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Insulin types and regimens

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Insulin Types /Action

Ultra-Fast/Short Acting Insulin
  • Starts to work immediately - 15 minutes after given
  • Peaks 1 hour after given
  • Lasts up to 4 hours after it is given
  • [Humalog / Novorapid /Apidra]
Fast/Short Acting Insulin
  • Starts to work 30-60 minutes after given
  • Peaks 2-4 hours after given
  • Lasts up to 6-8 hours after given
  • [Actrapid / Humulin R]
Long Acting Insulin
  • Starts to work 1-2 hours after given
  • Peaks 4-12 hours after given
  • Lasts up to 8-24 hours after given
  • [Protophane / Humulin N]
Long Acting Insulin Analogues
  • No pronounced peak, lasts 24 hours after given = basal insulin
  • Given either once or twice a day, morning or night
  • Still need fast-acting insulin to work with meals (like a bolus)
  • [Lantus = insulin glargine - currently funded in N.Z. on special authority]
  • [Levemir = insulin determir - not currently funded in N.Z.]
Mixed Insulins
  • Starts to work immediately
  • Peaks 4-12 hours after given
  • Lasts up to 8-24 hours after given
  • [Novomix 30 - 30% Novorapid and 70% Protaphane]
  • [Humalog mix 25 - 25% Humalog and 75% Humulin N or Humalog mix 50 - 50% Humalog and 50% Humulin N]

 These can either be given in a syringe or given separately with an insulin pen.

You can read a  transcript of this video here.

Insulin regimens

Most children newly diagnosed in hospital start on injections twice a day. If using pens doses may be prescribed three times a day, having fast acting at dinner and long-acting at bed.

For some children (most children above the age of 13 years) a basal bolus regimen with a Long-acting insulin such as Lantus in the morning or evening and fast-acting insulin such as Novorapid or Humalog at breakfast, lunch and dinner will allow for more flexibility with eating and general lifestyle.

You can read a  transcript of this video here.

Twice daily

Most pre-school and younger age children will start on twice daily injections. This will depend on factors such as age, ability to give injections at school and motivation or wanting to give extra injections. Many children are not able to or not keen to give injections at school and in this case two injections a day will be the preferred regimen.Twice daily insulin can be given either via syringes (where the short acting and long acting insulins are mixed into the syringe) or via pen devices where separate injections are given for each individual insulin type.

twice daily inj

Three times daily

As children grow, stay up later and want more flexibility with eating and general lifestyle, there is usually a need to change the insulin regime. This commonly means splitting the dinner time dose (i.e. giving very fast acting insulin with dinner and giving the long acting insulin before bed). Most children find it easier to use an insulin pen device for these evening doses.

Children who are very hungry after school and eating a large amount of carbohydrate at afternoon tea, will generally need additional insulin with this. This additional dose will be very short-acting insulin. This dose can be given with either a syringe or a pen device.

three tx inj

Basal bolus or MDI injections

To mimic the own body's insulin production and provide flexibility with when and how much is eaten, more injections need to be given. "MDI" means multiple daily injections and "basal bolus" refers to a very short acting insulin given before each main meal and a long-acting insulin at bedtime or breakfast. Most children and young people using MDI or basal bolus regimes will opt to use pens. When changing from a less intensive regime to an MDI/basal bolus regime additional education about carbohydrate counting and use of insulin to control blood glucose levels (Insulin sensitivity factor or ISF), will need to be undertaken.

basal bolus inj

Pumps

Insulin pumps give a basal insulin continuously 24 hours a day which is pre-programmed for a person's body's requirements - the amount of insulin children and young people need increases as they have diabetes longer and grow bigger. Blood glucose levels and weighed amounts of carbohydrates eaten need to be entered into the pump. The pump automatically calculates a bolus dose of insulin for food with additional insulin added to blood glucose levels that are above the target range for that child.

You can read a  transcript of this video here.

Pumps give more accurate insulin delivery and allow different amounts to be eaten at different times. Pumps can also make it easier to adjust insulin doses for intensive sports regimes or during periods of sickness.

In New Zealand Pharmac fund insulin pumps and insulin pump consumables under strict criteria. Talk to your diabetes nurse or doctor at your diabetes clinic if you would like to know more about insulin pumping.

pumps 

Click on the image below to read or download and print the Starship Diabetes Service Insulin Pump Administration Booklet.

Insulin pump therapy

Think you've got it sorted now?

If you and your parent/carer have read through the information above and watched the videos, and you feel confident that you understand this topic, print off and fill in the evaluation form below (you might need to ask someone to print this off for you) and return to the nurse on your ward. If you have any questions, note them down on this form and your diabetes nurse specialist will discuss them with you.

Insulin Types and Regimens: Evaluation

Click on the image below for a printable version of this document

Insulin types and regimens evaluation

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