How do commercially available insulin preparations differ from each other

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Commercially available insulin preparations are separated into five main categories (Table 28.1) depending on time of onset and duration of their action:

1. Insulins of very rapid onset and very brief duration of action, which include only insulin analogues (insulin Lispro, insulin Aspart and insulin Glulisine).

Diabetes in Clinical Practice: Questions and Answers from Case Studies. Nicholas Katsilambros et al. © 2006 John Wiley & Sons, Ltd. ISBN: 0-470-03522-6

Table 28.1. Characteristics of insulin preparations

Onset

Peak

Duration

Insulin preparations

of action

of action

of action

Very-rapid-acting insulin

analogues

Insulin Lispro

5-15 min

30-90min

3-5 hours

Insulin Aspart

5-15 min

30-90min

3-5 hours

Insulin Glulisine

5-15 min

30-90min

3-5 hours

Rapid-acting insulin

Soluble (regular) insulin

30-60 min

2-3 hours

5-8 hours

Insulins of intermediate action

Isophane insulin (NPH)

2-4 hours

4-10 hours

10-16 hours

Zinc insulin (Lente)

3-4 hours

4-12 hours

12-18 hours

Insulins of delayed action

Insulin Glargine

2-4 hours

It does not exist

20-24 hours

Insulin Detemir

2-4 hours

6-14 hours *

16-20 hours

Zinc insulin of extended

6-10 hours

10-16 hours

18-24 hours

action (Ultralente)

Mixtures of insulin

90/10 (90% intermediate,

30-60 min

Two-phase

10-16 hours

10% rapid)

80/20 (80% intermediate,

30-60 min

Two-phase

10-16 hours

20% rapid)

75/25 (75% protamine

5-15 min

Two-phase

10-16 hours

lispro, 25% Lispro)

70/30 (70% intermediate,

30-60 min

Two-phase

10-16 hour

30% rapid)

70/30 (70% protamine

5-15 min

Two-phase

10-16 hours

Aspart, 30% Aspart)

60/40 (60% intermediate,

30-60 min

Two-phase

10-16 hours

40% rapid)

50/50 (50% intermediate,

30-60 min

Two-phase

10-16 hours

50% rapid)

*The peak of action of this insulin is mild

*The peak of action of this insulin is mild

2. Insulins of rapid onset and short duration of action, including soluble insulin, which is often reported in the international literature as insulin 'Regular'.

3. Insulins of medium (or intermediary) action, which include the isophane insulin or insulin NPH (Neutral Protamine Hagedorn) and the zinc-containing insulin (Lente).

4. Insulins of slow onset and prolonged duration of action, which include newer insulin analogues (Glargine, Detemir) as well as the (older) zinc-containing insulin of prolonged action (Ultralente).

5. Mixtures of insulins that contain two types of insulin, one with very rapid or rapid action and the other of intermediary action, in different proportions.

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