Types of Insulin for Type 1 Diabetes

Types of insulin for Type 1 Diabetes are primarily categorized based on their onset and duration of action. All individuals with Type 1 diabetes and some type 2 diabetics require insulin to manage their blood glucose.

The principles of Insulin therapy in Type 1 diabetes differ compared to type 2 diabetes. Since Type 1 diabetics have absolute insulin deficiency, they require multiple doses of insulin per day.

However, in type 2 diabetics, insulin may be added to oral medications as once or twice daily injections.

Types of Insulin for Type 1 Diabetes are classified as:

Ultra-rapid acting Insulins for Type 1 Diabetes:

The ultra-rapid-acting insulins have a quicker onset of action. It takes about 12 to 30 minutes to start lowering blood glucose.

The maximum blood glucose lowering effect is seen in one hour. The total duration of its action lasts about 4 hours ranging from 1 to 7.3 hours

Ultra-rapid-acting insulins are commonly used before or with meals by type 1 diabetics to control the post-meal spikes in blood glucose. They may also be used in an insulin infusion pump by type 1 diabetics.

Commonly, ultra-rapid-acting insulins are used with basal insulins to prevent marked fluctuations in blood glucose.

Ultra-rapid-acting insulins include:

• Insulin Lispro-aabc or Insulin Lyumjev
• Insulin FiAsp or Faster Aspart
• Inhaled Insulin Afrezza

Inhaled Insulin Afrezza has the shortest onset and duration of action compared to all insulins. Unlike other insulins, it is not injected but rather inhaled via a device.

Insulin FiAsp (Faster Aspart) and Insulin Lyumjev (Lispro-aabc) are modified formulations of Insulin Aspart and Insulin Lispro. Their onset and duration of action are:

Here is a sample prescription for Type 1 Diabetics when using ultra-rapid-acting insulin and basal insulin:

Rapid-Acting Insulins for Type 1 Diabetes:

Typically, rapid-acting insulins are administered with or immediately before a meal. They act rapidly to minimize the spike in blood sugar that occurs after eating.

Rapid-acting insulins are frequently provided to persons with type 1 diabetes, but they may also be recommended for type 2 diabetes under certain circumstances.

Rapid-acting insulins can raise the risk of hypoglycemia since they work so fast. As a result, dosage should be taken with caution.

• Insulin Lispro (Humalog):

Lispro insulin acts pretty quickly and usually starts working within 15 minutes. The insulin’s effects continue for two to five hours. Because it works more quickly than soluble insulin, it is pretty helpful right before meals.

Humalog can be used with an intermediate or longer-acting insulin, like many other rapid-acting insulins, to maintain blood sugar levels for a longer time [Ref].

• Insulin Aspart (Novorapid):

Insulin Aspart is an exceptionally fast-acting medication that normalizes blood sugar levels immediately when administered.

After 10 to 20 minutes, it usually starts functioning and continues for three to five hours. To provide rigorous control over postprandial levels, it may be injected prior to a meal and occasionally just after.

• Insulin glulisine (Apidra):

Fast-acting insulin known as Apidra (insulin glulisine) helps people with both type 1 and type 2 diabetes manage their blood sugar levels during mealtimes.

Apidra (insulin glulisine) dosage varies depending on the individual. Your weight, blood sugar level, and insulin sensitivity will all influence how much you require.

Here is a sample prescription for Type 1 Diabetics when using rapid-acting insulin and basal insulin:

Short-acting Insulin for Type 1 Diabetes:

Human Regular Insulin is one of the most commonly used short-acting insulin. It has an onset and duration of action as:

Because of its short duration of action, it is administered before each meal three times a day (or two times a day if a person is consuming two meals per day).

Here is a sample prescription if short-acting insulin is combined with basal insulin:

Intermediate Acting Insulin for Type 1 Diabetes:

Human NPH insulin is available as the only intermediate-acting insulin available. Other NPH insulins which are also intermediate-acting are available in combination with rapid-acting insulins.

For example:

• Humalog Mix 25 and Humalog Mix 50 insulin contain Insulin Lispro and NPH Lispro in different strengths
• Novomix 30 contains Insulin Aspart and NPH Aspart at 30:70.

Although it is used sometimes as basal insulin in non-affording patients with short and rapid-acting insulins, it is not a true basal insulin.

Unlike basal insulins, it has a shorter duration of action and a peak effect because of which it is associated with a significant risk of hypoglycemia.

It has a comparable A1C-reducing effect but the risk of hypoglycemia especially nocturnal hypoglycemia is increased with NPH insulin compared to other long and ultra-long-acting insulins.

In addition, the dawn phenomenon is more frequently seen with NPH insulin than with long and ultra-long-acting insulins.

The dawn phenomenon is early morning hyperglycemia as the effect of insulin is lost. It can be minimized by administering NPH insulin at bedtime than with evening meals.

Here is a sample prescription incorporating NPH insulin with short-acting insulin in Type 1 diabetics:

Long-acting Basal Insulins for Type 1 Diabetes:

Slow-acting insulins or basal insulins are given in combination with prandial insulins. Prandial or short and rapid-acting insulins cover post-meal hyperglycemia while basal insulins provide a basal cover to prevent sugar spikes.

Basal insulins maintain insulin levels in the blood for 24 hours or more and are usually peakless. They provide background coverage, especially in fasting states, and are not associated with a significant risk of hypoglycemia.

Long-acting insulins are further classified as:

• Long-acting insulins:

  • Insulin Detemir
  • Insulin Glargine U-100
  • Insulin Glargine U-300

• Ultra-long-acting Insulins:

  • Insulin Degludec

• Once-weekly Insulin:

  • Insulin Icodec

The blood sugar can be controlled with long-acting insulins for a full day without a peak like short-acting insulins. This is comparable to how insulin works to help regulate blood sugar levels in between meals.

Insulins with a long half-life are often known as background or basal insulins. Throughout your regular activities, they continue to operate in the background to maintain the management of your blood sugar.

• Insulin glargine U-100 (Lantus Insulin) for Type 1 Diabetes:

Lantus is a synthetic version of the hormone insulin, created by the body. Insulin glargine is a long-acting insulin that begins to function several hours after injection and continues to function consistently for 24 hours.

Insulin Glargine U-100 means that one ml of the solution contains 100 units of Insulin Glargine. Insulin Glargine is usually administered at a fixed time of the day.

Treatment with insulin glargine is usually initiated at bedtime in a low dose of 0.2 units per kg in individuals with Type 1 diabetes along with prandial or short/ rapid-acting insulins.

The dose is then titrated up or down to achieve optimal glucose control.

Here is a sample prescription of insulin glargine in individuals with Type 1 Diabetes:

• Insulin Glargine U-300 (Toujeo) for Type 1 Diabetes:

Toujeo has FDA approval to treat adults and children six years of age and older who have type 1 or type 2 diabetes.

Children 6 years of age and older receive the same dosage as adults. 0.2 units of insulin per kilogram of body weight is the usual beginning dosage. And this dosage is often taken once per day.

U-300 means that one ml of the solution contains 300 units of insulin glargine. Toujeo is formulated particularly for individuals who require a higher dose of insulin.

Toujeo is a concentrated form of insulin and a small amount of the solution is used to deliver the same units of insulin glargine compared to Inj. Lantus.

Because of the concentrated formulation of Toujeo, it has slightly different pharmacological characteristics as well.

Unlike Inj. Glargine U-100 (Lantus Insulin), Toujeo Insulin has a slightly longer duration of action and may be administered with greater flexibility as far as time of administration is concerned.

It may be administered a few hours earlier or later than the fixed scheduled time recommended for Insulin Glargine.

Here is a sample prescription for Type 1 Diabetics using Insulin Glargine U-300 (Toujeo):

• Insulin Detemir (Levemir) for Type 1 Diabetes:

The long-acting insulin Levemir begins to operate several hours after injection and continues to function consistently for up to 24 hours.

Levemir is used to help persons with diabetes mellitus better regulate their blood sugar levels. This medication can be used by both adults and kids that are at least two years old.

Levemir insulin (Detemir) has a shorter duration of action compared to Insulin Glargine and is not a true basal insulin.

It is administered just like insulin glargine U-100 but some patients with poorly controlled diabetes may require twice daily dosing as well.

The only advantage of using insulin detemir compared to insulin glargine is that it does not cause significant weight gain.

Here is a sample prescription of Insulin Detemir for type 1 Diabetics:

Warning: If you have an allergy to insulin detemir or are suffering from diabetic ketoacidosis, you shouldn’t use Levemir. You are never allowed to share your syringe with anyone.

Ultra-long-acting Insulin for Type 1 Diabetes:

Ultra-long-acting insulin is called true basal insulin. It can be administered at any time of the day. you can inject it in the morning one day and in the evening the next day.

Insulin Degludec is the only ultra-long-acting insulin.

• Insulin Degludec (Tresiba):

Tresiba is intended to help persons with diabetes mellitus better regulate their blood sugar levels. It can be used by both type 1 and type 2 diabetics. Tresiba is sold as a FlexTouch pen for single-patient usage or in multiple-dose vials.

Degludec insulin (Tresiba) can be administered at any time of the day without regard to meals. It has no peak effect and thus does not cause significant hypoglycemia.

Compared to insulin detemir and insulin glargine, it is less likely to cause nocturnal hypoglycemia.

Insulin Degludec (Tresiba) is not recommended in pregnant diabetics or those with gestational diabetes (GDM).

Here is a sample prescription of Insulin Degludec for Type 1 Diabetics:

Once-weekly Insulin Icodec for Type 1 Diabetes:

Once-weekly Insulin Icodec is not yet on the market. However, studies have shown its safety and efficacy in individuals with Type 1 and Type 2 Diabetics.

Insulin Icodec may provide the best basal coverage and reduce the number of injections per week.

Because of its peakless effect, it is less likely to cause hypoglycemia compared to most other basal insulins.

Mixed Insulins for Type 1 Diabetics:

Fast and slow-acting insulins are combined in a single dosage when using “premixed” insulin, which is preferred by some patients to avoid frequent needle pricks.

While this often requires fewer shots each day, it lessens your freedom to eat whenever you want. In addition, there is less flexibility in the dosage.

Diabetics who use pre-mixed insulins have more fluctuations in their blood glucose compared to individuals who are on a basal-bolus regimen.

Patients using pre-mixed insulins are likely to develop more frequent and more severe episodes of hypoglycemia and hyperglycemia.

Here is a sample prescription of individuals who prefer pre-mixed insulins using:

• Injection Humalog Mix 25, Injection Humalog Mix 50, or Injection Novomix 30

Another sample prescription using Insulin Ryzodeg (Combination of Insulin Aspart and Insulin Degludec):

In Conclusion:

Insulin is essential for all individuals with Type 1 Diabetes. Insulin prescription is formulated keeping the onset and duration of insulin in mind.

Premixed insulins are not recommended for type 1 diabetics but may be used in less motivated individuals and those who can not inject three or four insulin injections.

Calculating dosages, taking into account various insulin types, and being under pressure to maintain normal blood glucose levels in order to avoid both immediate and long-term consequences are all necessary.