From the Guidelines
Most Common Type of Prandial Insulin
The most common type of premeal insulin is rapid-acting insulin, which includes medications such as insulin lispro (Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra) 1.
Characteristics of Rapid-Acting Insulin
These insulins have a fast onset of action, typically within 15 minutes, and a peak effect between 1-3 hours, with a duration of action of approximately 4-6 hours.
Typical Dosing
Typical dosing ranges from 0.5-1.5 units per kilogram of body weight per meal, administered 15-30 minutes prior to eating. The recommended starting dose of mealtime insulin is 4 U per meal, 0.1 U/kg per meal, or 10% of the basal insulin dose per meal if the HbA1c level is less than 8% 1.
Preference for Rapid-Acting Insulin Analogues
Rapid-acting insulin analogues are preferred because of their quick onset of action, making them ideal for premeal insulin dosing to target postprandial glycemia 1.
Other Options
Premixed insulin products containing both basal and bolus insulin are another option for patients who may benefit from simpler dosing, but they require a relatively fixed meal schedule and carbohydrate content per meal 1. Concentrated insulin preparations, such as U-500 regular insulin, are available for patients requiring more than 200 units of insulin per day, but they may be more expensive than U-100 insulins 1.
From the Research
Types of Prandial Insulin
- Rapid-acting insulin analogues, such as insulin glulisine 2, 3, 4 and insulin lispro 5, are commonly used as prandial insulin.
- Regular human insulin (RHI) is also used as prandial insulin, but it has a slower onset of action compared to rapid-acting insulin analogues 2, 5, 3, 4.
Characteristics of Prandial Insulin
- Insulin glulisine has a rapid onset of action, with a peak effect at 1 hour and a shorter duration of action (approximately 4 hours) 4.
- Insulin lispro has a more rapid absorption and a shorter duration of action compared to human regular insulin 5.
- Insulin aspart is another rapid-acting insulin analogue that is used as prandial insulin, and it has been shown to be effective in controlling postprandial blood glucose levels in children with type 1 diabetes mellitus 6.
Comparison of Prandial Insulin
- Insulin glulisine has been shown to provide superior postprandial blood glucose control compared to regular human insulin (RHI) injected 30 min premeal 3, 4.
- Insulin lispro has been shown to provide greater postprandial glycaemic control than human regular insulin without increasing the risk of hypoglycaemia 5.
- Insulin aspart has been shown to be more effective than insulin glulisine in controlling 2- and 4-hour postprandial blood glucose excursions in prepubertal children with type 1 diabetes mellitus 6.