From the Guidelines
Fast-acting insulin is a crucial medication for managing postprandial blood glucose levels, and the most recent guidelines recommend using rapid-acting insulin analogues, such as Humalog or NovoLog, due to their quick onset of action and flexibility in meal planning 1.
Key Characteristics of Fast-Acting Insulins
- Onset of action: within 15 minutes of injection
- Peak action: 1-2 hours after injection
- Duration of action: 3-5 hours
- Examples: Humalog (insulin lispro), NovoLog (insulin aspart), Apidra (insulin glulisine), and Fiasp (faster-acting insulin aspart)
Dosing Considerations
- Starting doses: 0.05-0.1 units per kilogram of body weight per meal
- Sliding scale: based on pre-meal blood glucose readings
- Individual factors: weight, meal content, and insulin sensitivity
Mechanism of Action
- Facilitate glucose uptake into cells, particularly muscle and fat cells
- Bind to insulin receptors on cell surfaces, mimicking the body's natural insulin spike
- Modified versions of human insulin with slight structural changes for faster absorption and action
Clinical Recommendations
- Use rapid-acting insulin analogues for their quick onset of action and flexibility in meal planning 1
- Consider switching regimens if HbA1c targets are not met or if there are other patient considerations 1
- Regular insulin and 70/30 NPH/regular insulin mix are less costly alternatives, but their pharmacodynamic profiles may make them suboptimal 1
From the FDA Drug Label
Insulin aspart is a rapid-acting human insulin analog The duration of action for Insulin Aspart is 3 to 5 hours. The insulin aspart is a fast acting insulin with a duration of action of 3 to 5 hours 2.
- Onset of action: The maximum glucose-lowering effect of Insulin Aspart occurred between 1 and 3 hours after subcutaneous injection.
- Key characteristics: Insulin aspart is a rapid-acting human insulin analog produced by recombinant DNA technology utilizing Saccharomyces cerevisiae (baker's yeast) 2.
From the Research
Fast Acting Insulin and Hypoglycemia
- Fast acting insulin is not directly mentioned in the provided studies, but hypoglycemia, a potential side effect of insulin therapy, is discussed in several studies 3, 4, 5, 6, 7.
- Hypoglycemia is a major limiting factor to successful glycaemic management, and its risk is increased by all insulins and insulin secretagogues, including glinides and sulfonylureas 3.
- The incidence of hypoglycemia is higher in people with type 1 diabetes, but those with insulin-treated type 2 diabetes are also at risk 3, 4, 5.
Hypoglycemia Detection and Prevention
- Continuous glucose monitoring (CGM) is a useful tool for detecting hypoglycemia, especially nocturnal hypoglycemia, and can provide clinically valuable information about glucose control in patients with insulin-treated type 2 diabetes 4, 6.
- CGM has been shown to reduce time with nocturnal and daytime hypoglycemia in persons with type 1 diabetes treated with multiple daily insulin injections (MDI) 6.
- Education and regular review are essential for people with diabetes and their caregivers and healthcare professionals to be aware of the symptoms, prevention, and treatment of hypoglycemia 3.
Risk Factors for Hypoglycemia
- History of hypoglycemia and severe hypoglycemia are consistent risk factors for hypoglycemia 5.
- Intensification of therapy, longer duration of insulin therapy, and the presence of congestive heart failure are associated with a higher risk of developing and frequency of hypoglycemia 5.
- Defective glucose counterregulation due to combined deficiencies of glucagon and epinephrine secretory responses occurs in many patients with longstanding diabetes and increases the risk of hypoglycemia 7.