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Table 2 Currently Available Insulin Formulations

From: Common crossroads in diabetes management

Insulin Formulation

Coverage

Duration of Action

Dosing

Special Considerations

NPH insulin [69]

Basal

13 hours

Twice daily

Nocturnal hypoglycemia; morning hyperglycemia; intersubject variability

Insulin glargine [69,70]

Basal

24 hours

Once daily

Less risk of hypoglycemia (overall and nocturnal) compared with NPH insulin; once-daily dosing

Insulin detemir [38,45,71]

Basal

14 hours

Once or twice daily

Less nocturnal hypoglycemia and less weight gain compared with NPH insulin; most patients require twice-daily dosing

RHI [40]

Prandial

6–8 hours

30 minutes premeal

Limited mealtime flexibility

Insulin lispro [42,72]

Prandial

3–4 hours

Up to 15 minutes premeal or immediately postmeal

Pregnancy category B rating

Insulin aspart [40,44]

Prandial

3–4 hours

Up to 15 minutes premeal or immediately postmeal

Pregnancy category B rating.

Insulin glulisine [72,73]

Prandial

3–4 hours

Up to 15 minutes premeal or up to 20 minutes after start of meal

Only rapid-acting agent evaluated in conjunction with a dosing algorithm

Premix (human)

70% NPH, 30% RHI

50% NPH, 50% RHI

Basal-prandial

16–24 hours

Prebreakfast and presupper

Short- and long-acting components in fixed ratio; difficult to titrate, increased risk of hypoglycemia

Premix (insulin analogs)

75% NPL, 25% lispro

50% NPL, 50% lispro

70% protamine aspart, 30% aspart

Basal-prandial

16–24 hours

Prebreakfast and presupper

Short- and long-acting components in fixed ratio; difficult to titrate, increased risk of hypoglycemia

  1. NPH = neutral protamine Hagedorn; NPL = neutral protamine lispro; RHI = regular human insulin.