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For people with type 1 diabetes, insulin is the most well-known and likely the most important medication they will take. While most people produce insulin within their own bodies, people with type 1 diabetes cannot do this. As a result, they must take insulin injections to help their body metabolize glucose. Each day, insulin therapy saves the lives of millions of people.
In daily conversation, we often refer to the medications type 1 diabetics take as “insulin,” but there are actually multiple types of insulin, which can be tailored to the needs of each individual. Many people use multiple types of insulin to control their blood sugar throughout the day.
For someone new to the type 1 life, the different types and their properties can make your head spin! In this article, we will make the type 1 life simpler for diabetics and their loved ones by reviewing the most common drugs used for insulin therapy.
How many types of insulin are there?
There are five types of insulin that we use to categorize various drugs used in insulin therapy. They are categorized by how quickly they begin to work and how long they last.
They are:
- Rapid (or Ultra-short) Acting Insulin
- Short-Acting Insulin
- Intermediate Acting Insulin
- Long-Acting Insulin
- Mixed Insulin
Which insulin you should take is determined by you and your doctor and can depend on various factors, such as how you prefer to inject your insulin, whether you plan to use a medical device, compliance, insurance, and more. Whatever is prescribed to you, work with your doctor and diabetes nurse educator to understand how to best implement your care. If you have questions or concerns, ask! Nurse educators love to answer questions and help deliver the best care possible.
Rapid (or Ultra-short) Acting Insulin
This category of insulin includes drugs like insulin lispro, insulin aspart, and insulin glulisine. These drugs work quickly, as they begin to take effect within 12-30 minutes. They reach their peak effectiveness between 30 minutes and 3 hours and last approximately 3-5 hours total.
Rapid-acting insulin is taken approximately 15 minutes before meals and is used to maintain stable blood glucose levels after eating. These drugs are combined with longer-acting insulins to keep a steady blood sugar throughout the day.
Insulin pumps are primarily used with rapid-acting insulin, as its quick onset and short duration of action mean the pump can release small amounts of insulin throughout the day in response to blood glucose levels, similar to the way insulin is secreted in a functioning pancreas.
Short-Acting Insulin
This category includes regular insulin. This drug begins to work in about 30 minutes and reaches its peak effectiveness in 2.5-5 hours. Its effects can last 4-24 hours, though, like rapid-acting insulin, it is often paired with other longer-lasting drugs to maintain stable blood sugars throughout the day/night.
Short-acting insulin is often taken 30 minutes prior to meals to prevent blood glucose levels from elevating after meals.
Intermediate Acting Insulin
This category includes insulin NPH. These drugs begin to work in about 1-2 hours and reach their peak effectiveness in 4-12 hours. Their total duration is approximately 14-24 hours.
Intermediate-acting insulins are often given twice per day and are paired with a shorter-acting insulin to take at mealtimes. Intermediate-acting insulin is used to regulate blood glucose levels throughout the day to prevent unwanted spikes in blood glucose.
Long-Acting Insulin
This category includes insulin glargine, insulin detemir, and ultralente insulin (now discontinued). They begin to take effect after 3-4 hours and last 24 hours or more. There is no peak effectiveness for long-acting insulins.
These drugs are taken once or twice a day and used in conjunction with shorter-acting insulins to keep blood glucose levels stable throughout the day.
Mixed Insulin
This category includes a number of drugs that are a pre-mixed combination of rapid/short-acting insulins and intermediate or long-acting insulins. For example, they may come in proportions such as 25% rapid-acting and 75% intermediate-acting insulin. These mixes will often be used to cover two meals and a snack, so they are frequently taken in the morning and again in the evening. Exact dosing regimens will depend on a variety of factors determined by your doctor.
Why would multiple types of insulin be used?
Managing blood sugar can be tricky. Some individuals may find that using just one type of insulin doesn’t adequately manage their blood glucose, particularly just after meals. While long-lasting insulins can keep their blood sugar down most of the day, a rapid or short-acting insulin can be used to manage and adjust insulin dosage in response to meals. This is when patients can use sliding scales and other tools to appropriately manage their blood sugar from day to day.
With time, experience, and guidance from medical professionals, many patients find a dosing regime that works for them, which can include the use of tools like CGMs and insulin pumps. These tools measure blood glucose levels throughout the day and even track trends over time. Using medical devices to track blood sugar can give people with diabetes much-needed peace of mind as they simplify the process of keeping blood glucose levels in the ideal range.
Skin Grip helps people with type 1 diabetes by keeping their CGMs and insulin pumps in place. Our adhesive overlay patches secure Dexcom G6, Medtronic Guardian, Freestyle Libre, and Omnipod devices. They allow you to get the full life out of your device and stop worrying about it falling off. If you want to stop losing sensors, you can try a free sample at SkinGrip.com.
