Insulin
Currently, insulin is derived from recombinant (human) sources. Regular (rapid onset, short-acting) and NPH (slower onset, longer duration) human insulin are the most commonly-used preparations. An ultrarapid-acting insulin analog, insulin lispro injection (Humalog(r)) is a chemically-modified, natural insulin. It was approved by the FDA in June, 1996.
Insulin is administered by injection via the subcutaneous (under the skin) route. Regular insulin acts within 30 minutes, and its effects last 6 to 8 hours. The maximal effect occurs 1 to 3 hours following the injection.
As compared to regular insulin, insulin lispro acts more rapidly, has an earlier maximal effect, and a shorter duration action. Therefore, insulin lispro should be given within 15 minutes of a meal, compared to regular insulin, which is given 30-60 minutes before meals.
NPH insulin is an insulin with an intermediate-duration of action. It has an onset of action about 2 hours following administration and a duration of action of 18 to 26 hours. Its maximal effect is 4 to 12 hours after administration.
Lente insulin also is an intermediate-acting insulin. It has an onset of action after 2 to 4 hours and a duration of action of 18 to 26 hours. The peak activity of lente insulin occurs 6 to 12 hours following administration.
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