The Flexibility of Newer Insulins

Not so many years ago, your options for insulin were limited to Neutral Protamine Hagedorn (NPH) and regular, or some combination of the two. While these insulins are still around and work well, they don’t offer much in the way of flexibility. Your eating and activity patterns have to be structured to meet these insulins’ action patterns and peaks. This is done in an effort to reduce your risk of severe high and low blood sugars and minimize swings (or variability) in the blood sugar levels.

More flexible and more expensive

Zoom ahead to today and we suddenly have an array of insulins - from long-acting to ultra-long acting and rapid-acting to ultra-rapid acting. These insulins offer flexibility that NPH and regular can’t. Although to be fair, newer insulins can be quite costly and are often injected more frequently.

For example, NPH and regular can be purchased over-the-counter, at typically less than $40/vial, whereas newer insulins are prescription only and can be several hundred dollars a month. With such an extreme cost difference, using NPH and regular may be the best option for some. Seeking out diabetes training on how to use these types of insulin can make them a successful part of your diabetes care plan.

How are new types of insulin more flexible?

Let’s explore the flexibility that newer insulins offer.

Faster acting options

Rapid and ultra-rapid acting insulins are typically taken with meals. They work quickly (usually within 15 minutes or less) and last in your body from 4-5 hours. They also “peak,” or work their hardest around 1-2 hours. Compare this to regular insulin which takes 30 minutes to work, peaks in 2-3 hours, and lasts in the body up to 6-8 hours.

Can adjust based on meals and activity

The faster action of the first types of insulin means you don’t have to plan in advance of your meals nearly as much.  They are also better timed to your body’s blood sugar spikes post-meal. Given they leave the body more quickly, you have more flexibility in your post-meal activity plans. And, finally, because you dose rapid or ultra-rapid acting insulins with each meal (vs regular which is typically dosed before breakfast and supper), you can modify your doses to fit changes in your meal plans or activity patterns.

Once-a-day options

Long or ultra-long acting insulins are typically dosed once a day and are intended to give you insulin slowly over a 24-hour period or longer. In fact, ultra-long acting insulins last 36-42 hours in the body and have some flexibility in the timing of your dose.

Compare this to NPH, which must be taken twice a day (typically prior to breakfast and supper meals along with regular) to get similar 24-hour coverage. NPH also has peaks to it, whereas longer-acting or ultra-long acting insulins have minimal if any. The overlap of NPH peaks with regular peaks usually means it’s best to avoid strenuous physical activity mid-day or near bedtime. It also means snacks at those times may be necessary to prevent low blood sugars.

Weigh your insulin options

Both older and newer insulins can offer improvements in your blood sugars. Each has its unique set of benefits and drawbacks, with newer insulins offering flexibility and older insulins offering affordability. Talk with your medical team about which option may be the best fit for you!