8 Types of Injectable Diabetes Medications: Insulin and Non-Insulin Injections

The management of diabetes has made remarkable progress over the years, thanks to the incredible power of injectable medications. From the groundbreaking discovery of insulin to the advent of non-insulin injectables like Ozempic, these developments have introduced therapies that play a pivotal role in helping people with diabetes manage their condition.

Injectable diabetes medications can offer the benefits of convenience, improved blood glucose (sugar) control, and more. Depending on your treatment plan and goals, there are many options available to meet your needs. In this article, we explore what you should know about eight different types of injectable diabetes medications.

1. Synthetic human insulins

Fully synthetic human insulin was first created in a laboratory in 1975. But it wasn't used to treat people until the 1980s. This was a monumental moment in the history of diabetes treatment, because until then only animal-derived insulins were available as a treatment option.

Synthetic insulins can be either short-acting (called "regular" insulin) or intermediate-acting (NPH insulin). Both are available in over-the-counter (OTC) formulations.

Here are a few examples of synthetic human insulin brands:

• Novolin R (regular insulin)

• Humulin R (regular insulin)

• Novolin N (insulin NPH)

• Humulin N (insulin NPH)

Regular insulin is typically injected 30 to 60 minutes before a meal. And it lasts in the body for about 6 hours.

NPH insulin is typically injected 1 to 2 times daily. It takes about 2 to 4 hours to start working, but its effects last for 12 to 18 hours. It's considered a "basal" insulin because it provides blood glucose control over an extended period of time, even while you're not eating.

Synthetic human insulins are often more affordable than other types of insulin. However, they may be more likely to cause hypoglycemia (low blood glucose) and weight gain.

Synthetic human insulins are generally not the preferred choice for people with Type 1 diabetes, but they can be appropriate for many people with Type 2 diabetes

2. Insulin analogs

Insulin analogs are modified versions of human insulin that are made to act a certain way in the body. They were developed not long after the introduction of synthetic human insulin.

Rapid-acting insulin analogs

Rapid-acting insulin analogs are designed to kick in fast - within 15 minutes. Their effects last for 2 to 4 hours, which can help control blood glucose spikes after you eat. Because of this, you'll typically use this type of insulin right before meals. This type of insulin is also commonly used in insulin pumps. Examples of rapid-acting insulin analogs include:

• NovoLog (insulin aspart)

• Humalog (insulin lispro)

• Apidra (insulin glulisine)

Ultra-fast-acting insulin analogs are also available. They're rapid-acting insulins that contain additives that help you absorb the insulin faster - usually within a few minutes. Like rapid-acting insulins, they're injected at mealtimes and may also be used in insulin pumps. Examples include:

• Fiasp (insulin aspart)

• Lyumjev (insulin lispro)

Long-acting insulin analogs

Long-acting insulin analogs are basal insulins designed to last up to 24 hours, and some may last even longer. They're typically injected once daily and take about 2 hours to start working. But they provide glucose control throughout the day. Examples include:

• Levemir (insulin detemir)

• Lantus (insulin glargine)

• Basaglar (insulin glargine)

• Semglee (insulin glargine-yfgn)

• Rezvoglar (insulin glargine-aglr)

• Tresiba (insulin degludec)

Tresiba (and Toujeo, which is mentioned below) are sometimes called ultra-long-acting insulin analogs. They take longer to start working (about 6 hours), but their effects last for 36 hours or longer.

If you're prescribed a long-acting insulin, you may also be prescribed rapid-acting insulin to inject throughout the day. Some insulin analogs are available at a reduced price. But if cost is an issue, taking an insulin NPH along with short-acting or rapid-acting insulins may be an appropriate alternative.

3. Concentrated insulins

Most insulins are available in concentrations of 100 units/mL. For those who need large amounts of insulin, however, it's often beneficial to take a more concentrated form.

Concentrated insulins usually contain somewhere between 200 and 500 units/mL, depending on the product. These higher concentrations, which deliver more insulin in the same amount of liquid, make it easier for the body to absorb larger doses. Both synthetic human insulin and insulin analogs come in concentrated forms. Common brands include:

• Lyumjev U-200

• Humalog U-200

• Humulin R U-500

• Toujeo U-300 (insulin glargine)

• Tresiba U-200

The duration of action varies between different types of concentrated insulin. In some cases, a concentrated insulin's effects may last longer than other formulations. For example, Toujeo lasts up to 36 hours, while Lantus, the less concentrated version of the same medication, lasts up to 24 hours.

Concentrated insulins can be a good option for people who need high insulin doses. For older adults or anyone struggling with hypoglycemia who needs long-acting insulin, Toujeo and Tresiba can be good options. That's because they may be less likely to cause hypoglycemia than less-concentrated options.

4. Insulin mixes

Intermediate-acting insulins can be mixed into an injection with short- or rapid-acting insulins for convenience. Both synthetic human insulin and insulin analogs can come premixed in this way. Here are some examples:

• Novolin 70/30 (insulin NPH / insulin regular)

• Humulin 70/30 (insulin NPH / insulin regular)

• Humalog 75/25 (insulin lispro protamine / insulin lispro)

• Humalog 50/50 (insulin lispro protamine / insulin lispro)

• NovoLog 70/30 (insulin aspart protamine / insulin aspart)

Insulin mixtures usually start working 5 to 60 minutes after injection and last about 10 to 16 hours, depending on the product. These insulins are commonly injected twice daily - before breakfast and dinner. This helps provide blood glucose control around and between mealtimes, as well as overnight.

People who have a difficult time giving themselves multiple injections throughout the day may benefit from an insulin mix. However, insulin mixes can have an increased risk of hypoglycemia. And since they contain fixed amounts of each type of insulin, there can be less flexibility in adjusting doses.

5. GLP-1 agonists

Glucagon-like peptide 1 (GLP-1) agonists are a class of Type 2 diabetes medication that work by mimicking a gut hormone called GLP-1. This has several effects, including triggering insulin release after meals, decreasing glucose production in the liver, and slowing down how fast your stomach empties.

Together, these effects can help improve blood glucose levels with a low risk of hypoglycemia. GLP-1 agonists can also cause weight loss, making them a good option for people with diabetes who are trying to lose weight. Several also have proven benefits for people with heart disease. GLP-1 agonists can be used on their own or in combination with insulin or oral diabetes medications.

With the exception of Rybelsus (semaglutide), most GLP-1 agonists are available as injections with varying dosage schedules:

GLP-1 agonists can cause side effects such as nausea, vomiting, and diarrhea, especially when first starting treatment and after dose increases. While rare, they've been linked to pancreatitis and gallbladder problems. A rare form of thyroid cancer was seen in rats treated with these medications, but this hasn't been seen in humans.

6. Premixed insulin/GLP-1 agonists

For people with Type 2 diabetes, there are premixed injections that combine a long-acting insulin with a GLP-1 agonist. Examples include:

• Xultophy (insulin degludec / liraglutide)

• Soliqua (insulin glargine / lixisenatide)

If you have Type 2 diabetes and you're prescribed insulin, there's a good chance that a GLP-1 agonist will be added to your treatment, if you're not taking one already. In this case, premixed insulin/GLP-1 agonists can help reduce the number of injections you give yourself. However, they contain fixed doses of each medication. So you can't adjust the dose of one without changing the dose of the other.

Combining insulin with a GLP-1 agonist can increase the risk of hypoglycemia. Nausea, diarrhea, and headache are also common side effects.

7. GIP/GLP-1 agonists

Mounjaro (tirzepatide) is a newer once-weekly injection for Type 2 diabetes. It works like a GLP-1 agonist and can cause similar side effects. But it also mimics a second gut hormone, called glucose-dependent insulinotropic polypeptide (GIP). It's the first and only medication in a class called GIP/GLP-1 agonists.

Compared to GLP-1 agonists like Ozempic, Mounjaro works better at lowering hemoglobin A1C, which is your average blood glucose level over 3 months. It also results in greater weight loss and has a low risk of hypoglycemia. Mounjaro's side effects are similar to those of GLP-1 agonists.

Mounjaro can be a good option if you need more help lowering your A1C or losing weight. But while some of the GLP-1 agonists have known benefits for people with heart disease, these same benefits haven't been proven with Mounjaro yet.

8. Amylin analogs

Amylin analog medications are approved for managing both Type 1 and Type 2 diabetes. They have some of the same effects as GLP-1 agonists, but they work by mimicking a different hormone, called amylin. The pancreas normally releases amylin at the same time as insulin. It slows down stomach emptying and glucose production in the liver.

Amylin analogs can make you feel full, reducing your appetite. This can cause some weight loss. Nausea and vomiting, reduced appetite, and headache are common side effects.

Symlin (pramlintide) is currently the only amylin analog on the market. It can be an add-on option if you're injecting insulin before meals but still have high blood glucose levels after you eat. You'll typically inject Symlin before large meals.

Since amylin analogs are typically added to insulin therapy, there's a risk of hypoglycemia. Your healthcare provider may have you lower your mealtime insulin dose when starting Symlin to lower this risk.

Public link

Please use the above public link if you want to share this noodl on another website.