Insulin Types & Action

Insulin Types &  Their Action

All people with type 1 diabetes are “insulin dependent” – i.e. must take insulin by injection (syringe or pump infusion). Insulin cannot be taken by mouth because stomach acids will destroy it. Insulin helps sugar get into the body’s cells. Insulin also helps children grow.

Brands of Insulin

Your child will be taking human insulin. It does not come from humans but is made in a laboratory. It is like the insulin our body makes. There are three companies that make insulin:

 

  • Eli Lilly (Humulin N® and Humalog®)
  • Novo Nordisk (Novolin ge NPH®, NovoRapid®, Fiasp® and Levemir®)
  • Sanofi Aventis (Lantus®, Apidra®)

Insulin Action

There are many types of insulin. They are differentiated by the way they act in terms of:

  • Onset (the length of time it takes to start working after injection/infusion);
  • Peak (the time at which insulin action is strongest); and
  • Duration (how long the insulin lasts).

Rapid-Acting

  • Clear
  • Onset: starts to work in approximately 15 minutes
  • Peak: strongest action at 1 hour
  • Duration: lasts approximately 3-5 hours
  • Examples: Humalog® (insulin lispro), NovoRapid® (insulin aspart), Fiasp® (insulin aspart), Apidra® (insulin glulisine)
Rapid-Acting Insulin Curve
Rapid-Acting Insulin Curve

Note: “Rapid”-acting insulin may not act as rapidly as the name seems to suggest. It’s important to remember that rapid-acting insulin takes at least 15 minutes to even start having an effect, and it takes about an hour to peak. This has important implications for timing of insulin with food intake.

With a goal to have rapid Insulin live up to its name, insulin manufacturers continue to work on bigger, better, faster versions. With a quicker onset and shorter tail, Fiasp® is the most recent player to come to market in Canada, and currently the fastest-acting insulin available here (though it’s not approved for used with kids – your child’s doctor may be willing to write an off-label prescription for it if they believe the potential benefits outweigh the risks).

Intermediate-Acting

  • Cloudy
  • Onset: starts to work in 2-4 hours
  • Peak: strongest action at 6-10 hours
  • Duration: lasts up to 18 hours
  • Examples: Humulin N®, Novolin NPH®
Intermediate-Acting Insulin Curve
Intermediate-Acting Insulin Curve

Long-Acting (Basal)

  • Clear
  • Onset: starts to work in 60-90 minutes
  • Peak: none (provides a consistent concentration of insulin over the duration of insulin action)
  • Duration: lasts 12-24 hours
  • Examples: Lantus® (insulin glargine), Levemir® (insulin detemir)
Long-Acting Insulin Curve
Long-Acting Insulin Curve

Short-Acting

(or Regular insulin; an earlier generation of insulin, not commonly used today)

  • Clear
  • Onset: starts to work in about 30 minutes
  • Peak: strongest action at 2-4 hours
  • Duration: lasts approximately 4-6 hours
  • Examples: Humilin R®, Novolin Toronto®

References

The above information was adapted with permission from The Alberta Children’s Hospital Diabetes Clinic information handouts.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.