Insulin regimes | Know Diabetes

Different insulin regimens

There are a few different insulin regimes that people on insulin therapy can follow. These include:

Multiple daily injection insulin regimens / basal-bolus therapy

This regime includes an injection of bolus insulin (fast-acting) e.g. Humalog or Novorapid at each meal and basal insulin (long-acting) which is usually taken once or twice a day. Those who are on this regimen are able to adjust their bolus insulin at each meal time. The amount of bolus insulin taken is directly related to the amount of carbohydrates consumed.

Most people with type 1 will be on a basal-bolus or multiple daily injection regime.

Twice daily mixed insulin regimen

Insulin used twice daily may contain a mixture of shorter and intermediate-acting insulin e.g. Humulin M3; Novomix 30 and is taken twice a day at breakfast and evening meal. Individuals who are on this regimen, are unable to adjust their insulin, but carbohydrate counting principles can be applied to maintain similar amounts at meals.

Insulin profiles

This is a brief guide to the types of insulin and how long each type of insulin lasts over a 24-hour period. Please note, insulins in each group can vary in their effect and duration of action. Visit the manufactures website for specific information about your insulin.

Rapid-acting

Short-acting

Intermediate-acting

Long-acting

Rapid-acting insulin

Area graph showing effect of prapid acting insulin over time. Peak at 1 hour. Zero effect at 3

The fastest-acting insulin, usually taken immediately before meals or as a correction dose. Starts working in 5–10 minutes and lasts 2–5 hours.

Examples include insulin aspart (Novorapid®), insulin lispro (Humalog®), insulin glulisine (Apidra®), insulin aspart (FiAsp®).

Short-acting insulin

Area graph showing effect of short-acting insulin over time. Peak at 3 hours. No effect by 6 hours

Short-acting insulin is usually taken about 30 minutes before meals or just after eating. Starts working in 30 minutes to 1 hour and lasts up to 8 hours.

Examples include human soluble insulin (Actrapid®, Humulin® S and Insuman Rapid®).

Intermediate-acting insulin

Area graph showing effect of intermediate-acting insulin. Peaking at 8 hours. Effect stopping at 22 hours

Usually taken once or twice a day. Starts working within 2 hours and lasts 8–14 hours.

Examples include isophane insulin (Insuman® Basal, Insulatard® and Humulin® I)

Long-acting insulin

Area graph showing effect of long acting insulin over time. Reaches peak effect at 6 hours and continues trailing off at 24 hours

Usually taken once or twice a day. Starts working within 2 hours and lasts up to 18–24 hours.

Examples include insulin detemir (Levemir®), insulin glargine (Abasaglar®, Lantus®, Toujeo®) and insulin degludec (Tresiba®).

Mixed insulin

Area graph showing effect of mixed insulin over time. Shorter acting insulin peaks at 30 minutes and tails of quickly to zero at 6 hours. Longer acting insulin peaks at 8 hours and tails off at 24 hours.

These insulins are a mixture of shorter-acting and longer-acting insulins and come in different preparations. Usually taken twice or three times daily, between 15–30 minutes before or just after food. Starts working within 30 minutes (depending on short-acting insulin).

Examples include biphasic insulin aspart (Novomix® 30), biphasic insulin lispro (Humalog® Mix 25, Humalog® Mix 50), soluble and isophane insulin (Humulin® M3, Insuman® Comb 15, Insuman® Comb 25, Insuman® Comb 50).