Up front I will post a disclaimer. I worked for Novo Nordisk in Canada for 4 1/2 years. I loved working for the company. I know the clinical studies they provided inside out and backwards. In researching this article I have done my best to be impartial to the information I offer. The pic is a result of the fact Kurtis & I use Novo Nordisk products. I have no other product to showcase in my portfolio. I am presenting this blog as a health care professional & peep & Mom of a peep living with diabetes, not as a sales person.
Here is the ‘low down’ in a nutshell based on current clinical evidence AND practical information for intermediate & long acting insulin…
NPH (Novolin NPH, Humulin N): first created in 1950 by Novo Nordisk – NPH is an intermediate acting insulin. The onset is 1-2 hours, peak (meaning the insulin is at its highest potency) is in 4-12 hour & it lasts 18 − 24 hours. Upon injection it can cover about 1/2 a day or night. It is a highly variable insulin, it can add to the challenges of achieving goals of long-term metabolic control. To equalize the distribution of crystals within the solution of NPH , it needs to be rotated an excessive number of time. This in itself does not guarantee accurate distribution.
Glargine (Lantus): It is a long acting insulin. I can not find when it was first created or by who, so I won’t show what I know from that perspective. It’s onset is 1 − 1 1/2 hours. On product monograph it claims to have ‘no peak’. Duration of action is 18 − 24 hours. Once injected it cover about 1 full day, 24 hours. It is an acidic solution so upon injection there may be burning & stinging. There are studies being conducted with regards to concerns of carcinogenicity. Results will not be published for a few more years.
Detemir (Levemir): It is a long acting insulin. Unlike any other insulin which is bound to fat, it binds to albumin. When bound to albumin, it is inactive. It is unclear when it was created. At any given time 98% of Levemir is considered inactive because it is bound to albumin providing more predictability. It’s onset is 1 − 2 hours. It’s peak is 6 − 8 hours. Duration of action is up to 24 hours.depending on dose. It is shown that smaller amounts injected offer smaller duration of action. Many people living with T1 need 2 injections per day.
If you look up the impact of NPH vs. long-term analogue it may seem that is a better choice. As a sales rep & practitioner, I have seen this. Clinically, it doesn’t the peeps that do the studies aren’t ready to say so yet.
So regardless of what insulin you are on, here are some tips & tricks to help make the insulin you are taking work better:
1. Label each insulin bottle upon opening.
2. Discard that insulin, whether it is finished or not, 28 days after first date of taking out of the fridge.
3. Keep insulin at room temperature. If it freezes or gets too warm (>28C) THROW IT OUT!!
4. Know your insulin.
5. Know your body.
6. Know how to inject properly. (any needle tip more than 8mm should be changed under your diabetes team watch!!)
7. Don’t switch brands without consulting with your diabetes team.
8. Do not mix Lantus or Levemir with any other insulin!
9. Levemir & Lantus are CLEAR!! Read the label before injecting!!
10. Keep to the same site to rotate your sites. HUH?!? you say….I tell my patients…Long acting legs, short acting stomach. BUT, rotate. It prevents lipohypertrophy (fat deposits) but guarantees more predictability with insulin release.
11. Higher doses of insulin reduce the blood sugar levels more than lower doses.
12. If you have exercised be conscience of where you have injected or are going to inject. Areas that have been exercised & then injected with insulin offer more unpredictability.
13. Do not apply heat (such as bath, shower, heat pack or massage) to the area injected. Heat speeds the insulin along.
14. Keep hydrated. Insulin is not absorbed as readily when there is not as much fluid available because blood isn’t flowing as easily as it should.
I also urge you to Google the brands. Ask your health care team. Read, read, read. That’s how I started on Humalog!!
Insulin is a complicated topic. It’s variables are abounding. But with common sense, getting to know you or your child well & being informed to the choices available as well as asking for the change that may be needed, this enables you & your loved one to live with Diabetes Beyond Borders.