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Insulin Types

Rapid-acting analogue (clear)
Fast-acting (clear)
Intermediate-acting (cloudy)
Long - acting (cloudy)
Extended long-acting analogue (clear)
Premixed (cloudy)

Insulin Type:

Rapid-acting analogue (clear)

Humalog (insulin lispro)
NovoRapid (insulin aspart)

Onset

10 - 15 minutes

Peak

1-1.5 hours

Duration

4 - 5 hours

Considerations

Client should eat within 10–15 minutes of injection. Use of pre-filled syringes of Humalog alone or Humalog with anintermediate insulin is not recommended due to blunting of effect.

Insulin Compatibility

Rapid-acting insulin can be mixed with N, NPH, Lente, Ultralente.

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Insulin Type:

Fast-acting (clear)

Regular
Toronto

Onset

30 - 60 minutes

Peak

2 - 4 hours

Duration

5 - 8 hours

Considerations

Should be given 30 - 45 minutes prior to meals.

Insulin Compatibility

Mixing fast-acting & Lente or Ultralente insulin is not generally recommended except for the client already experiencing adequate control on this mixture. The time between mixing & injecting should be consistent. Zinc present in the Lente/ Ultralente binds with the short-acting insulin and delays its onset of action.

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Insulin Type:

Intermediate-acting (cloudy)

NPH
N
Lente

Onset

1 – 3 hours

Peak

5 - 8 hours

Duration

Up to 18 hours

Considerations

Must be adequately re-suspended before injecting.

Insulin Compatibility

N or NPH & fast-acting insulin may be mixed & used immediately or stored, refrigerated, for future use. Pre-filled syringes should be stored in the fridge, with needle tips up. They are stable for 1 month. NPH or N cannot be mixed with Lente or Ultralente insulin.

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Insulin Type:

Long - acting (cloudy)

Ultralente

Onset

3 - 4 hours

Peak

8 - 15 hours

Duration

22 - 26 hours

Considerations

Must be adequately re-suspended before injecting.

Insulin Compatibility

See insulin compatibility for rapid-fast-& intermediate-acting insulins.

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Insulin Type:

Extended long-acting analogue (clear)

Lantus (insulin glargine) *approved, but not yet marketed in Canada

Onset

90 minutes

Peak

none

Duration

24 hours

Considerations

Glargine is only available in vials & is clear. Clients must be alerted to the potential danger of confusing glargine with other clear insulins (rapid or short-acting insulins). Use of pre-filled syringes is not recommended.

Insulin Compatibility

Due to its pH, Glargine cannot be mixed with any other insulin or solution

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Insulin Type:

Premixed (cloudy)

A single vial contains a fixed ratio of insulin (% rapid or fast-acting to % of intermediate acting insulin)

Onset

See rapid or fast

Peak

5 - 8 hours

Considerations

Must be adequately re-suspended before injecting. If using a rapid-acting mixture, client must eat within 15 minutes of injecting. If using a fast-acting mixture, client should eat within 30 minutes of injecting.

Insulin Compatibility

Should not be mixed with any other insulin

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**Action times are “estimates” only. Action times depend on the individual, the injection site & the type of insulin
used. There can be approximately a 45% variation in daily absorption from the same site in the same person with
intermediate-acting insulin (Weiland & White, 2002).

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