Type 2 Diabetes Insulin Medications

Reviewed by Daphne E. Smith-Marsh, PharmD, CDE

While injecting insulin is a treatment option normally associated with type 1 diabetes, some people with type 2 diabetes may need to use insulin. If you have type 2 diabetes and have trouble controlling your blood glucose levels with meal plan changes, exercise, and medications, then your healthcare provider may suggest insulin.

Insulin injections and inhalable insulin activate insulin receptors, increase glucose disposal, and decrease glucose production. Here are the types of insulin on the market:

Rapid-acting inhalables

Names: insulin human (Afrezza)

Onset (time it takes to reach bloodstream): 15 mins

Peak (most effective time frame): 30 mins-1.5 hrs

Duration (how long it works): 3-5 hrs

Benefits: inhaled

Possible side effects: sudden lung problems (acute bronchospasm)

Notes: taken with meals; contraindicated for patients with long-term lung disease such as asthma or chronic obstructive pulmonary disease, or COPD.

Rapid-acting analogs

Names: lispro (Humalog); aspart (Novolog); glulisine (Apidra)

Onset: 10-30 mins

Peak: 30 mins-1.5 hrs

Duration: 3-5 hrs

Benefits: nearly universal response.

Possible side effects: hypoglycemia; weight gain; redness, swelling, itching at injection site.

Notes: requires training; injectable.

Short-acting analogs

Name: human regular (Humilin R)

Onset: 30 mins-1 hr

Peak: 2-3 hrs

Duration: < 8 hrs.

Benefits: Nearly universal response.

Possible side effects: hypoglycemia, weight gain, redness, swelling, itching at injection site.

Notes: requires training, injectable.

lntermediate-acting analogs

Name: humanNPH (Humilin N)

Onset: 1.5-4 hrs

Peak: 4-12 hrs

Duration: < 24 hrs

Benefits: nearly universal response

Possible side effects: hypoglycemia, weight gain, redness, swelling itching at injection site.

Notes: requires training; injectable.

Basal Insulin long-acting analog

Names: glargine (Lantus, Basaglar); degludec (Tresiba); detemir (Levemir)

Onset: 0.8-4 hrs

Peak: minimal peak

Duration: <24 hrs-48 hrs

Benefits: nearly universal response

Possible side effects: hypoglycemia, weight gain, redness, swelling itching at injection site.

Notes: requires training; injectable.

Updated on: April 30, 2018

View Sources

1. American Diabetes Association. Approaches to glycemic treatment. In: Standards of Medical Care in Diabetes—2015. Diabetes Care. 2015;38(Suppl. 1):S41-S48.

2. American Diabetes Association. Oral medications: What are my options? American Diabetes Association Web site. http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/what-are-my-options.html. March 3, 2015. Accessed December 14, 2015.

3. Agency for Healthcare Research and Quality. Medicines for type 2 diabetes: A review of the research for adults. Effective Health Care Program Web site. http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=721&pageaction=displayproduct. June 30, 2011. Accessed December 14, 2015.

4. United States Food and Drug Administration. FDA drug safety communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain. United States Food and Drug Administration Web site. http://www.fda.gov/Drugs/DrugSafety/ucm459579.htm. August 28, 2015. Accessed December 14, 2015.

5. United States Food and Drug Administration. SGLT2 inhibitors: Drug safety communication - Labels to include warnings about too much acid in the blood and serious urinary tract infections. United States Food and Drug Administration Web site. http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm475553.htm. May 15, 2015. Accessed December 17, 2015.

6. Joslin Diabetes Center. Insulin A to Z: A guide on different types of insulin. Joslin Diabetes Center Web site. http://www.joslin.org/info/insulin_a_to_z_a_guide_on_different_types_of_insulin.html. Accessed December 14, 2015.

7. United States Food and Drug Administration. FDA approves Basaglar, the first “follow-on” insulin glargine product to treat diabetes. United States Food and Drug Administration Web site. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm477734.htm. December 16, 2015. Accessed December 17, 2015.

8. Sanofi-Aventis. Afrezza. Afrezza Web site. http://products.sanofi.us/afrezza/afrezza.pdf. Accessed December 17, 2015.

Sources:
1. Gallwitz, B and Bretzel, R G. How do we continue treatment in patients with type 2 diabetes when therapeutic goals are not reached with oral antidiabetes agents and lifestyle? Incretin versus insulin treatment. Diabetes Care August 2013, 36(no. Supplement 2):S180-S189.
2. Joslin Diabetes Center. Oral diabetes medications chart. Joslin diabetes Center Web site. http://www.joslin.org/info/oral_diabetes_medications_summary_chart.html. Accessed December 17, 2015.
3. Leontis, L M and Hess-Fischl, A. Introduction: Medication for type 2 diabetes. EndocrineWeb Web site. http://www.endocrineweb.com/conditions/type-2-diabetes/introduction-medications-type-2-diabetes. Accessed December 14, 2-15

Type 2 Diabetes Oral Medications