Insulin is a hormone produced by beta cells in the pancreas. It has three important functions:1
- Allow glucose to pass into cells, where it is used for energy.
- Suppress excess production of sugar in the liver and kidneys.
- Suppress breakdown of fat for energy.
In the absence of insulin, blood sugar levels rise because muscle and fat cells aren't able to utilize glucose for energy. They signal the body that they're "hungry." The liver then releases glycogen, a form of stored glucose. This further increases the blood sugar level. When the blood sugar level rises above 180 mg/dl, glucose begins to spill into the urine. Large amounts of water are needed to dissolve the excess sugar, resulting in excessive thirst and urination.
Without glucose for energy, the body begins to metabolize protein and fat. Fat metabolism results in the production of ketones in the liver. Ketones are excreted in the urine along with sodium bicarbonate, which results in a decrease in the pH of the blood. This condition is called acidosis. To correct the acidosis, the body begins a deep, labored respiration, called Kussmaul's respiration. Left unchecked, a person in this situation will fall into a coma and die.
- Why do I have to inject insulin?
- Insulin must be injected because it is a protein. If it were taken orally, the body's digestive system would break it down, rendering it useless.
- Where should I store insulin?
- Unopened insulin vials or pens should be kept cool. Storing them in the refrigerator will help them last as long as possible. Never freeze insulin or expose it to extreme heat, however, as freezing can destroy it. Open insulin, whether vials or pens, should be kept at room temperature for a month or longer, depending on the brand of insulin.
- Where does insulin come from?
- Insulin used by people with diabetes can come from three sources: human (created via recombinant DNA methods), pork, or beef. Beef insulin has been discontinued in the US, and essentially all people who are newly diagnosed are placed on human insulin.
- What kinds of insulin are there?
- Insulin is classified according to how long the insulin works. There are several types of insulin, listed here in order of rate of action. Be aware that duration of insulin action varies by individual, activity level and location of injection.
Types and Duration of Action of Insulins Available in the United States
Type of Insulin
Supplier Appearance Begins Working Peak Activity All Gone Rapid Acting Afrezza (Regular insulin) MannKind Inhaled 12 minutes 35 - 45 minutes 2 hours Fiasp® (insulin aspart) Novo Nordisk Clear 16 - 20 minutes 90 - 120 minutes 5 - 6 hours NovoLog® / NovoRapid® (insulin aspart) Novo Nordisk Clear 15 - 20 minutes 60 - 180 minutes 3 - 5 hours Apidra® (insulin glulisine) Sanofi Clear 15 - 20 minutes 60 - 120 minutes 4 - 5 hours Humalog® (insulin lispro) Eli Lilly Clear 20 - 45 minutes 60 - 120 minutes 4 - 5 hours Admelog® (insulin lispro) Sanofi Clear 20 - 45 minutes 45 - 150 minutes 3.5 - 4.75 hours Short Acting Regular
(Humulin, Actrapid, Velosulin®)
Eli Lilly and Novo Nordisk Clear 30 minutes 2 - 4 hours 5 - 8 hours Intermediate Acting NPH
Eli Lilly and Novo Nordisk Cloudy 2 - 4 hours 6 - 8 hours 12 - 15 hours Human Regular U-500 Eli Lilly Clear 30 minutes 5 - 6 hours 18 - 20 hours Long Acting LANTUS® (insulin glargine U-100) Sanofi Clear 4 - 6 hours No pronounced peak Up to 24 hours (depends on injected dose) Toujeo® (insulin glargine U-300) Sanofi Clear 4 - 6 hours No pronounced peak Up to 24 hours (depends on injected dose) Basaglar® (insulin glargine U-100) Eli Lilly Clear 4 - 6 hours No pronounced peak Up to 24 hours (depends on injected dose) Levemir® (insulin detemir) Novo Nordisk Clear 1 - 2 hours 2 - 12 hours
(mild, varies by dose)
Up to 24 hours
(varies by dose)
Tresiba (insulin degluec U-100 or U-200) Novo Nordisk Clear ~ 1 hour ~ 12 hours 42+ hours Pre-Mixed (Action Varies) NPH/Regular
70/30 or 50/50 are common mixes
Eli Lilly and Novo Nordisk Cloudy 30 minutes Varies 18 - 24 hours NPL/Humalog
75/25 and 50/50
Eli Lilly Cloudy 10-15 minutes Varies 12 - 15 hours NovoLog Mix 70/30 Novo Nordisk Cloudy 10-15 minutes Varies 10 - 12 hours
Production of Insulin in the Body
The creation of insulin in the beta cells of the pancreas is a two step procedure. Beta cells first produce preproinsulin. Preproinsulin is cleaved to create proinsulin, which is further cleaved to produce equal amounts of insulin and C-peptide. Endogenous (self-produced) insulin has a half-life of about four minutes in the bloodstream. C-peptide lasts about 30 minutes. By measuring the amount of C-peptide in the blood, scientists can determine the amount of insulin produced by the pancreas.2
In people who do not have diabetes, the pancreas stores about 200 units of insulin. The average basal rate for adults is one to two units per hour. After meals, insulin secretion increases to four-to-six units per hour3
For More Information
- Clinical Data
- Insulin questions and insulin analog questions from the Diabetes Team
- Insulin Treatment In Type 1 Diabetes.
- Long-term Intervention Studies Using Insulin In Patients With Type 1 Diabetes.
- How Long Should Insulin Be Used Once a Vial Is Started?
- Avoiding Insulin Errors. Also available in PDF format.
- Insulin from Insulin-Dependent Diabetes in Children, Adolescents and Adults by Ragnar Hanas, M.D.
- Correction Factor: The 1800 Rule For Determining Your Correction Factor shows how far your blood sugar is likely to drop per unit of short-acting insulin
- The Protein Data Bank has a 3-D graphical view of an insulin molecule.
- Severe insulin resistance secondary to insulin antibodies: successful treatment with the immunosuppressant MMF.
- History of Insulin
- The Discovery of Insulin explores the work of Canadians Banting, Best, Colip and Macleod
- Understanding Insulin-Dependent Diabetes, 12th Edition by H. Peter Chase, MD. & David Maahs, MD, PhD, 2012.
- Management of Diabetes Mellitus: Perspectives of Care Across the Life Span edited by Debra Haire-Joshu, MSEd, MSN, PhD, RN., St. Louis, 1992, pp. 120-121.
Updated December 19, 2018
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