Insulin is the main medicine used to treat type 1 diabetes. Pramlintide may be used with it. Here are the basics about each of these medicines. Only common problems with them are listed.

Insulin

Insulin is injected 2 to 4 times during the day to replace the insulin that the pancreas cannot make. It is often given before meals, at snacks, and at bedtime. The amount of insulin must be balanced with the amount and type of food that is eaten and the amount of activity that is done. Making changes to a person's diet, exercise, or both without making changes to the insulin dose can cause blood glucose to drop too low or rise too high.

Insulin Injection Sites

Main Types

The main types of insulin are:

Type of insulin	Onset*	Peak time*	Duration*	Notes on use
Rapid-acting Novolog (aspart) Humalog (lispro) Apidra (glulisine) Afrezza (technosphere, inhaled)	10 to 30 minutes	0.5 to 3 hours	3 to 5 hours	Inject right away before a meal.
Regular or short-acting Novolin R Humulin R	0.5 to 1 hour	2 to 5 hours	5 to 8 hours
Intermediate-acting (NPH )	1 to 2 hours	3 to 12 hours	18 to 24 hours	This is often used with short-acting insulin.
Long-acting Insulin glargine (Lantus), Levemir (detemir)	1 hour	n/a	24 hours	This may not be mixed with other types of insulin.

*Each person has a unique response to insulin. The times listed are approximate.

Pre-Mixed

Premixed insulins are a mixture of short-acting and intermediate-acting. It is usually given twice per day with breakfast and dinner.

Type of insulin	Onset	Peak time	Duration
Humulin (50/50)	30 minutes	2 to 5 hours	18 to 24 hours
Humalog mix (75/25)	15 minutes	0.5 to 2.5 hours	16 to 20 hours
Humulin (70/30)	30 minutes	2 to 4 hours	14 to 24 hours
Novolin (70/30)	30 minutes	2 to 12 hours	up to 24 hours
Novolog Mix (70/30)	10-20 minutes	1 to 4 hours	up to 24 hours

Common Brands

The table below shows types of insulin and common brand names.

Type of insulin	Brand names
Rapid-acting	Humalog (insulin lispro) NovoLog (insulin aspart) Apidra (glulisine) *all require a prescription
Regular or short-acting	Humulin R (regular) Novolin R
Intermediate-acting	Humulin N (NPH) Novolin N (NPH)
Long-acting	Levemir (detemir) Lantus (insulin glargine)

Methods of Delivery

Here are methods to deliver insulin:

Syringe and vial —used to inject insulin into the fat layer between the skin and the muscles
Pen a one-time-use pen that contains a dose of insulin is used to inject insulin
Pump —uses a device the size of a pager that is worn on a belt or in a pocket to deliver a steady, measured dose of insulin through a tube that is inserted through the skin

Pramlintide

Common name: pramlintide

Amylin is a hormone made by the same beta cells that make insulin. Pramlintide is chemically related to amylin. It lowers blood glucose when used with insulin. It is given to people who cannot manage blood glucose with insulin alone.

Pramlintide is injected right before meals. It can lower appetite and result in weight loss. This can be helpful to those who need to reach a healthy weight and those who have gained weight as a side effect of using insulin.

References:

American Diabetes Association. Standards of medical care in diabetes-2019. Diabetes Care. 2019. Jan; 42 (Suppl 1):S1-193.

Diabetes mellitus type 1. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/diabetes-mellitus-type-1-34. Updated June 28, 2019. Accessed November 22, 2019.

Type 1 diabetes. American Diabetes Association website. Available at: https://www.diabetes.org/diabetes/type-1. Accessed November 22, 2019.

Last reviewed September 2019 by EBSCO Medical Review Board James P. Cornell, MD
Last Updated: 12/8/2020

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