Ginger Vieira was diagnosed with type 1 diabetes when she was 13, celiac disease a year later, and fibromyalgia in 2014. Ginger provides great insights into life with multiple chronic illnesses, including how to make the most of your life despite your health setbacks.
Sometimes it's easy to forget that the insulin we're prescribed is not the same as the insulin our bodies make (or don't make, for that matter). These manufactured insulins are great; they help us live longer, healthier lives with diabetes. But they are chemicals, and they are all very different.
In fact, some types of insulin work really well for some people and not so well for other people, just as one type of pain reliever might work well for one person but not as well for another person. Our bodies react differently to different chemicals.
That's why it's important to know your options and try different insulin regimens with your doctor's help if you're having trouble controlling your blood sugar levels.
Here are the basic insulin options available today:
Regular: Also known as "Humilin R" or "Novolin R," this is a "short-acting" insulin, also referred to as a “neutral” insulin. According to the American Diabetes Association, it usually reaches the bloodstream within 30 minutes after being injected, and it peaks in effectiveness anywhere from two to three hours after injection. It stays in your body for three to six hours. This older insulin isn't used as widely today because it's considered a "fast-acting" insulin, but isn't nearly as fast as the newer types of insulin. This insulin is often paired with NPH insulin.
NPH: This "intermediate-acting" insulin serves as a background or “basal” insulin, and is classified as an “isophane” insulin. The ADA says it "generally reaches the bloodstream about two to four hours after injection, peaks four to 12 hours later, and is effective for about 12 to 18 hours." This insulin helps control your blood sugar both between and during meals, but requires a more consistent eating schedule because its peaks can be fairly significant, dropping your blood sugar if you don't eat regularly.
Novolog, Humalog, or Apidra: These are "fast" or "rapid-acting" insulins taken before meals or to correct high blood sugars. “Aspart” insulins like these start working within 15 minutes and stay in the bloodstream for two to four hours. Often, an aspart insulin is paired with a background “basal” insulin. People with type 1 diabetes must pair a rapid-acting insulin with a background insulin, and the same is true for some people with type 2 diabetes. These rapid-acting insulins are appreciated for better prevention of post-meal high blood sugars compared to the older “short-acting” insulin, Regular.
Lantus or Levemir: These are "long-acting" insulins because they stay in the bloodstream for 18 to 24 hours and help to keep the blood sugar steady, in contrast to the fast-acting insulin used at meal times. Lantus is a “glargine” insulin while Levemir is in the “determir” classification. They are similar but not identical medications. Doses can either be split in half and taken 12 hours apart or taken all at once depending on your doctor's recommendations.
Toujeo: Approved by the Food and Drug Administration (FDA) in 2015, this “glargine” insulin falls in the same category as Lantus insulin, but it’s said to continue working in your system just over 24 hours. That may prevent higher blood sugars from occurring toward the end of the 24 hours since your last dose. Another difference between Toujeo and Lantus is that Toujeo usually does not cause a burning sensation at the injection site. Lantus sometimes may because it is very acidic, while Toujeo is not. Many patients have reported in online forums that Toujeo was very steady in its impact on their blood sugars for the first few weeks and then became oddly erratic and unpredictable.
Tresiba: One of the newest basal or “ultra-long-acting” insulins on the market, approved by the FDA in 2016, Tresiba stays in your system for up to 42 hours. It stands in its own classification as a “degludec” insulin. Despite how long it stays in the body, it’s important to still take your prescribed dose each day because Tresiba takes about 12 hours to become fully effective. Taking your dose every 24 hours like any other basal insulin actually does not mean your doses will overlap, but instead, just as the previous does is wearing off, the next dose is getting ready to do its job. This 12-hour window also means that when you first begin taking Tresiba, it can take a couple of days to see the full impact of your dose on your blood sugars—so be patient and work with your healthcare team! A perk to its 42-hour effectiveness is that you can miss or forget to take your dose on time and the consequences won’t be as severe as forgetting a Lantus or Levemir dose. With Tresiba, it’s advised that if you do forget to take your dose, you should take it as soon as you remember.
Afreeza: This insulin is in a category all its own as “inhaled” insulin. Afreeza is taken through a small inhaler device that fits in the palm of your hand. This inhaled insulin actually works quite differently in the body compared to injected insulin. Afreeza is dosed in cartridges containing four or eight units. While injected rapid-acting insulin takes 20 to 30 minutes to even begin working and is in your body for up to four hours, Afreeza’s inhaled insulin achieves its full effects on your blood sugar within 15 minutes and is out of your system within two hours. For people with type 1 diabetes, Afreeza must be used with a basal insulin or an insulin pump, as it cannot replace your background insulin needs. For most people, it cannot fully replace your meal insulin needs either because of the limited dosing options. For those with type 2 diabetes, Afreeza may be an effective replacement or supplement for your rapid-acting insulin needs.
If you're currently on an insulin regimen that doesn't seem to be keeping your blood sugars in the range you'd like them to be, talk to your doctor about fine-tuning your dosages or trying a new type of insulin. All insulin doses need to be adjusted and fine-tuned frequently throughout your life as your lifestyle, diet, body weight, stress levels, age, and activity levels change.