Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-33

Table 1. Properties of rapid-acting analogues and short-acting insulin (concentrated insulins not included) Rapid-acting analogues

Short-acting insulin (Regular and Toronto)

• Onset, in general, is 10-15 minutes after injection. Inject 10–20 min before eating to target postprandial spikes for lispro, aspart, glulisine (63). • Faster-acting insulin aspart (Fiasp ®) has a faster onset and had a significantly greater glucose- lowering effect within 90 min after dosing compared with insulin aspart (62). Inject 0-2 minutes before eating (52). Can be given up to 20 minutes after starting the meal (52). • Better prandial insulin profile and less postprandial hyperglycemia without the risk of hypoglycemia than short-acting insulin; less variable action. • Both lipro, aspart and glulisine are preferred over humulin regular insulin in CSII (1) • With CSII, glulisine is indicated to be changed every 48 h while lispro and aspart are to be changed, according to pump manufacturer’s recommendations (1). • Fiasp is not yet approved for use in CSII in Canada. • Duration: peak absorption within 1–2 h, lasts about 3- • 5 h, depending on the person and rapid analogue used. A between-meal snack is not usually required to prevent hypoglycemia. • Fiasp ®: peak 0.5-1.5 h, lasts 3-5h. • Duration of action is affected by dose size, injection site but, to a lesser degree, than human regular insulin.

• Absorption begins about 30 min after injection. Inject 30–45 min before eating • More postprandial hyperglycemia than rapid insulin. • Increase risk of postprandial hypoglycemia. • In Canada, Humulin R, but not Novolin Toronto, may be used in CSII, but rapid-acting analogues are preferred (1).

• Duration: peak absorption within 2–3 h; lasts about 6.5 h (or more). A between-meal snack may be required to prevent hypoglycemia. May contribute to overnight hypoglycemia (depending on the time and dose of insulin). • Lasts longer than rapid-acting insulin and, therefore, may contribute to basal insulin requirements. • This may be an advantage after lunch or dinner if intermediate-acting insulin is used once daily for basal replacement. • Duration of action is affected by dose size, injection site to a greater degree than rapid acting analogues. More episodes of low BG between meals and overnight than with rapid-acting insulin. More likely to need to “eat up to the insulin”.

• Fewer episodes of low BG between meals and overnight than with short-acting insulin. Less likely to need to “eat up to the insulin”. •

• Inject immediately when mixed with intermediate acting insulin.

• May premix with intermediate-acting insulin.

• Fiasp cannot be mixed with any other insulin (40).

• Cost: 1 box of 3 ml cartridges or a vial is more expensive than short-acting insulin and may not be equally covered by provincial or territorial health plans. •

Cost: 1 box of 3 ml cartridges or a vial is less expensive than rapid-acting insulin and is covered by more provincial or territorial health plans