Types of Insulin and how to start insulin in type 2 diabetics 1-Rapid Acting e.g,Insulin Lispro ( Humalog), Insulin Aspart (Novalog, Novorapid) 2-Short Acting Insulin Regular (Humulin R or Novolin ) 3-Intermediate Acting NPH (Humulin N, Insuget, Insulatard ) 4-Long Acting Insulin Glargine (Lantus), Detemir ( Levemir ) 5-Pre-Mixed NPH/Regular (70/30 or 50/50) Lispro protamine/ Lispro (70/30) e.g, NovoMix 30 Flexpen Aspart protamine/ Aspart (e.g, Novolog mix 70/30) Type of Insulin Rapid-acting Short-acting Brand Name Generic Name Duration Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours Humalog Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours Humulin R Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours 1 to 3 hours 8 hours 12 to 16 hours 1 hour Peakless 20 to 26 hours 30 to 60 minutes Varies 10 to 16 hours Humulin N NPH (N) Novolin N Long-acting Peak NovoLog Novolin R Intermediate-acting Onset Levemir Insulin detemir Lantus Insulin glargine Pre-mixed NPH Humulin 70/30 (intermediate-acting) and regular (shortNovolin 70/30 acting) Humulin 50/50 70% NPH and 30% regular 30 to 60 minutes Varies 10 to 16 hours Pre-mixed insulin Humalog Mix lispro protamine 75/25 suspension (intermediate-acting) Humalog Mix and insulin lispro 50/50 (rapid-acting 75% insulin lispro 10 to 15 minutes protamine and 25% insulin lispro Varies 10 to 16 hours 50% insulin lispro 10 to 15 minutes protamine and 50% insulin lispro Varies 10 to 16 hours Pre-mixed insulin NovoLog Mix aspart protamine 70/30 suspension (intermediate-acting) and insulin aspart (rapid-acting) 70% insulin aspart protamine and 30% insulin aspart Varies 10 to 16 hours 50% NPH and 50% regular 5 to 15 minutes Starting Insulin in type 2 diabetes Once daily Start with 10 units of Lantus once daily (or Levemir twice daily) irrespective of meal but at a regular time.Increase by 2 units every 3rd day depending upon fasting glucose. If price is the issue,then also start with NPH (Humulin N, Insulatard) at night with 10 units and increment of 2 unit every 3rd day.Sightly ncreased risk of hypoglycaemia and effective only for 10-12 hours. Twice daily Premixed insulins are twice daily (pre-breakfast and pre-evening meal),assuming that patient eats three times a day.Nocturnal hypoglycaemia and poor glycaemic control are often the issues. Basal-Bolus Regime The best evidence based combination is basal+bolus regime with basal analogue at night and bolus (Humalog or Humulin R) at meal times if HbA1c not controlled only on basal dosage only.Total dosage would be half at night and rest of the half divided in 3 times.E.g,if a patient takes 30 units,then 15 units of Lantus and rest of 15 units as 5 units of humalog tds.