Humalog, Lispro

Action - Onset - Peak - Duration - Adminster time

• Action:  Rapid-acting
• Onset:  less than 15min
• Peak:  1/2 to 1hr
• Duration:  2-6hrs
• Administer:  5-15min AC

Humulin R, Regular

Action - Onset - Peak - Duration - Adminster time

• Action:  Short-acting
• Onset:  30-60min
• Peak:  2-3hrs
• Duration:  3-10hrs
• Administer:  30min AC

Humulin N, NPH, 70/30, 75/25

Action - Onset - Peak - Duration

• Action:  Intermediate-acting
• Onset:  2-4hrs
• Peak:  4-10hrs
• Duration:  10-18hrs

Lente

Action - Onset - Peak - Duration

• Action:  Long-acting
• Onset:  3-4hrs
• Peak:  4-12hrs
• Duration:  12-20hrs

Ultralente

Action - Onset - Peak - Duration

• Action:  Long-acting
• Onset:  6-10hrs
• Peak:  8-20hrs
• Duration:  18-24hrs

Lantus

Action - Onset - Peak - Duration

• Action:  Long-acting
• Onset:  None
• Peak:  None
• Duration:  24hr acting

• Glipizide, Glyburidy, Glimpride
  • Directly stimulates pancreas to produce insulin
  • Functioning pancreas necessary
  • May also decrease glucose production by liver
  • Affected by several other medications

• Metformin
  • Decreases glucose production by liver
  • Doesn't promote weight gain
  • Facilitates insulin's action on peripheral receptor sites
  • Insulin must be present
  • No effect on pancrease itself
  • Lactic acid = serious side effect

• Acarbose (Precose), Migletol (Glyset)
  • Delays absorption of glucose in GI tract
  • take immediately before a meal as food absorption affected
  • Most effective in lowering postprandial blood sugar

• Piglitazone (Actos), Posiglitazone (Avandia)
  • Enhance insulin action at receptor site
  • sometimes called insulin sensitizers
  • Improve lipid levels also
  • Affects liver function
  • Liver function test needed
  • shouldn't be used in Pts with Ht failure

• Repaglinide, Nateglinide
  • Stimulates Insulin release from pancrease
  • Functioning beta cells necessary
  • Fast action & short duration
  • Take just before meals to stimulate insulin production in response to the meal

• Sitagliptin (Januvia), Vildaglystin (Galvus)
  • Incretin Hormones released by intestine and increase during day in response to eating a meal
  • Incretin increases insulin release and decreases hepatic glucose production
  • DDP-4 inactivates incretin
  • Prolongs and increases level of incretin by inhibiting DDP-4

• Pramlintide (Symlin)
  • Amylin = hormone secreted by beta cells alone with insulin
  • Symiln= Synthetic amylin
  • Used with insulin by those with difficult to control cases
  • Inject into abdomen or thigh only
  • Can cause severe hypoglycemia

• Exanatide (Byetta)
  • For Type 2 only
  • Stimulates Incretin Hormone
  • Also stimulates release of insulin
  • Used with metformin or sulfonylureas
  • Not a substitute for insulin
  • Injection BID