Patients may experience blurred vision if they have had elevated blood sugar levels for a prolonged period of time and then have the elevated levels rapidly brought to normal. This is due to a shift of fluid within the lens of the eye. Over time, vision returns to normal. Other side effects that may occur include headaches, skin reactions (redness, swelling, itching or rash at the site of injection), worsening of diabetic retinopathy, changes in the distribution of body fat (lipodystrophy), allergic reactions, sodium retention, and general body swelling. Insulin causes weight gain and may reduce potassium blood levels. In addition to these side effects, inhaled insulin (Afrezza) may cause throat pain or irritation and cough and patients should inform their healthcare professional of any unresolved symptoms affecting the lungs for follow up.
PRESCRIPTION: Yes; No (regular and NPH insulin)
PREPARATIONS: Types of Insulin
- Regular (Humulin R, Novolin R) insulin is short acting and has an onset of action (begins to reduce blood sugar) within 30 minutes of injection, reaches a peak effect at 1-3 hours, and has effects that last 6-8 hours. It should be given 30 minutes before a meal.
- NPH insulin (Novolin N, Humulin N) is an insulin with an intermediate on set of action. Its activity starts about 2 hours after injection. It has a peak effect of 4-12 hours after injection, and a duration of action of 18-26 hours.
- Lente insulin also is an insulin with an intermediate duration of action. It has an onset of action 2-4 hours after injection, a peak activity 6-12 hours after injection, and a duration of action of 18 to 26 hours. Lente insulins have been discontinued.
- Ultralente insulin is a long-acting insulin with an onset of action 4-8 hours after injection, a peak effect 10-30 hours after injection, and a duration of action of more than 36 hours. Ultralente insulins have been discontinued.
- Novolog (Insulin aspart) is a human insulin with a slightly modified chemical composition that makes it a rapid acting insulin. The chemical changes provide insulin aspart with a faster onset of action (20 minutes) and a shorter duration of action (3-5 hours) than regular human insulin. It reaches peak activity 1-3 hours after injection.
- Humalog (Insulin Lispro) is a rapid acting insulin. It is a chemically-modified, natural insulin. It was approved by the FDA in June, 1996. As compared to regular insulin, insulin lispro has a more rapid onset of action, an earlier peak effect, and a shorter duration of action. It reaches peak activity 0.5-2.5 hours after injection. Therefore, insulin lispro should be injected 15 minutes before a meal as compared to regular insulin which is injected 30-60 minutes before a meal.
- Apidra (insulin glulisine recombinant) is a chemically modified human insulin that is rapid acting with a shorter duration of action than regular insulin. It has an onset of action of 20-30 minutes, peaks at one hour and its duration of action is 5 hours.
- Lantus (insulin glargine recombinant) is a human insulin with a slightly modified chemical composition. The chemical changes provide Insulin glargine with a slower onset of action (70 minutes) and a longer duration of action (24 hours) than regular human insulin. Its activity does not peak.
- Levemir (insulin detemir recombinant) is modified human insulin with an onset of 3-4 hours a peak of 6-8 hours and duration of up to 24 hours.
- Insulin degludec is available in some countries but is not currently approved in the United States. It is a long acting insulin that is slowly absorbed with no peak. It has a more stable activity in the body compared to insulin glargine (Lantus). An advantage of insulin degludec is that it may be dosed three times a week instead of daily in some individuals and it can be mixed with rapid-acting insulins unlike detemir or glargine insulins.
- Afrezza (recombinant inhaled human insulin) is a rapid-acting insulin available as an inhaled powder that peaks in 15 – 30 minutes with a duration of action similar to subcutaneously administered rapid acting insulins (lispro, aspart or glulisine). Inhaled insulin can be given before meals in place of subcutaneous regular or rapid acting insulins. It was approved by the FDA in June 2014.
- Insulin comes in several forms including vials, prefilled syringes and cartridges. The cartridges are typically used in a pen-like device that simplifies injection. The recently approved inhaled insulin is also available in cartridges for use. Regular human insulin (Novolin R, Humulin R) is available in vials, cartridges, and prefilled syringes.
- NPH human insulin (Novolin N, Humulin N) is available in vials, cartridges and prefilled syringes. A mixture of 70% NPH human insulin and 30% regular human insulin (Novolin 70/30, Humulin 70/30) is available in vials, cartridges and pre-filled syringes.
- A mixture of 50% NPH human insulin and 50% regular human insulin (Humulin 50/50) is available in vials.
- Insulin lispro (Humalog) is available in vials and cartridges.
- Insulin aspart (Novolog) is available in vials and cartridges.
- Insulin glargine (Lantus, Lantus Solostar) is available in vials and cartridges.
- Levemir (insulin detemir): Supplied in a vial, prefilled pen (FlexPen).
- Apidra, Apidra Solostar (insulin glulisine): Supplied in a cartridge, vial, prefilled pen (Solostar).
- Afrezza (insulin human) inhalation powder will be available in 2015 as single-use cartridges.
Quick GuideType 2 Diabetes Symptoms, Warning Signs, and Management
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