Side by side

1. 1.Binds the insulin receptor, triggering glucose uptake in muscle and fat.
2. 2.Suppresses liver glucose output between meals and overnight.
3. 3.Microprecipitates form at the injection site and dissolve slowly, giving a peakless profile.
4. 4.Stimulates glycogen and fat storage and inhibits fat breakdown.
5. 5.Shifts potassium into cells, which matters in overdose.

• Basal-bolus regimens in type 1 diabetes
• Type 2 diabetes when oral agents are insufficient
• Comparison with NPH insulin in treat-to-target trials
• Cardiovascular and cancer outcomes (ORIGIN)
• Diabetes in pregnancy

• HbA1c reduction similar to NPH insulin with fewer nocturnal hypoglycaemias
• Roughly 24-hour duration with a flat action profile
• Weight gain of about 1 to 3 kg
• Neutral cardiovascular outcomes in ORIGIN over six years
• Improved fasting glucose when titrated to target

• Hypoglycaemia, including severe episodes
• Weight gain
• Lipohypertrophy at injection sites
• Oedema
• Hypokalaemia
• Allergic and injection-site reactions

Research context only - prescription medicine. A common labelled starting basal dose is 0.1 to 0.2 units per kilogram once daily, titrated against fasting glucose every few days; trial protocols used fasting targets of roughly 5.0 to 6.5 mmol/L and ran from six months to over six years in ORIGIN. Insulin is a drug where the wrong number is dangerous, which is why a clinician sets it.

Research context only