Insulin Forms

Insulin cannot be taken orally because the body's digestive juices destroy it. Injections of insulin under the skin ensure that it is absorbed slowly by the body for a long-lasting effect. The timing and frequency of insulin injections depend upon a number of factors, including the type of insulin, amount and type of food eaten, and the person's level of physical activity. For example, ingestion of food makes the blood glucose level rise, whereas exercise and alcohol make blood glucose levels fall. Insulin is available in several brands, including Humulin, Novalin, and Iletin.

Longer-acting insulins, referred to as NPH or L, can last up to 24 hours. Regular insulin (R) takes effect more rapidly and its actions last four to 12 hours. Insulin lispro (Humalog) lowers blood sugar even more quickly and, because of its rapid effectiveness, is particularly beneficial when taken right before eating. Its short action also reduces the risk for hypoglycemic events afterward. Lispro may also be used shortly after a meal starts if a patient forgets to take insulin beforehand. (Lispro should not be used regularly in this manner, however.) Taking it right after a meal may prove to be useful in toddlers, who frequently refuse to eat meals on schedule. Lispro has no effect on glycolated hemoglobin levels, however.

Patients who may benefit from lispro are those with low glycolated hemoglobin levels but who are at high risk for hypoglycemia and those with recent-onset diabetes who still have some beta-function and can maintain some insulin levels between meals. There is some indication that it may cause birth defects if pregnant women take it.

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