Diabetes Mellitus - Insulin Treatment

According to onset and duration of action, they are classified as Rapid acting, Intermediate acting, Long acting, mixed and ultra-long acting.

Rapid-acting insulins

Available in two forms:

• Regular insulins:Biosynthetic human insulin (rDNA) manufactured by recombinant DNA technology.

  Onset	Peak	Duration
  30-60 min	2-4 hrs	6-9 hrs

  Brands:
  • Human Actrapid (Torrent)
  • Actrapid (Novo Nordisk)
  • Actrapid Flexpen (Novo Nordisk) 100IU
  • Huminsulin-R (Eli Lilly)
  • Insuman Rapid (Sanofi Aventis)
  • Lupisulin-R (Lupin)
  • Wosulin R (Wockhardt)
• Analog insulins: Also known as insulin receptor ligands are manufactured by recombinant DNA technology.
  • Insulin lispro Brand: Humalog (Eli Lilly).
  • Insulin aspart Brand: Novalog / Novorapid (Novo Nordisk),
  • Insulin glulisine Brand: Apidra (Sanofi Aventis)

Intermediate-acting insulins

NPH (Neutral Protamine Hagedorn).

Onset	Peak	Duration
1-2 hrs	3-6 hrs	12-15 hrs

Brand: Human Insulatard (NPH) from Novo Nordisk.

Pre-mixed insulins

Intermediate-acting insulins are mixed with rapid-acting insulin analogs or fast-acting human Regular insulin.

Onset	Peak	Duration
30-60 min	3-8 hrs	12-15 hrs

Brands:

• Human Mixtard 30/70 & 50/50 (Novo Nordisk)
• Huminsulin 30/70 & 50/50 (Eli Lilly)
• Novomix-30 (insulin aspart/protamine - crystallised insulin aspart in the ratio 30/70 ) from Novo Nordisk
• Humalog mix 25/75 (Eli Lilly)
• Insuman 25/75 & 50/50 (Sanofi Aventis)
• Lupisulin-M 30/70 & 50/50 (Lupin) &
• Wosulin 30/70 & 50/50 (Wockhardt)

Long-acting (Basal) insulins

Onset	Peak	Duration
1-2 hrs	2-20 hrs	20-24 hrs

• Glargine: Brands:
  • Lantus (Sanofi Aventis)
  • Basalog (Biocon)
  • Insuman Basal (Sanofi Aventis)
• Detemir Brand: Levemir Flexpen (Novo Nordisk)

Ultralong-acting basal insulin analogue

Duration of action that lasts up to 42 hours. E.g. Insulin degludec Brands:

• Tresiba
• Ryzodeg (70/30) (Insulin degludec / Insulin Aspart)
• Xultophy (Insulin degludec / Liraglutide)