From the Guidelines
There is no single "best" short-acting insulin to start with, as insulin aspart, insulin lispro, and insulin glulisine are all effective options with similar onset, peak, and duration profiles. Any of these rapid-acting insulin analogs would be appropriate for initial therapy, with the choice often depending on insurance coverage, cost considerations, and provider preference 1. These insulins typically begin working within 15 minutes, peak in 1-2 hours, and last 3-5 hours. The standard starting dose is usually 0.1-0.2 units/kg/day divided before meals, or 4 units before each meal, with subsequent adjustments based on blood glucose monitoring. Patients should administer these insulins 15 minutes before or immediately at the start of meals. All three options have comparable safety profiles and efficacy in controlling post-meal glucose excursions. The selection may ultimately be influenced by the patient's insurance formulary, as this often determines which insulin will be most affordable and accessible for long-term use.
Some key points to consider when choosing a short-acting insulin include:
- Onset, peak, and duration of action: All three options (insulin aspart, insulin lispro, and insulin glulisine) have similar profiles, making them suitable for mealtime dosing 1.
- Cost and insurance coverage: The choice of insulin may be influenced by the patient's insurance formulary and out-of-pocket costs 1.
- Provider preference: The choice of insulin may also depend on the provider's experience and preference 1.
- Patient factors: The patient's lifestyle, meal schedule, and ability to administer insulin injections should also be considered when choosing a short-acting insulin.
Overall, the choice of short-acting insulin should be individualized based on the patient's specific needs and circumstances. The most important factor is to choose an insulin that the patient can afford and adhere to, in order to achieve optimal glycemic control and minimize the risk of complications.
From the Research
Short-Acting Insulin Options
The choice of short-acting insulin depends on various factors, including the patient's lifestyle, diet, and activity level. Some of the most commonly used short-acting insulins are:
- Insulin aspart
- Insulin lispro
- Insulin glulisine
Comparison of Short-Acting Insulins
Studies have shown that insulin aspart and insulin lispro have nearly identical pharmacokinetic and pharmacodynamic profiles, providing better postprandial glucose control and less hypoglycaemia than regular insulin 2. Insulin glulisine is a new rapid-acting analogue with characteristics nearly identical to those of its predecessors 2.
Efficacy and Safety
Insulin aspart has been shown to provide significantly greater improvements in glycosylated haemoglobin and better postprandial glycaemic control than regular human insulin in patients with type 1 diabetes mellitus 3. Insulin lispro has a faster onset of action and a more rapid postpeak decrease compared to regular human insulin, with similar rates of insulin allergy, lipodystrophy, hypoglycemia, and abnormal laboratory test results 4. The three marketed rapid-acting analogues (insulin lispro, insulin aspart, and insulin glulisine) are equally efficacious and safe, providing comparable glycaemic control with a reduced risk of hypoglycaemia compared to human insulin 5.
Clinical Consequences
The use of rapid-acting analogues can lead to better control of postprandial glucose excursions, which can inhibit achievement of good glycaemic control and possibly have a specific effect on the risk of vascular comorbidities 5. Treatment satisfaction in patients with diabetes has been higher when therapy with a rapid-acting analogue is used instead of human insulin, perhaps due to differences in advised timing of injection 5.
Key Findings
- Insulin aspart and insulin lispro have similar pharmacokinetic and pharmacodynamic profiles 2, 6
- Insulin glulisine has a slightly faster onset of action compared to insulin lispro or insulin aspart, but this has not been translated into demonstrable clinical benefit 5
- Rapid-acting analogues provide comparable glycaemic control with a reduced risk of hypoglycaemia compared to human insulin 2, 5