INSULIN | ADVANTAGES | DISADVANTAGES | |
---|---|---|---|
Bolus | Short acting
Human regular (Humulin R, Novolin ge Toronto) |
|
|
Rapid acting*
Lispro (Humalog) Aspart (NovoRapid) Glulisine (Apidra)† |
|
| |
Basal | Intermediate acting
Human NPH Humulin N, Novolin ge NPH |
|
|
Long acting
Detemir (Levemir) Glargine (Lantus) |
| ||
Mixed | Premixed20,21 |
|
|
BID—twice daily, DM—diabetes mellitus, HbA1c—hemoglobin A1c, NNT—number needed to treat, NPH— neutral protamine Hagedorn.
↵*Rapid onset might lead to better postprandial control; significance is uncertain.
↵†Glulisine appears similar to lispro and aspart but is too new to be included in systematic reviews referenced here.
↵‡There are no clinically significant differences in HbA1c control likely to affect clinical outcomes.
↵§Most pronounced decreased risk for long-acting insulin analogs is on nocturnal hypoglycemia16 (long acting vs NPH, NNT ≥ 6 [95% confidence interval 4–33]).15
↵||Weight change with long-acting insulin analogs vs NPH: type 1 DM −0.73 to −0.4 kg; type 2 DM −1.27 to −0.8 kg (with detemir; glargine no difference). There are questions about the clinical significance of the minor weight change of < 1.3 kg here (or < 5% in general).