Insulin FAQs

Insulin is a hormone made by the pancreas. It allows your body to use the sugar in carbohydrates from food to make energy or to store glucose for future use. Read More

The cells in your body need sugar for energy. But sugar doesn’t go directly into your cells; your pancreas must signal the release of insulin into your bloodstream. Insulin then attaches to, and signals cells to absorb sugar from the bloodstream.

Read More:

The role of insulin in the human body

The role of insulin and how it helps your body

If our pancreas stops producing insulin, we develop type 1 diabetes. Type 2 diabetes occurs when our pancreas doesn’t produce enough insulin. Women can also develop gestational diabetes during pregnancy.

If left untreated and without insulin, people living with type 1 diabetes die. When people living with type 2 diabetes do not take enough insulin, complications, including diabetic ketoacidosis, nerve and kidney damage, blindness, heart disease and other complications can occur.

Insulin products were created to replace this much needed hormone for people who don’t make any, or enough, insulin themselves. Read More.

 

Further reading:

1. Diabetes

2. Facts about Diabetes and Insulin

Leonard Thompson, a 14 year-old boy living in Toronto, Canada, was the first person with type 1 diabetes to be given an injection of insulin on 11 January, 1922. Prior to this, people living with type 1 diabetes were often put on starvation diets and other treatments, which would only delay death from the condition.

Although the first batch of insulin was not perfect, the second, injected on 23 January, 1922, successfully lowered Leonard’s blood sugar levels. This insulin, which was developed from ox pancreatic extract, was developed by Frederick Banting, Charles Best and James Collip. The three men owned the patent for insulin and famously sold it to the University of Toronto for US$1. In 1922, the pharmaceutical company, Eli Lilly and Company, negotiated large-scale insulin manufacturing with the researchers and the University of Toronto. Read More

 

Further reading:

1. History Of Insulin

2. The Discovery Of Insulin

3. Watch Video

In its current state, insulin must be injected into the body. This can be done either by measuring insulin from a vial and injecting via a syringe, using an insulin pen and pen needle, or using an insulin pump, which provides insulin through a small catheter that attaches to the body and must be changed every 2 – 3 days. Read more

Insulin must be taken every day. When a person living with type 1 diabetes misses a single  insulin dose, severely high blood sugar levels can occur. This may lead to complications, sickness, and even death.

For some people, particularly those only using intermediate- or long-acting insulins (known as ‘basal’ insulins), insulin is typically taken once or twice a day. Many also take short- or rapid-acting insulins (called ‘bolus’ insulins) in addition to their basal insulin. Bolus insulins are taken at every meal, and sometimes for snacks, or to adjust high blood sugar levels. There are also mixed insulins, which contain a combination of bolus and basal insulins. These are typically taken once or twice a day, as well.

The amount of insulin a person takes on a daily basis varies. According to the World Health Organization, the average daily dose is 40 units. The dosage depends on a person’s weight, age, daily carbohydrate intake and other factors. Some people take the same amount of insulin each day based on their doctor’s recommendation; others vary their insulin intake based on a pre-arranged ratio to match the amount of carbohydrates eaten during a meal. People who take the same dose of bolus insulins every day must often eat the same amount of carbohydrates each day to match their insulin doses. Read more about the experiences of insulin users in our User Perspective’s Profile.

People taking insulin must also, when available, measure their blood sugar levels using a glucometer and test strips many times a day. This ensures the medicine is appropriately adjusting their blood sugar levels and that they are not too high or low. In high-income countries, glucometers are a mainstay in diabetes management. In many low- and middle-income countries, people struggle to afford the test strips, which are often more expensive than insulin (IDF Diabetes Atlas – 8th Edition).

It’s possible for a person with diabetes to give themselves too much, or too little, insulin because this insulin is not internally regulated.

For example, if a person does not calculate the correct ratio of carbohydrates to insulin units, s/he may be at risk of an insulin overdose, which could result in hypoglycemia. Most people using insulin have experienced hypoglycemic episodes. If caught early, hypoglycemia can be treated with 15g of sugar (e.g. candy or juice). Severe episodes can lead to hospitalisation, or even death.

Animal Insulin

‘Animal’ insulin was the first type of insulin to be used on humans in 1922. It is derived from cows (known as ‘bovine insulin’) or pigs (known as ‘porcine insulin’).  Until the 1980s, it was the only treatment for people dependent on insulin. Following that decade, animal insulin started to be phased out by ‘human’ and ‘analogue’ insulins. Porcine insulins are still available, but only a limited number of manufacturers still produce it. Given its limited manufacture, this form of insulin can be expensive. Some people still use animal insulin because of allergies to other insulin types, or personal preference.

Types of animal insulins include short- and intermediate-acting, and premixed insulins. Read More

 

Human Insulin

Introduced on the market in 1982 and originally created to help people who experienced bad reactions to beef or pork insulin, ‘human’ insulin is synthetically grown in a laboratory. It mimics insulin that is already in humans. The first form of ‘recombinant’ human insulin was Humulin®, developed by Eli Lilly and Company. It was created in a laboratory by growing insulin proteins within Escherichia coli (E. coli) bacteria. Most versions of human insulin on the market today are biosimilar insulins

Read more about biosimilars here. 

Types of human insulin include short-acting, intermediate acting and pre-mixed insulins.

 

Analogue Insulin
Similar to human insulin, analogue insulin is made from recombinant DNA. The difference is that it is modified to change the absorption rates of the insulin. This allows the insulin to be released more quickly, or slowly, into the bloodstream. Several biosimilar versions of analogue insulin are available.

Types of analogue insulin include fast-acting, long-acting and pre-mixed insulins.

Click here for our ACCISS tool on guidelines for insulin use.

Below is a brief summary of the different types of insulin. You can read more here:

1. Insulin A to Z: A Guide on Different Types of Insulin.

2.  Insulin Types and Information.

3. Types of Insulin

Source: University of California, San Francisco  

 

Rapid-Acting Insulin (Analogue Insulin)

Rapid-acting, or ‘analogue’ insulin is typically used to cover meal time bolus and to make corrections (i.e. if the glucose levels are higher than the target range after testing). Because these insulins have a rapid onset, meals must be eaten at the same time as they are taken. Rapid-acting insulins are often used in combination with either a long-acting or intermediate-acting insulin. The only exception to this is when an insulin pump is used. In these cases, people take very small doses of rapid-acting insulin many times a day as a basal, as well as their bolus.

Brand names (and types) include: Humalog (lispro), Novolog (aspart) and Apidra  (glulisine).
Onset: Approximately 15 minutes

A newly approved ultra-rapid insulin, which is a faster-acting version of aspart insulin, called Fiasp, is now also available.

Peak: 1–2 hours

Duration 4–6 hours

Example of Patient Prices of Insulin in a few Countries: (see the map)

 

Short-acting Insulin (Human Insulin)
Short-acting insulin, also known as regular or soluble insulin, is similar to rapid-acting insulin in that it is also considered a bolus insulin that is taken at mealtimes. Its onset and peak are longer than rapid-acting insulin, so it is often recommended to be taken 30 minutes prior to meal time.

Brand names include: Humulin R, Novolin n R , Wosulin

Onset : Approximately 30 minutes

Peak: 2–4 hours

Duration: 6– 8 hours

Example of Patient Prices of Insulin in a few Countries: (see the map)

Intermediate-acting Insulin
Intermediate-acting insulin, also known as NPH or isophane insulin, is the longest-acting human insulin. Similar to long-acting insulins, its onset is between one and two hours and its typical peak occurs between four and 12 hours. Given that it can last between 18 to 24 hours, people who use it take it about twice a day. This basal insulin is often combined with rapid- or short-acting insulins, particularly among those living with type 1 diabetes.

 

Brand names include: Humulin N, Novolin N, Wosulin N, Lente

Example of Patient Prices of Insulin in a few Countries: (see the map)

Long-acting Insulin
Long-acting insulins were created to last a full day and have no, or less, of a peak to reduce possible hypoglycemic episodes. This type of insulin can be combined, when needed, with short- or rapid-acting insulins. Long-acting insulin is typically used once or twice a day.

Brand names (and types) include: Lantus, Basaglar (glargine), Levemir (detemir), Tresiba (deguldec)

 

Example of Patient Prices of Insulin in a few Countries: (see the map)

 

Pre-mixed Insulin
Many different pre-mixed insulins exist. They are manufactured in combinations of short- and intermediate-acting insulins, or rapid- and long-acting insulins. Pre-mixed insulins are often taken two to three times a day. They can be especially helpful for people who have trouble drawing insulin out of two bottles and /or correctly dosing themselves. In many low-income settings, premixed insulins are used because they are the most affordable option. (See ACCISS pricing information for more). Mixed insulin has two peaks: The first for the bolus insulin; the second for the basal insulin.

Brand names: Human insulin: Novolin 70/30, ReilOn 70/30, Humulin 70/30

 

Analogues: Humalog Mix 50/50, Ryzodeg 70/30, Humalog Mix 75/25, Novolog Mix 70/30

Example of Patient Prices of Insulin in a few Countries: (see the map)

 

Further Reading:

1.  Insulin Types and Information.

2. Types of Insulin

3. Differences in bioactivity between human insulin and insulin analogues approved for therapeutic use- compilation of reports from the past 20 years.

4. Short-acting insulin analogues versus regular human insulin for type 1 diabetes mellitus