This blog on the types of insulin is part of a series celebrating the 100th anniversary of the discovery of insulin. You can check out previous blogs in this series, written by CIM Intern Eleanor Medley, here!
When insulin was first introduced, there was essentially one type sourced from animals. Definitely not all the variations we have today! So what’s the deal with all these different types of insulin? Keep reading, we’ll break it down for you.
Insulin can be modified to change how fast it works in the body. There are actually 3 factors in this: how long it takes to reach the bloodstream and begin lowering BG (onset), how long it takes to reach maximum strength (peak time), and how long the effect lasts (duration). [1] The following are brief descriptions of each type of insulin based on these factors.
Ultra Rapid-Acting Insulin
Ultra rapid-acting insulins can reach the bloodstream in just a few minutes. This is achieved by modifying the insulin formulation (e.g. Fiasp is made of Novolog and Vitamin B3) or by modifying the insulin delivery route (e.g. Afrezza is inhaled).
Onset: 2 – 15 minutes
Peak time: 30 minutes – 1 hour
Duration: 3 – 6 hours [2]
Common Uses: Bolus
Examples: Fiasp, Lyumjev, Afrezza
Photo from “Fiasp,” NovoMedLink > Diabetes, https://www.novomedlink.com/diabetes/products/treatments/fiasp/about/fiasp-and-type-1-diabetes.html [Image description: Fiasp vial and pens with red, yellow and blue labels]
Rapid-Acting Insulin
Rapid-acting insulin analogs are genetically modified to act more quickly than regular human insulin. [3]
Onset: 15 minutes
Peak time: 1-2 hours
Duration: 2-4 hours [4]
Common Uses: Continuous delivery in insulin pumps, Bolus
Examples: Novolog, Humalog, Apidra
[Image description: Novolog vial with orange label and cap]
Short-Acting Insulin/Regular Insulin
Recombinant DNA technology allowed human insulin to be made in bacteria. Before this, insulin was isolated from animals.
Onset: 30 minutes
Peak time: 2-3 hours
Duration: 3-6 hours [5]
Common Uses: Bolus
Examples: Humulin R, Novolin R
Photo from “Humulin R,” https://www.humulin.com/insulin-options [Image description: Humulin R vial with yellow and blue label]
Intermediate-Acting Insulin
NPH (Neutral Protamine Hagedorn) insulin was first created in 1946. The addition of zinc and protamine causes it to act over an extended period. [6]
Onset: 2-4 hours
Peak time: 4-12 hours
Duration: 12-18 hours [7]
Common Uses: Basal, Gestational diabetes
Examples: NPH (marketed as Novolin N, Humulin N)
Photo from “Humulin N (Insulin Isophane aka Insulin NPH)”, Diabetes Daily, https://www.diabetesdaily.com/learn-about-diabetes/treatment/types-of-insulin/long-acting-insulins/humulin-n-insulin-isophane-aka-insulin-nph/ [Image description: Humulin N vial and box with light green label.]
Long-Acting Insulin
Long-acting insulin mimics the baseline flow of insulin a pancreas would release between meals. They are insulin analogs genetically modified to act more slowly than regular human insulin.
Onset: 1 – 2 hours
Peak time: 6 – 8 hours for Levemir, Lantus has no peak [9]
Duration: 24 hours
Common Uses: Basal
Examples: Levemir, Lantus, Basaglar
[Image description: Basaglar KwikPen with yellow label resting on a white table]
Ultra Long-Acting Insulin
Ultra long-acting insulins have a prolonged effect—they can lower BG for more than 24 hours, allowing greater flexibility in the timing of daily insulin doses. [10]
Onset: 6 hours
Peak time: N/A (no peak)
Duration: 36 – 42 hours [11]
Common Uses: Basal
Examples: Tresiba, Toujeo
[Image description: Hiker wearing a light green jacket and holding up a light green and navy blue Tresiba FlexTouch pen]
Many times, different types of insulin are used in combination with each other. For example, rapid-acting Afrezza is taken with long-acting insulin as well. [12] Pre-mixed insulins often composed of NPH and regular or rapid-acting insulin are also available. [13]
[1] “Insulin Basics.” ADA, www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics
[2] Afrezza: “Insulin Basics.” ADA, www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics; Lyumjev: “Novel Formulation”, Lyumjev, https://www.lyumjev.com/hcp/formulation; Fiasp: “Fiasp Insulin: Why It’s Different & How It Works”, One Drop, https://onedrop.today/blogs/blog/fiasp-insulin-why-its-different-how-it-works
[3] Tibaldi, J. M. (2014). Evolution of insulin: From human to analog. American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2014.07.005
[4] “Insulin Basics.” ADA, www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics
[5] “Insulin Basics.” ADA, www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics
[6] Saleem F, Sharma A. NPH Insulin. [Updated 2020 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549860/
[7] “Insulin Basics.” ADA, www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics
[8] Saleem F, “NPH Insulin”
[9] “Levemir vs. Lantus: Similarities and Differences”, Healthline, https://www.healthline.com/health/diabetes/levemir-lantus
[10] Ooi, Cheow Peng et al. “Ultra‐long acting insulin versus long‐acting insulin for type 1 diabetes mellitus.” The Cochrane Database of Systematic Reviews vol. 2018,7 CD011102. 26 Jul. 2018, doi:10.1002/14651858.CD011102.pub2
[11] Toujeo: “Product Monograph Toujeo SoloSTAR, Toujeo DoubleSTAR”, Sanofi, https://products.sanofi.ca/en/toujeo-solostar.pdf; Tresiba: “About Tresiba”, Novo MedLink, https://www.novomedlink.com/diabetes/products/treatments/tresiba/about/product-profile.html
[12] Mohanty, et al.,“Inhaled Insulin – Current Direction of Insulin Research.”
[13] “Pre-Mixed Insulins.” UCSF Diabetes Education Online, dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/types-of-insulin/pre-mixed-insulin/.
