Medicine & USMLE

Insulin Preparations

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Diabetes Drugs (New)
  1. DPP-4 Inhibitors
  2. GLP-1 Analogs
  3. Pramlintide (Amylin Analogs)
  4. SGLT2 Inhibitors
  5. Metformin (Biguanides)
  6. Insulin Preparations
  7. Alpha-Glucosidase Inhibitors

Summary

Insulin preparations refer to the different types of insulin that can be administered to patients. These drugs are used to treat diabetes mellitus, especially in type 1 diabetes.

The first type of insulin preparations are the rapid-acting insulins, which take less than 1 hour to reach peak levels in the bloodstream after subcutaneous administration. The rapid-acting insulins include insulin aspart, insulin lispro, and insulin glulisine. These insulins are most commonly used for controlling the rapid spikes in blood glucose that occur after eating.

The next type of insulin preparations are the short-acting insulins, which take between 2-3 hours to reach peak levels after subcutaneous administration. The only important short-acting insulin to know is regular insulin. Regular insulin is unique among all the insulin preparations for its ability to be given intravenously or IV. When given IV, regular insulin works extremely quickly within a few minutes - making it useful for when we need to lower blood glucose levels very quickly.

The third type of insulin preparations are the intermediate-acting insulins, which take between 4-10 hours to reach peak levels after subcutaneous administration. The only important intermediate-acting insulin to know is insulin NPH. These insulins are generally used to set a baseline level of insulin in patients, although they have become less popular after the invention of the long-acting insulins. 

The last type of insulin preparations are the long-acting insulins, which have no real peak after subcutaneous administration. Instead, these drugs diffuse slowly into the blood over the course of a day, making them the best available option for establishing basal levels of insulin in the body. Long-acting insulins include insulin detemir and insulin glargine.

Key Points

  • Insulin Preparations
    • Rapid-Acting Insulins
      • <1 hour to peak after subcutaneous injection
        • used to control glucose spikes after meals
      • Names
        • insulin lispro
        • insulin aspart
        • insulin glulisine
    • Short-Acting
      • 2-3 hours to peak after subcutaneous injection
        • used to control glucose spikes after meals
      • Only form of insulin that can be given IV
        • works nearly immediately to lower blood sugar quickly in diabetic emergencies
      • Names
        • regular insulin
    • Intermediate-Acting
      • 4-10 hours to peak after subcutaneous injection
        • used to establish baseline insulin levels
      • Names
        • insulin NPH
          • Neutral Protamine Hagedorn: neutral pH (pH = 7), protamine (a protein), and Hans Christian Hagedorn (the original researcher)
    • Long-Acting
      • no real peak after subcutaneous injection
        • used to establish baseline insulin levels
      • Names
        • insulin detemir
        • insulin glargine