Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Insulin Type
  1. Rapid-acting analogue (clear)
  2. Short-acting (clear)
  3. Intermediate-acting (cloudy)
  4. Long - acting  analogues (clear)
  5. Premixed (cloudy)

Insulin Type:

Rapid-acting analogue (clear)

  • Humalog (insulin Lispro)
  • NovoRapid (insulin Aspart)
  • Apidra (insulin glulisine)

Onset
10 - 15 minutes

Peak

  • Humalog 1-2 h
  • NovoRapid 1- 1.5 h
  • Apidra 1-1.5 h

Duration

  • Humalog 3.5 - 4.75 h
  • Novorapid 3 -5 h
  • Apidra 3 - 5 h 

Considerations
Client should eat within 10–15 minutes of injection. 

Insulin Compatibility
Rapid-acting insulin can be mixed with N, NPH.  Mixture should be given within 15 minutes of a meal.

Insulin Type:

Short-acting analogue (clear)
Humulin R
Novolin ge Toronto

Onset
30  minutes

Peak
2 - 3 hours

Duration

6.5h

Considerations
Should be given 30 - 45 minutes prior to meals.

Insulin Type:

Intermediate-acting (cloudy)

  • Novolin ge NPH
  • Humulin N

Onset
1 – 3 hours

Peak
5 - 8 hours

Duration
Up to 18 hours

Considerations
Must be adequately re-suspended before injecting.

Insulin Compatibility
N or NPH & short-acting insulin may be mixed & used immediately or stored, refrigerated, for future use. Pre-filled syringes should be stored in the fridge, with needle tips up. They are stable for 1 month.

NPH or N cannot be mixed with Lentus or Levemir insulin.

Insulin Type:

Long - acting analogues (clear)

  • Lantus (insulin glargine)
  • Levemir (insulin detemir)

Onset
90 min

Peak
not applicable

Duration
Up to 24 h (glargine 24 h, determir 16-24 h)

Considerations

  • Lantus is available in vials, catridges & pre-filled disposable pens (SoloStar). 
  • Levemir is only available in catridges.
  • Both Lantus and Levemir are clear.
  • Clients must be alerted to the potential danger of confusing Lantus or Levamir with other clear insulin (rapid or short-acting insulins).  Use of pre-filled syringes are not recommended

Insulin Compatibility
Glargine and Levemir cannot be mixed with any other insulin or solution

Insulin Type:

Premixed (cloudy)

  • A single vial contains a fixed ratio of insulin (% rapid or short-acting to % of intermediate acting insulin)

Onset
See rapid or short

Peak
see intermediate

Considerations
Must be adequately re-suspended before injecting. If using a rapid-acting mixture, client must eat within 15 minutes of injecting. If using a short-acting mixture, client should eat within 30 minutes of injecting.

Insulin Compatibility
Should not be mixed with any other insulin