1Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
2Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
3Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Copyright © 2018 Korean Diabetes Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST: Ahmed Iqbal and Peter Novodvorsky have no relevant conflicts of interest to disclose. Simon R. Heller received research grants from Medtronic UK Ltd. He has served on speaker panels for Sanofi Aventis, Eli Lilly, Takeda, NovoNordisk, and Astra Zeneca for which he has received remuneration. He has served on advisory panels or as a consultant for Boeringher Ingelheim, Novo Nordisk, Eli Lilly, and Takeda for which his institution has received remuneration.
Origin | Type | Name of insulin/Brand name (manufacturer) | Chemical structurea | Onset of effect | Peak of effect | Duration of effect |
---|---|---|---|---|---|---|
Bovine | Neutral insulin (quick acting) | Hypurin Bovine Neutral® (Wockhardt UK Ltd.) | Ala → Thr at A8 | 30 min | 3–4 hr | 8 hr |
Val → Ile at A10 | ||||||
Ala → Thr at B30 | ||||||
Bovine | Intermediate | Hypurin Bovine Isophane® (Wockhardt UK Ltd.) | Protamine suspension | 4–6 hr | 8–14 hr | 16–20 hr |
Bovine | Long acting | Hypurin Bovine Protamine Zinc® or Hypurin Bovine Lente® (Wockhardt UK Ltd.) | Protamine or zinc suspension | 4–6 hr | 8–14 hr | 16–20 hr |
Porcine | Neutral insulin | Hypurin Porcine Neutral® (Wockhardt UK Ltd.) | Ala → Thr at B30 | 30 min | 3–4 hr | 8 hr |
Porcine | Intermediate | Hypurin Porcine Isophane® (Wockhardt UK Ltd.) | Protamine suspension | 4–6 hr | 8–14 hr | 16–20 hr |
Porcine | Pre-mixed (biphasic) | Hypurin Porcine Mix 30/70® (Wockhardt UK Ltd.) | Neutral and protamine suspension | |||
Human | Neutral insulin (quick acting) | Actrapid® (Novo Nordisk Ltd.) | – | 30 min | 2–4 hr | 6–8 hr |
Humulin S® (Elly Lilly Ltd.) | ||||||
Insuman Rapid® (Sanofi) | ||||||
Human | Intermediate | Insulatard® (Novo Nordisk Ltd.) | – | 2–4 hr | 4–8 hr | 14–16 hr |
Humulin I® (Elly Lilly Ltd.) | ||||||
Insuman Basal® (Sanofi) | ||||||
Human | Pre-mixed (biphasic) neutral/Isophane | Humulin M3® (Elly Lilly Ltd.) | Neutral insulin and insulin protamine suspension | Preparation specific | ||
Insuman Comb 15®/25®/50® (Sanofi) | ||||||
Analogues | Rapid-acting | Aspart/Novorapid® (Novo Nordisk Ltd.) | Pro → Asp at B28 | 5–15 min | 1–1.5 hr | 4–6 hr |
Lispro/Humalog® U100 or U200 (Elly Lilly Ltd.) | Pro at B28 and Lys at B29 | |||||
Glulisine/Apidra® (Sanofi) | Asn → Lys at B3 and Glu → Lys at B29 | |||||
Faster aspart/Fiasp® (Novo Nordisk Ltd.) | Pro → Asp at B28 with added L-arginine and niacinamide (vitamin B3) | 4 min | ||||
Analogues | Long-acting | Detemir/Levemir® (Novo Nordisk Ltd.) | No Thr at B30, C14 fatty acid to B29 | 1–4 hr | – | 20–24 hr |
Glargine/Lantus® (Sanofi) or Abasaglar® (Elly Lilly Ltd.) | Asn → Gly at A21 +2x Arg to B31/B32 | 1–4 hr | 18–26 hr | |||
Glargine U300/Toujeo® (Sanofi) | ||||||
Degludec/Tresiba® U100 or U200 (Sanofi) | No Thr at B30 C16 fatty acid to B29 | 1–4 hr | Up to 42 hr | |||
Analogues | Pre-mixed (biphasic) rapid acting/intermediate | NovoMix 30® (Novo Nordisk Ltd.) | Aspart and aspart protamine suspension | Preparation specific | ||
Humalog Mix 25®/50® (Elly Lilly Ltd.) | Lispro and lispro protamine suspension |
Type | Description | Example(s) of devices | Advantagesa | Disadvantagesa |
---|---|---|---|---|
Blood glucose (BG) meters with finger-prick testing | Finger-prick capillary blood samples applied to reagent test strips | Multitude of devices from several manufacturers | Availability, price | Necessity for frequent finger pricking with associated discomfort/pain |
BG meters with availability for ketone bodies testing | As above plus availability to test for ketone bodies (mostly β-hydroxybutyrate) | FreeStyle® Optium Neo (Abbott Diabetes Care), GlucoMen® Areo, LX2 or LX PLUS (Menarini Diagnostics Ltd.) and others | As above plus ability to detect ketone bodies earlier than with urine testing | As above plus higher cost of ketonaemia test strips in comparison to urine test strips |
Continuous glucose monitoring (CGM) | Subcutaneous sensor measures interstitial glucose (IG) every 5–10 min. IG data is then transmitted to a reader with a monitor where it can be viewed by the user. | Several devices from various manufacturers | No need for finger-prick testing (apart from calibration). More data available in comparison to BG meters enabling more sophisticated data analysis. Trends in IG available with option of predictive alarms | Higher cost in comparison to BG meters. 4–10 min lag between BG and measured IG. Calibration by the user required |
CGM linked with insulin pumps (CSII) | SAP: CGM data shown on CSII monitor | Sensor augmented pump (SAP): Animas® Vibe™ (Animas Corp.), Accu-Chek Insight or Combo (Roche Diabetes Care) and others. SAP with low glucose suspend (LGS): MiniMed™ Paradigm Veo™, MiniMed™ 640G (Medtronic Inc.) | As above plus steps towards ‘artificial pancreas’ with SAP, SAP with LGS and ‘hybrid closed-loop’ systems | Cost, availability |
SAP with LGS and Hybrid closed-loop system: CGM data able to influence the rate of insulin delivery by the insulin pump (see the text) | Hybrid closed-loop system: MiniMed™ 670G (Medtronic Inc.) | |||
Flash glucose monitoring systems | Similar to CGM, but IG data does not get automatically transmitted to the reader—need for swiping | FreeStyle® Libre (Abbott Diabetes Care) | Lower cost in comparison to CGM. No need for calibration | No availability of predictive alarms for hypo/hyperglycaemia |
aCompared to structure of human insulin molecule.
CSII, continuous subcutaneous insulin infusion. aPlease note listed advantages and disadvantages might be perceived by patients on highly individual basis and discussion with patients about the most appropriate device is encouraged.