Types of insulin

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Human insulin is available in rapid, short, intermediate, and long-acting forms (regular, NPH, lente, and ultralente). In addition, five insulin analogs are currently available for clinical use (insulins aspart, lispro, glulisine, detemir, and glargine). Rapid-acting insulin analogs (lispro, aspart, and glulisine)

Changes in the amino acid sequence of the insulin analogs lispro, aspart, and glulisine reduce the tendency to self-associate into hexamers, resulting in more rapid onset and a shorter duration of action compared to regular human insulin. Insulin lispro (Humalog) has a reversal of amino acid sequence at the B28 (proline) and B29 (lysine) positions, resulting in insulin lysine-proline. Insulin aspart (Novolog) has a B28 amino acid proline substitution with aspartic acid. Insulin glulisine (Apidra) has two amino acid substitutions and differs from human insulin in that B3 asparagine is replaced by lysine, and B29 lysine is replaced by glutamic acid.78

Table 9 Pharmacodynamics of insulin and insulin analogs

Type of insulin

Time to onset of activity (hours)

Peak concentration (hours)

Duration of action (hours)

Rapid acting

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