Basal Insulins (Intermediate and Long-Acting)

Intermediate- and long-acting (basal) insulins are recommended for patients with type 1, type 2, or gestational diabetes. They may also be used in other types of diabetes (i.e. steroid-induced).

• Persons with type 1 diabetes generally use intermediate-acting insulin or long-acting insulin in conjunction with regular or rapid acting insulin.
• Persons with type 2 diabetes may use intermediate or long-acting insulins in conjunction with regular or rapid acting insulins or with oral medications.

Injections given under the skin. Not suitable for insulin pumps.

These medications can be injected with a traditional syringe and needle, or with a disposable pen that has been prefilled with insulin. Most patients tend to prefer pens though while convenient, they can be more expensive.

Long-acting insulins are marketed as different brands. The common ones are:

• Glargine (marketed as Lantus, Basaglar, and the Solo Star Pen)
• Detemir (marketed as Levemirand the FlexPen)
• Degludec (marketed as Tresiba and the FlexTouch Pen)

• NPH is usually injected twice a day. It begins working 1-3 hours after injection, and is most effective between 4-10 hours of injection. It generally keeps working for 10-16 hours.
• Detemir can be used once or twice a day. It begins working a few hours after injection and generally keeps working for anywhere from 20-24 hours.
• Glargine is usually injected once a day. It begins working a few hours after injection, and remains highly effective until it wears off 20-24 hours later.
• Degludecis usually injected once a day. It begins working a few hours after injection and can remain effective longer than 24 hours.

• When NPH and regular insulin are injected together, patients should first draw up the clear regular insulin, followed by the cloudy NPH insulin. Always remember: clear first, cloudy second!
• Never mix Detemir, Glargine, or Degludec with other insulins.

• Pregnant women are sometimes prescribed NPH which is the preferred basal insulin during pregnancy.
• Patients with kidney or liver problems can take these insulins under careful supervision by their doctors. Reduced doses may be needed.
• Intermediate- and long-acting insulins can cause low blood glucose if they are absorbed too quickly. Insulin that is kept warm, rather than at room temperature, may also be absorbed too quickly by the body. Massaging the site of injection can also speed the absorption of insulin, as can exercise.
• May require dose reductions if you are not eating or are eating less than normal – always talk to your doctor about this.