringes are graduated to match this insulin concentration.
There are four categories of insulins depending on how quickly they start to work in the body after injection:
*Very rapid acting insulin
*Regular, or Rapid acting insulins
*Intermediate acting insulins
*Long acting insulin.
In addition, some insulins are marketed mixed together in different proportions to provide both rapid and long acting effects. Certain insulins can also be mixed together in the same syringe immediately prior to injection. A very rapid acting form of insulin called Lispro insulin is marketed under the trade name of Humalog. A second form of very rapid acting insulin is called Aspart and is marketed under the trade name Novolog.
Humalog and Novolog are:
*They begin to work 10 minutes after injection,
*peak at 1 hour after injection,
*and last 3-4 hours in the body.
*Most patients also need a longer-acting insulin to maintain good control of their blood sugar.
Humalog and Novolog can be mixed with NPH insulin. Humalog and Novolog are used as “bolus” insulins to be given 15 minutes before a meal. Most patients also need a longer-acting insulin to maintain good control of their blood sugar. Humalog and Novolog can be mixed with NPH insulin.
Check your blood sugar level before giving Humalog or Novalog. Your doctor or diabetes educator will instruct you in determining your insulin dose based on your blood sugar reading and anticipated meals and exercise. Always check the bottle before drawing up the insulin. If the solution is cloudy, discard the bottle. If you are mixing Humalog or Novalog with a longer-acting insulin, always draw up the Humalog or Novalog first to maintain the purity and clarity of the Humalog and Novalog solutions.
Another solution of insulin that acts rapidly is called “Regular” or “R” insulin. This insulin does not act as quickly as Humalog or Novalog.
Regular insulin is:
*a clear, colorless liquid.
*It begins to work 30 minutes after injection,
*peaks at 3-5 hours
*and lasts 6-10 hours in the body.
*usually given 30 minutes before a meal.
*It can also be mixed with in the same syringe with longer acting NPH insulin or given separately immediately after each other.
*Glargine cannot be mixed with it.
*the most stable of all the different types of insulin,
*but unopened regular insulin is best refrigerated.
*Always check the bottle before drawing up the insulin.
*If the solution is cloudy, discard the bottle.
*If you are mixing Regular with a longer-acting insulin, always draw up the Regular insulin first to maintain the purity and clarity of the Regular solution.
Examples of intermediate acting insulins are NPH.
Intermediate acting insulins are:
*cloudy suspensions of crystalline insulin.
*They need to be gently rotated between the hands before being used.
*They begin to work 1 hour after injection,
*peak at 6-12 hours after injection
*and last 20-24 hours in the body.
*often given before breakfast.
*They may also be given at bedtime, depending on your blood glucose reading.
*They can be mixed in the same syringe with Regular, Lispro and Aspart insulins.
Ultralente is a long-acting insulin.
*a cloudy suspension.
*It begins to work 2-8 hours after injection,
*peaks at about 12 hours
*and lasts around 18-24 hours in the body.
Ultralente insulin is:
*often given before breakfast.
*It may also be given before dinner in the evenings or at bedtime, on your doctor’s instruction.
*It can be mixed in the same syringe with regular insulin.
*When unopened, it is best stored in the refrigerator.
Another long-acting insulin is called Glargine insulin. It is an insulin analog manufactured by recombinant DNA technology.
Unlike other long-acting insulins, Glargine insulin is:
*a clear solution of insulin.
*It begins to work around 1 hour after injection.
*There is no pronounced peak.
*Small amounts of Glargine insulin are released slowly to provide a relatively constant amount of insulin in the body over 24 hours.
*Glargine insulin cannot be mixed with any other insulin.
*A change to Glargine from NPH insulins s hould be done under the close supervision of your medical team. There are three stable, premixed formulations of insulin.
*One contains 70% of NPH insulin and 30% of Regular insulin.
*Another formulation contains 50% of NPH and 30% of Regular insulin.
*The third contains 75% of NPH and 25% of Humalog.
*begin to work around one half hour after injection,
*peak in 2-8 hours
*and last up to 24 hours in the body.
*As these premixed insulins contain rapid or very rapid acting insulin, they should be taken before meals as directed by your medical team.
*With your doctor’s instructions, several combinations of two different kinds of insulin can be mixed together in the same syringe and given as one injection.
*Once mixed, the combined injection must be given immediately or the effect of the regular component of the injection will be diminished.
*The rapid-acting insulins, Lispro, Aspart and Regular, can be mixed with the longer acting NPH insulin. *Glargine cannot be mixed with any other insulin.
By washing your hands correctly:
* you remove germs from your hands.
* Handwashing is the single most important way you can prevent infection from occurring and
* prevent the spread of infection.
You must carefully wash and dry your hands:
* Before and after each time you care for your family member or your patient.
* Before and after you handle your patient’s and your own food and drink.
* Before and after you manipulate any contact lenses.
* Before you apply and after you remove gloves
* After you use the toilet.
* After you cough, sneeze or blow your nose.
* After contact with anything that could be soiled or have germs on it.
* After you pick up any object from the floor
* Handwashing takes a minimum of 10-15 seconds,
* longer if your hands are soiled.
* The longer you wash, the more germs are removed.
* The friction generated by rubbing your hands together removes the germs from your skin and
* running water can then wash them away
* Every time you wash your hands, take your time and don’t rush.
* Do the handwashing carefully and thoroughly.
Use liquid soap from a dispenser. Bar soap holds germs on its surface. Make sure you have paper towels and a waste receptacle nearby. Remove all jewelry from your hand except a wedding band and push your watch and sleeves up, away from your hands.
Turn on warm water. Point your fingers down to prevent water running onto your arms and wet your hands. Apply soap from the dispenser. Point your fingers down and rub your hands vigorously together in a circular motion. Star counting seconds at this point.
Intertwine your fingers to clean all surfaces of the fingers. Rub your fingernails against the palm of the other hand to get soap under the tips of the nails. If your nails are soiled, clean under them with an orange stick or brush. Keep your hands down and continue to rub them together in a circular motion until the end of your count for 15 seconds.
Keep your hands down and rinse them from the wrist to fingertips. Pick up a clean paper towel and turn off the water, still keeping your hands pointing down. Discard the paper towel into a waste receptacle Pick up another clean paper towel and carefully and completely dry your hands. Discard the paper towel into a waste receptacle.
The key points to remember are:
* that friction is critical for removing germs
* and the friction should be applied for at least 15 seconds.
* Always keep your fingers pointed down
* and turn off the water with a paper towel.