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Insulin

  • Insulin preparation
  • Injection technique
  • Complications

To know more click on any drug

Actrapid

Humalog

Humulin L

Humulin N

Humulin R

Humulin U

Humulin 80/20 or 70/30

Mixtard 30/70 or 50/50

Monotard

Penmix 10, 20, 30, 40, or 50

Ultratard

Insulin: Type and timing help manage your blood sugar

The time effect of insulin and length of action can vary from person to person, and can also depend on

  • Where the injection was given
  • Temperature
  • Physical activity
  • Blood supply
  • The type of diabetes you have and your blood sugar level trends
  • Your lifestyle
  • What you eat
  • Whether or not you have other health conditions
  • How insulin may interact with other medications or supplements you take

The type of insulin best for you depends on when and the extent to which it affects your blood sugar, including:

  • Onset of action – When it starts lowering your blood sugar
  • Peak of action – When it exerts the maximum effect on your blood sugar
  • Duration of action – How long the overall effect lasts

Your doctor may prescribe a mixture of insulin types to keep your blood sugar in target range throughout the day. You must keep a record of your blood sugar and record the time you give yourself insulin. Blood sugar readings that are persistently above or below your target range may mean you need to revise your treatment plan.

Pre-mixed insulin is available in a variety of types and strengths. You can also mix different types yourself when you prepare to give yourself an injection.
These are the types of insulin available and the timing of their effects.

Type
Generic and brand names
Onset of action
Peak of action
Duration of action
Rapid-acting Insulin lispro* (Humalog)
Insulin aspart* (NovoLog)
5 to 15 minutes 1 to 2 hours 3 to 4 hours
Short-acting Insulin regular
(Humulin R,
Novolin R, others)
Insulin regular buffered (Velosulin)
30 to 60 minutes 2 to 4 hours 6 to 8 hours
Intermediate-acting Isophane insulin
(Humulin N,
Novolin N)
Insulin zinc
(Humulin L)
1 to 2 hours 4 to 8 hours 14 to 20 hours
Long-acting Insulin zinc extended
(Humulin U)
2 to 4 hours 4 to 20 hours 20 to 36 hours
Insulin glargine*
(Lantus)
2 hours No pronounced Up to 24 hours

*A modied form of synthetic insulin (analogue) that more closely resembles the action of insulin secreted by your pancreas.

INSULIN INDEXING

TYPES ACTIONS SIDE EFFECTS SPECIAL PRECAUTION

Very fast acting:

Contains Insulin Lispro.
Humalog

Fast acting:

Contains Soluble Insulin (Neutral).
Actrapid
Humulin R

Medium acting:

Contains Isophane Insulin or Insulin Zinc Suspension.
Humulin L
Humulin N
Monotard

Long acting:

Contains Insulin Zinc Suspension (Crystalline).
Humulin U
Ultratard

Mixed long and short acting insulin (biphasic):

Neutral and Isophane Insulin
Humulin 80/20 or 70/30
Mixtard 30/70 or 50/50
Penmix 10, 20, 30, 40, or 50

Insulin is important to our health because it allows the energy from our food to be used by the body. Food is made into glucose which goes into the bloodstream and travels around the body. Insulin controls the level of glucose in the blood, helping it to act as a fuel for our body. Without insulin glucose does not leave the bloodstream, but instead accumulates in the blood, causing major problems.
  • Skin reaction where the insulin is injected (e.g. red itchy skin) but this doesn’t usually last.
  • Fat buildup if the injection site is not rotated (which can then make insulin absorption from that spot changeable).
  • Extremely uncommon: allergy to insulin.
  • Do not use insulin if the blood glucose is too low (hypoglycemic).
  • Do not use in people who are not diabetic.
  • Changing from one insulin to another, or to do more intensive treatment may change the usual warning signs of a “hypo”. Only do this under a doctor’s supervision and take blood glucose tests frequently.
  • The amount of insulin needed will usually increase with illness, stress and during operations. Extra monitoring and extra care with food is needed at these times.
  • The amount of insulin needed will reduce with liver or kidney damage.

Additional Patient Information:

  • Follow the instructions on the label of the medicine or as directed by your doctor.
  • Keep your extra stocks of insulin refrigerated.
  • The insulin vial you are using can be left at room temperature. If you will soon be changing to a new vial, the new vial can be removed from the refrigerator so that it can come up to room temperature before you need to inject it.
  • Most insulin can be kept at room temperature (up to 25oC) for up to a month. Discard any remaining insulin in a vial four weeks after first using.
  • Insulin must not be frozen; if it is frozen do not thaw then use, throw it away.
  • Regular blood glucose monitoring is important and will give you control over your diabetes.
  • Do not miss meals or snacks.
  • Always carry something sugary with you (e.g. glucose tablets, jellybeans) in case of a “hypo” or hypoglycaemic incident.
  • When you get sick, your insulin needs might change. It is important you check your blood glucose regularly, and you should not stop your insulin. Your doctor or diabetes nurse should be able to advise you on what to do if you become ill.
  • Frequent high blood glucose will cause long-term problems such as eye and kidney problems, so should be avoided.
  • If you are thinking of getting pregnant, talk to your doctor first. It is best to get your diabetes very well controlled before conception.
  • Rotate your injection sites.
  • Check blood glucose levels before driving and every couple of hours during long journeys. It is important to avoid a “hypo” while driving.
  • Wash your hands well before drawing up the insulin and injecting the dose.

SELF CARE

  • avoid foods with high sugar and fat contents
  • avoid taking snack between meals
  • do not miss meals
  • stop smoking
  • stop alcohol
  • visit your doctor regularly
  • carry a card identifying that you are a diabetic (Medic Alert). This card
  • should show the type and amount of insulin that you are using

  • exercise regularly, test your blood sugar prior to activity (do not
  • exercise immediately after an insulin injection)

  • have regular check on your eyes
  • take care of your feet, do not treat corns by yourself

DIABETIC MANAGEMENT DURING THE FASTING MONTH

The suggested time schedule for taking medications during the fasting month is shown below:

TIME
SCHEDULE
7.30 p.m.
  • “buka puasa” start with a light meal (fruit juice)
  • take medication and sugar free meals
  • Maghrib prayers
8.00 p.m.
  • main meals
8.30 p.m.
  • Isyak/Terawih prayers
TIME
SCHEDULE
10.00 p.m.
  • meals
1.30 a.m.
  • snack (optional)
  • sleep
4.45 a.m.
  • wake up
  • take medications
5.15 a.m.
  • main meals
5.45 a.m.
  • snack (optional)

(Remember: Sahur should be taken as near Imsak as possible and not at midnight or after snack meals.)

Patients should continue with self-monitoring of blood sugar as this will safeguard against serious
disturbances of blood sugar level during the day, especially during the first week of Ramadan. It
is best to check the levels around 9 a.m., 3-4 p.m. and about 2 hours after “buka puasa”. Excessive exercise is usually discouraged during Ramadan because over exertion and exposure
to the hot sun may cause dehydration and hypoglycemia.

Last Reviewed : 10 July 2008
Writer : Dr. Nour Hanah Othman
  : Hadijah bt. Mohd Taib
  : Rosidah bt. Din
  : Nor Eizlin bt. Mohd Helmi