Table 2 provides a list of combination insulin products. Table 1 provides a comparison between insulins for onset of action and duration of action. Insulins have varying pharmacokinetics that allow for specific products from which to choose. Some guidelines encourage early use of insulin if HgbA1C remains poorly controlled on maximal-dose, single-drug therapy. Most patients with type 2 diabetes eventually require multidrug therapy or insulin. When used as monotherapy, oral hypoglycemic drugs generally lower glycated hemoglobin (HgbA1C) by only 0.5%-1.5%. These provide more flexibility in dosing, mimic endogenous production of insulin, and lower the incidence of nocturnal hypoglycemia. Newer formulations have since been developed, allowing insulin to be provided in more physiologically appropriate ways. In the 1950s, the neutral protamine hagedorn (NPH) and insulin zinc (lente) were introduced.
In the 1930s, protamine zinc insulin, the first long-acting preparation, was introduced. Since the discovery of insulin approximately 80 years ago, insulin therapy has undergone various changes in formulations with different pharmacokinetics. Insulin therapy also has a clear role in type 2 diabetes mellitus in patients with long-standing or poorly controlled disease. Instructions for Patients Receiving Insulin Insulin is the cornerstone of therapy in the management of type 1 diabetes. Intermittent Insulin Injectionsinsulin Overview