Pre Mixed Insulin
There is premixed insulin mixing NPH insulin intermediate-acting insulin with rapid-insulin, where two different insulin types are combined in the same syringe. The insulin will start to work as quickly as the fastest-acting insulin in the combination. It will peak when each type of insulin typically peaks and lasts as long as the longest-acting insulin.
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Pre-Mix Insulin
There is less glucose (a type of sugar) in the blood when insulin is present. Beta cells in the pancreas make it and release it into the blood when the blood sugar level rises, like after a meal. Once glucose gets into the cells of the body, it can be used for energy or saved for later use.
There are two types of insulin in premixed insulin: basal and bolus. It comes in one shot. People with type 2 diabetes (T2D) can use premixed insulin as a treatment. Two types of insulin are mixed together to make premixed insulin. One type is short-acting (like regular insulin, R) or fast-acting (like insulin lispro or insulin aspart); the other type is intermediate-acting (like protamine insulin, NPH, N; insulin lispro protamine; insulin aspart protamine). It comes in either an insulin pen or a bottle already mixed and ready to use. In other words, you will only need one product to meet all of your insulin needs.
Basal insulin, also known as “background” insulin, keeps blood sugar levels steady all day, especially between meals and while you sleep. It can be long-acting, ultra-long-acting, or intermediate-acting.
Bolus insulin, also called “mealtime” or “prandial” insulin, can be either rapid-acting or short-acting. It helps control blood sugar spikes that happen after eating.
Insulin is not always the first thing that people with T2D try. Doctors may first suggest that you start with daily longer-acting insulin if you decide to start insulin. Some people also need to take insulin that works quickly before they eat. When this happens, premixed insulin can mix the two types to keep blood sugar levels steady all day.
Insulin Types:
Bolus insulins
| Type | Onset | Peak (When it is most effective) | Duration (How long it works) | Timing of injection (When should it be given) |
| Rapid acting analogues | ||||
| Apidra/Humalog/ NovoRapid | 10 – 15 min | 1 – 2 hours | 3 – 5 hours | Given with one or more meals per day. Should be injected 0 – 15 minutes before or after meals. |
| Fiasp | 4 min | 30 min – 1.5 hours | 3 – 5 hours | Fiasp is to be given two minutes before the start of your meal or within 20 minutes after. |
| Short-acting | ||||
| Humulin-R / Novolin ge Toronto | 30 min | 2 – 3 hours | 6.5 hours | Given with one or more meals per day. Should be injected 30 – 45 minutes before the start of the meal. |
Basal insulins
| Intermediate-acting | ||||
| Humulin-N / Novolin ge NPH | 1 – 3 hours | 5 – 8 hours | up to 18 hours | Often started once daily at bedtime. May be given once or twice daily. Not given at any time specific to meals. |
| Long-acting analogues | ||||
| Basaglar/Lantus U100 | 90 min | not applicable | up to 24 hours | Basaglar, Lantus U100, and Levemir are often given once daily at bedtime. |
| Levemir | 90 min | not applicable | 16 – 24 hours | Basaglar, Lantus U100, and Levemir are often given once daily at bedtime. |
| Toujeo U300 | 90 min | not applicable | > 30 hours | Toujeo U300 and Tresiba U100, U200 are given once daily at any time of day. |
| Tresiba U100, U200 | 90 min | not applicable | 42 hours | Toujeo U300 and Tresiba U100, U200 are given once daily at any time of day. |
Premixed insulins
| • Humulin 30/70 • Novolin ge 30/70, 40/60, 50/50 | The onset, peak, and duration of premixed insulins depend on the amounts of rapid-acting or short-acting insulin and intermediate-acting insulin. See above for more information based on the specific insulins contained in the premixed insulin. | Given with one or more meals per day. Should be injected 30 – 45 minutes before the start of the meal. |
| • Humalog Mix 25, Mix 50 / NovoMix 30 | Given with one or more meals per day. Should be injected 0 – 15 minutes before or after meals. |
The type of pre-mixed insulin and the exact ratio used will rely on the person’s lifestyle and goals for managing their diabetes. People whose daily plans and meal times are more stable often find pre-mixed insulin useful because it cuts down on the number of injections they need to do every day and makes their insulin regimen easier to follow. However, it might not be right for people whose blood sugar levels change a lot or who need very accurate and flexible insulin dosing.
Summary
Insulin that has already been mixed contains both fast-acting (mealtime) and intermediate-acting (basal) insulin in a single dose. This makes taking insulin every day easier and cuts down on the number of injections needed, which can make it more handy and less scary for some people.
People who use pre-mixed insulin don’t have to choose different doses of fast-acting and intermediate-acting insulin because the ratio is already set. This can help people who have trouble deciding how much insulin to take.
People whose lifestyles and meal plans are stable and regular may find pre-mixed insulin to be especially helpful. People who eat meals and snacks at the same times every day may find this a good choice.
Working with a doctor is important for any insulin therapy because they can help you find the best insulin regimen, product, and dosages for your personal needs and goals in managing your diabetes.