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Version 4.0 Comparison of Insulin Preparation a, b Appendix G-4 VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus Insulin RAPID-ACTING Onset (hours) Peak (hours) Duration (hours) Prandial (bolus) Insulin Compatible Mixed With Appearance / Role NPH c Clear / covers insulin needs Lispro (Humalog®) 0.25-0.50 0.5-1.5 3-5 NPH Glulisine (Apidra®) 0.33-0.50 0.5-1.5 3-4 NPH in Aspart (Novolog®) 0.17-0.33 0.67-0.83 3-5 subcutaneous use at the time of the injection. only (but not in IV or infusion pump) SHORT-ACTING Regular (Novolin R®, Humulin R®) 0.5-1 2-5 5-8 NPH Clear / covers insulin needs for meals eaten within 30-60 minutes. Basal Insulin INTERMEDIATE-ACTING NPH (Novolin N®, 1-1.5 4-12 24 Regular Cloudy / covers insulin Humulin N®) needs for about half the day or overnight. Often combined with rapid- or short-acting insulin. LONG-ACTING Glargine (Lantus®) 1.1 - d 20-24 Not to be mixed with other insulins Detemir (Levemir®) 1-2 6-8 Up to 24 Not to be mixed with other insulins Pre-Mixed Products 70%NPH/30% Regular (Novolin 70/30, Humulin70/30) 50%NPH/50% regular (Humulin 50/50) 75% intermediate/25% lispro (Humalog mix 75/25) 50% intermediate/50% lispro (Humalog mix 50/50) 70 % insulin aspart protamine recombinant; 30% insulin aspart recombinant (Novolog mix 70/30) 50 % insulin aspart protamine recombinant; 50% insulin aspart recombinant (Novolog mix 50/50) Not to be mixed with other insulins Not to be mixed with other insulins Not to be mixed with other insulins Clear / covers insulin needs for about 1 full day. Often used, when needed, with rapid- or short-acting insulin Cloudy / generally taken twice a day before mealtime. a Adapted from Facts and Comparisons 4.0; available at: www.online.factsandcomparisons.com/Insulin.mht and Web MD available at: http://diabetes.webmd.com/diabetes-types-insulin. Accessed 16 June 2009. b The time course of action is intended as a general guide as many factors may influence these parameters (e.g., type of preparation, dose, site of administration, and patient related variables). c The effects of mixing insulin aspart with insulins produced by manufacturers other than Novo Nordisk has not been studied. d No pronounced peak; small amounts of insulin glargine are released slowly, resulting in a relatively constant concentration/time profile over 24 hours. Module G: Glycemic Control: Appendices Page 87
Version 4.0 VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus MODULE E– EYE CARE Module E – Eye care Page 88
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