Endocrinology · USMLE Step 1 and Step 2

Insulin Types song

Insulin Types - Onset, Peak & Duration, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Insulin Types

Full song on YouTube ↗Spotify ↗

Key points in this song10

Lispro, aspart, and glulisine are rapid-acting insulins with onset in 15 minutes, peak at 1–2 hours, and duration of 3–5 hours; they are given immediately before meals.
Regular insulin is short-acting with onset 30–60 minutes, peak 2–4 hours, duration 6–8 hours; it is the only insulin given IV and is used in diabetic ketoacidosis and hyperkalemia management.
NPH (neutral protamine Hagedorn) is the only intermediate-acting insulin, with onset 2–4 hours, peak 4–10 hours, and duration up to 18 hours; it is associated with the Somogyi effect and Dawn phenomenon.
Glargine and detemir are long-acting insulins with no pronounced peak and duration of approximately 24 hours; glargine cannot be mixed with other insulins due to its acidic pH.
The Somogyi effect involves nocturnal hypoglycemia triggering rebound hyperglycemia in the morning, managed by decreasing the evening NPH dose.
The Dawn phenomenon involves early morning hyperglycemia due to physiologic GH and cortisol surges without preceding hypoglycemia, managed by increasing the evening NPH or basal insulin dose.
Insulin promotes glucose uptake via GLUT4 translocation in muscle and adipose tissue; it also stimulates glycogen synthesis and inhibits gluconeogenesis and lipolysis.
Hypoglycemia is the most common and dangerous side effect of insulin therapy; rapid-acting analogs carry lower postprandial hypoglycemia risk compared to regular insulin.
Insulin is the drug of choice for managing diabetes in pregnancy, as it does not cross the placenta; oral hypoglycemics are generally avoided.
In type 1 diabetes, basal-bolus regimens combine long-acting insulin for basal coverage with rapid-acting insulin at mealtimes to mimic physiologic insulin secretion.