Joslin Diabetes Center & Joslin Clinic Clinical Guideline for ...

INSULIN CHART*Insulin Type Product Onset Peak DurationVery Rapid ActingInsulin aspart analogNovoLogInsulin lispro analogHumalog10 – 30 minutes 0.5 – 3 hours 3 – 5 hoursRapid ActingRegular insulinIntermediate ActingLente insulinNPH insulinLong ActingInsulin glargineHumulin RNovolin RHumulin LHumulin NNovolin NLantus30 minutes 1 - 5 hours 8 hours1 – 4 hours 4 - 15 hours 16 – 26 hours1 – 4 hours 4 - 12 hours 14 –26 hours1 – 2 hoursWithoutUltralente insulinHumulin U4 - 6 hours8 - 30 hoursPremixed CombinationsInsulin TypeProduct50% NPH; 50% Regular Humulin 50/5070% NPH; 30% Regular Humulin 70/3070% NPH; 30% Regular Novolin 70/3075% lispro protamine suspension, 25% lispro Humalog Mix 75/2570% aspart protamine suspension, 30% aspart NovoLog Mix 70/3024 hours24 - 36 hours*The onset, peak and duration of any insulin type depend on many factors. Patients may experience variations in timing and/or intensity of insulinactivity due to dose, site of injection, temperature, level of physical activity, in addition to other factors. Therefore, TAP should be considered as onlyreasonable estimates of the action of an insulin.Insulins listed alphabetically by generic name; TAP derived from information provided by manufacturers.Guideline Authors: Martin Abrahamson, MD, Richard Beaser, MD, Elizabeth Blair, CS-ANP, Om Ganda, MD, James Rosenzweig, MDApproved by Joslin Clinical Oversight Committee 2/20/04GlossaryA1C: Glycohemoglobin (Hemoglobin A 1c)Casual plasma glucose: a random plasma glucoseCHF: congestive heart failureFDA: Food and Drug AdministrationFPG: fasting plasma glucoseHS: bedtimeMNT (Medical Nutrition Therapy): Begins with assessment of overall nutrition status, followed by individualized prescription for treatment. Registered dietitianconsiders food intake, physical activity, course of any medical therapy, individual preferences and other factors.Rx: treatmentTAP: time action profilesTZDs: thiazolidinedionesReferencesAmerican Diabetes Association. Screening for type 2 diabetes. Diabetes Care. 27:S11-S14, 2004.Beaser, RS and Staff of Joslin Diabetes Center. Joslin’s Diabetes Deskbook For Primary Care Providers. Revised edition. Joslin Diabetes Center, Boston; 2003.Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes: scientific review. JAMA. 287(3):360-72, 2002.Nesto RW et al. Thiazolidinedione use, fluid retention, and congestive heart failure: A consensus statement from the American Heart Association and American DiabetesAssociation. Circulation. 108:2941-2948, 2003.James Rosenzweig, MD - ChairpersonMartin Abrahamson, MDRichard Beaser, MDElizabeth Blair, MS, CS-ANP, CDEPatty Bonsignore, MS, RN, CDEAmy Campbell, MS, RD, CDECathy Carver, ANP, CDEJerry Cavallerano, ODSonya Celeste-Harris, RN, MSNOm Ganda, MDJohn Hare, MDJoan Hill, RD, CDEJoslin Clinical Oversight CommitteeLori Laffel, MD, MPHLuAnn Kimker, MS, RNWilliam Petit, MDEvan Rosen, MDKristi Silver, MDSusan Sjostrom, JDKenneth Snow, MDRobert Stanton, MDWilliam Sullivan, MDHoward Wolpert, MDAlan Moses, MD, ex officioCopyright © 2004 by Joslin Diabetes Center. All rights reserved. These Guidelines are the property of Joslin Diabetes Center and are protected by copyright. Any reproduction of thisdocument, which omits Joslin’s name or copyright notice is prohibited. This document may be reproduced for personal use only. It may not be distributed or sold. It may not bepublished in any other format (e.g., book, article, Web site) without the prior, written permission of Joslin Diabetes Center, 617-732-2695.