Type 2 diabetes injectable medications are often needed when blood glucose levels remain above target despite taking several oral diabetes medications. The reason for this change is to maintain the blood glucose levels within a healthy range.
Injectable medications such as exenatide (Byetta®) or liraglutide (Victoza®) mimic a special hormone our body makes. This is the GLP-1 incretin hormone, which works in the body to do the following:
- increase release of insulin after a meal
- lower the amount of glucose made by the body
- slow stomach emptying, resulting in a lower rise of blood glucose after a meal
- work centrally in the brain to reduce appetite, leading to weight loss (people feel full faster, so they feel satiated faster and stop eating)
Exenatide (Byetta) –injected twice daily (before breakfast and evening meal), can be combined with some oral diabetes medications or Lantus insulin
Liraglutide (Victoza) – injected once daily, can be combined with some oral diabetes medications
Insulin – a hormone made by our pancreas helps to move glucose from the blood stream into the cells. Glucose is the body’s main fuel. It comes from the digestion of carbohydrates in foods, and gives us energy. When a person with diabetes does not make enough insulin, despite taking oral diabetes medications, it can be supplemented by insulin injection.
Types of insulin for people with diabetes
(speed at which the insulin reaches the bloodstream and starts working)
(time when the insulin is at maximum strength and is most effective at lowering blood glucose)
(length of time over which the insulin lowers blood glucose )
|10 – 15 minutes||1 – 1.5 hours||3 – 5 hours|
|Short-acting(clear insulin)||Humulin-RNovilin ge Toronto||30 minutes||2 – 3 hours||6.5 hours|
|Humulin –NNovolin ge NPH||1 – 3 hours||5 – 8 hours||Up to 18 hours|
|90 minutes||Minimal peak||Up to 24 hours|
How do different types of insulin help people with diabetes?
Rapid-acting insulin and short-acting insulin are also called meal (or bolus) insulin:
Due to their fast onset and short duration of action, they are usually given before meals to cover the rise of blood glucose from eating. Either rapid-acting or short-acting insulin can be chosen for this purpose.
- Rapid-acting insulin is best given approximately 10-15 minutes of eating
- Short-acting insulin is best given approximately 30 minutes before eating
Mealtime insulin is often combined with either Immediate-acting or Long-acting insulin to provide the around-the-clock coverage the body requires.
Immediate-acting or long-acting insulin are also called background (or basal) insulin:
- Due to their slower onset and longer duration of action, these are usually given once or twice daily to cover the rise of blood glucose levels when the meal insulin stops working. Either Intermediate-acting or Long –acting insulin can be used.
- In some individuals, while taking their oral diabetes medications, their fasting blood glucose levels remain above target. In such a case, adding background insulin once daily has been found helpful.
A word about pre-mixed insulin:
In this group, rapid or short-acting insulin is combined with Intermediate-acting insulin, ready mixed in an insulin vial or cartridge. This combination offers the convenience of fewer injections per day (usually twice daily) and is suitable for individuals who follow a regular meal schedule with consistent carbohydrate for each meal. Combination of the 2 different types of insulin at various ratios offers more choices to match the lifestyle and eating habits of the individual.
The following pre-mixed insulin products combine short-acting insulin with intermediate-acting insulin in various ratios:
- Humulin 30/70, Novlin ge 30/70: each 10 units provides 3 units of short-acting insulin and 7 units of intermediate-acting insulin
- Novlin ge 40/60: each 10 units provides 4 units of short-acting insulin and 6 units of intermediate-acting insulin
- Novolin ge 50/50: each 10 units provides 5 units of short-acting insulin and 5 units of intermediate-acting insulin
The following pre-mixed insulin products combine rapid-acting insulin with intermediate-acting insulin:
- Humalog Mix25: each 10 units provides 2.5 units of rapid-acting insulin and 7.5 units of Intermediate-acting insulin
- Humalog Mix50: each 10 units provides 5 units of rapid-acting insulin and 5 units of intermediate-acting insulin
- NovoMix 30: each 10 units provides 3 units of rapid-acting insulin and 7 units of intermediate-acting insulin
What can you do to make sure your diabetes medication is working?
If you are starting injectable medication, it is important to discuss with the health care team how often your blood glucose levels should be monitored.
Keeping a log of the blood glucose readings and sharing them with health care providers will enable the appropriate medication and the correct dose to be chosen.