Insulin Types, Diabetes Medications, and DKA
Insulin orders are some of the most error-prone lines in a chart: look-alike brand names, five speeds of action, and doses that change with every glucose. This page sorts insulin types by how fast and how long they work, lists the other diabetes drugs by class with generic and brand names, shows the dose arithmetic clinicians use, and summarizes the current consensus on diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS).
Last reviewed October 8, 2026 against the 2024 ADA, EASD, JBDS, AACE, and DTS consensus report on hyperglycemic crises and the ADA Standards of Care in Diabetes, 2026. Guidelines change: check the current versions and your institution's protocols. This is a study and documentation reference, not dosing advice.
On this page: insulin types · reading insulin names · other diabetes drugs · dose arithmetic · DKA · HHS · in a note
Insulin types by speed
Insulins are grouped by onset, peak, and duration. Mealtime (bolus) insulins act fast and briefly; basal insulins act slowly and flatly to cover the hours between meals and overnight.
| Type | Generic (brand) | Onset | Peak | Duration | Typical use |
|---|---|---|---|---|---|
| Rapid acting | insulin lispro (Humalog, Admelog), insulin aspart (NovoLog), insulin glulisine (Apidra); faster versions: lispro-aabc (Lyumjev), faster aspart (Fiasp) | about 15 min | 1 to 2 h | 3 to 5 h | meals, corrections, insulin pumps |
| Inhaled | human insulin inhalation powder (Afrezza) | about 12 min | about 1 h | about 2 to 3 h | meals, adults |
| Short acting | regular human insulin (Humulin R, Novolin R) | 30 to 60 min | 2 to 3 h | 5 to 8 h | meals 30 minutes ahead; the insulin used in IV drips |
| Intermediate | NPH, isophane (Humulin N, Novolin N) | about 2 h | 4 to 12 h | 12 to 18 h | basal, usually twice daily; cloudy, rolled before use |
| Long acting | insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar); insulin detemir (Levemir, discontinued in the US) | 1 to 2 h | no pronounced peak | about 24 h (detemir 12 to 24 h) | basal, once daily |
| Ultra-long acting | insulin glargine U-300 (Toujeo), insulin degludec (Tresiba) | about 1 to 6 h | no pronounced peak | up to 36 h (Toujeo); more than 42 h (Tresiba) | basal, once daily |
| Once weekly | insulin icodec-abae (Awiqli, 700 units/mL) | flat after the first 2 to 4 weekly doses | 1 week | basal, adults with type 2 diabetes; FDA approved March 2026 | |
| Premixed | NPH/regular 70/30 (Humulin 70/30, Novolin 70/30); lispro mixes (Humalog Mix 75/25, 50/50); aspart mix (NovoLog Mix 70/30) | both components: a mealtime peak plus intermediate coverage | twice daily before meals | ||
Times are approximate and vary with the dose, the injection site, and the person. Larger doses act longer.
Reading insulin names
Two habits prevent most insulin mix-ups. First, brands ending in -log (Humalog, NovoLog) are rapid-acting analogs, while Humulin and Novolin are human insulins, regular (R), NPH (N), or premixed (70/30). Second, read the concentration: standard insulin is U-100 (100 units per mL), but U-200 (Humalog U-200, Tresiba U-200), U-300 (Toujeo), U-500 (Humulin R U-500), and U-700 (Awiqli) pens hold the same dose in less volume. The U in U-100 is part of the product name; in a dose, always write units.
Other diabetes medications by class
Generic names follow stems that tell you the class: -gliptin is a DPP-4 inhibitor, -gliflozin an SGLT2 inhibitor, -glutide a GLP-1 receptor agonist, -glitazone a thiazolidinedione, -glinide a meglitinide, and gli- or gly- at the start usually a sulfonylurea.
| Class | Generic (brand) | How it lowers glucose | Worth knowing |
|---|---|---|---|
| Biguanide | metformin (Glucophage) | less glucose released by the liver | first line for most type 2 diabetes; avoided when eGFR is below 30 |
| Sulfonylurea | glipizide (Glucotrol), glimepiride (Amaryl), glyburide (DiaBeta, Glynase) | more insulin released | can cause hypoglycemia |
| Meglitinide | repaglinide, nateglinide (Starlix) | short burst of insulin release | taken with meals |
| DPP-4 inhibitor | sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina) | keeps incretin hormones active longer | weight neutral, low hypoglycemia risk on its own |
| SGLT2 inhibitor | empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), ertugliflozin (Steglatro), bexagliflozin (Brenzavvy) | glucose lost in the urine | also used for heart failure and kidney disease; can cause DKA with near-normal glucose |
| GLP-1 receptor agonist | semaglutide (Ozempic; oral Rybelsus; Wegovy for weight), liraglutide (Victoza; Saxenda for weight), dulaglutide (Trulicity), exenatide (Byetta, Bydureon BCise) | glucose-dependent insulin release, slower stomach emptying, less appetite | mostly weekly or daily injections; nausea is common |
| GIP and GLP-1 receptor agonist | tirzepatide (Mounjaro; Zepbound for weight) | acts on both incretin receptors | weekly injection |
| Thiazolidinedione | pioglitazone (Actos) | makes tissues more insulin sensitive | fluid retention; avoided in symptomatic heart failure |
| Alpha-glucosidase inhibitor | acarbose (Precose), miglitol (Glyset) | slows carbohydrate absorption | taken with the first bite of a meal |
| Amylin analog | pramlintide (Symlin) | slows stomach emptying, lowers glucagon | mealtime injection alongside insulin |
Combination products pair two of these, such as sitagliptin and metformin (Janumet), empagliflozin and linagliptin (Glyxambi), or a basal insulin with a GLP-1 receptor agonist in one pen. Brand names in this table are the original or best-known US brands; some older brands are no longer marketed, and most prescriptions are filled with generics.
Insulin dose arithmetic
These estimates are where a regimen starts, not where it ends: doses are adjusted to glucose readings, food intake, kidney function, and age, usually by an order set or protocol.
| Estimate | Rule of thumb | Worked example (80 kg, total 40 units/day) |
|---|---|---|
| Total daily dose (TDD) | 0.3 to 0.6 units/kg/day when starting from weight, lower for older adults, reduced kidney function, or poor intake | 0.5 × 80 = 40 units/day |
| Basal and bolus split | 40 to 60% as basal insulin, the rest divided across three meals | glargine 20 units daily; about 6 to 7 units of rapid-acting insulin with each meal |
| Correction (sensitivity) factor | 1800 ÷ TDD for rapid-acting insulin (1500 ÷ TDD for regular): mg/dL lowered by 1 unit | 1800 ÷ 40 = 45; glucose 240, target 150: (240 − 150) ÷ 45 = 2 units |
| Insulin-to-carbohydrate ratio | 500 ÷ TDD: grams of carbohydrate covered by 1 unit | 500 ÷ 40 = about 12 g per unit; a 60 g meal needs 5 units |
The weight-based range and the basal share come from the 2024 consensus guidance for moving patients off an insulin drip. The 1800, 1500, and 500 rules are long-standing teaching rules of thumb, not validated protocols. The ADA Standards of Care discourage relying on a sliding scale alone in the hospital; a scheduled basal insulin, with mealtime and correction doses when the patient eats, is the usual approach.
DKA: what the 2024 consensus recommends
Diabetic ketoacidosis needs all three of these, the D, K, and A criteria: glucose of 200 mg/dL or more or known diabetes (so euglycemic DKA counts); ketosis, with beta-hydroxybutyrate of 3.0 mmol/L or more or urine ketones of 2+ or more; and acidosis, with pH below 7.3, bicarbonate below 18 mmol/L, or both. The anion gap was dropped from the criteria.
| Step | Consensus recommendation |
|---|---|
| Fluids | isotonic saline or a balanced crystalloid such as lactated Ringer's, 500 to 1,000 mL/hr for the first 2 to 4 hours if the heart and kidneys allow; smaller boluses of about 250 mL for older adults and people with heart or kidney failure; balanced crystalloids are suggested where available |
| Potassium | below 3.5 mmol/L at presentation: replace at about 10 mmol/hr and hold insulin until potassium is above 3.5; once below 5.0, replace to keep it between 4 and 5 |
| Insulin, severe DKA | IV regular insulin at a fixed 0.1 units/kg/hr, or a nurse-driven variable-rate protocol; a 0.1 units/kg IV or intramuscular bolus first if venous access will be delayed |
| Insulin, mild or uncomplicated moderate DKA | subcutaneous rapid-acting insulin every 1 to 2 hours with close nursing supervision, often outside the ICU; the weight-based doses come from the local protocol; not for severe or complicated DKA, or for HHS |
| Dextrose | once glucose falls below 250 mg/dL, add 5 to 10% dextrose and lower the drip to 0.05 units/kg/hr, keeping glucose near 200 mg/dL until the ketoacidosis resolves |
| Bicarbonate and phosphate | not routine: bicarbonate only for pH below 7.0; phosphate only when very low, especially with weakness or cardiac or respiratory compromise |
| Monitoring | capillary glucose every 1 to 2 hours; electrolytes, phosphate, creatinine, beta-hydroxybutyrate, and venous pH every 4 hours until resolution |
| Resolution | beta-hydroxybutyrate below 0.6 mmol/L, and venous pH of 7.3 or higher or bicarbonate of 18 mmol/L or higher |
| Transition | start subcutaneous insulin and overlap it with the drip for 1 to 2 hours; dose from the home regimen, in-hospital needs, or 0.3 to 0.6 units/kg/day; patients already on basal insulin can usually continue it during the drip |
SGLT2 inhibitors deserve their own warning: they can cause DKA with a glucose below 200 mg/dL, known as euglycemic DKA, which is why a history of diabetes now satisfies the D criterion.
HHS: fluids first, then low-dose insulin
The 2024 report set the first formal HHS criteria: glucose of 600 mg/dL or more; effective serum osmolality above 300 mOsm/kg (2 × sodium + glucose ÷ 18) or total osmolality above 320; and no significant ketonemia or acidosis (beta-hydroxybutyrate below 3.0 mmol/L, pH of 7.3 or higher). Patients who meet both sets of criteria have mixed DKA and HHS.
Fluid replacement is the cornerstone, and fluids alone lower glucose substantially. The consensus then starts a fixed-rate IV insulin infusion at 0.05 units/kg/hr, half the DKA rate; with significant ketonemia or acidosis the patient is treated as DKA at 0.1 units/kg/hr. The UK Joint British Diabetes Societies take a more cautious line in their 2023 HHS guideline: fluids alone first, with the 0.05 units/kg/hr infusion started only once glucose stops falling, unless ketones are above 3.0 mmol/L.
The danger in HHS is correcting too fast. Glucose should fall no faster than 90 to 120 mg/dL per hour, sodium by no more than 10 mmol/L in 24 hours, and osmolality by no more than 3 to 8 mOsm/kg per hour. Half-normal saline is reserved for osmolality that is not falling despite a positive fluid balance and insulin. HHS is considered resolved when osmolality is below 300 mOsm/kg, urine output exceeds 0.5 mL/kg/hr, mental status has improved, and glucose is below 250 mg/dL.
How it reads in a note
| As written | Read as |
|---|---|
| T1DM c/b DKA (BHB 6.1, pH 7.14, HCO3 9) 2/2 missed insulin | type 1 diabetes complicated by DKA, secondary to missed insulin doses |
| insulin gtt 0.1 units/kg/hr, LR 1 L/hr x 2 h, K 3.9: KCl 20 mEq/L | fixed-rate insulin drip, lactated Ringer's at 1 liter an hour for 2 hours, potassium added to the fluid |
| BG < 250: add D5, gtt to 0.05 units/kg/hr | dextrose added and the drip halved once glucose fell below 250 |
| DKA resolved (BHB 0.4, pH 7.34); glargine 20 units SUBQ, gtt off in 2 h | resolution criteria met; basal insulin given with a two-hour overlap |
Practice typing it
Insulin names, unit doses, and drip rates are dense typing: mixed case, digits, slashes, and look-alike brands. The endocrinology and ICU packs put this vocabulary into the stream.
Endocrinology notes with dosing ICU drips and titrations
Preset links open the trainer with those settings already applied; you can change them afterward.
For the abbreviations in these orders, see medication abbreviations; for the specialty vocabulary, see endocrinology typing practice.
Common questions
What is the difference between Humalog and Humulin?
Humalog is insulin lispro, a rapid-acting analog given at meals. Humulin is human insulin: Humulin R is short-acting regular insulin and Humulin N is intermediate-acting NPH. The same trap exists between NovoLog (insulin aspart) and Novolin (human insulin). Names ending in -log are the rapid-acting analogs.
Which insulins are long acting?
Glargine (Lantus, Basaglar, Semglee, Rezvoglar, and the more concentrated Toujeo), degludec (Tresiba), and detemir (Levemir, discontinued in the US) last about a day or longer with no pronounced peak. Insulin icodec (Awiqli) lasts a week and is approved in the US for adults with type 2 diabetes.
How do you calculate a correction dose of insulin?
A common rule of thumb divides 1800 by the total daily dose to estimate how many mg/dL one unit of rapid-acting insulin lowers glucose. With a total daily dose of 40 units, one unit lowers glucose about 45 mg/dL, so a glucose of 240 with a target of 150 needs about 2 units. Real correction scales come from the prescriber or the hospital order set.
Is insulin used in HHS, or just fluids?
Fluids come first and lower glucose on their own. The 2024 consensus report then starts a fixed-rate insulin infusion at 0.05 units/kg/hr, half the DKA rate, and treats mixed DKA and HHS at the DKA rate. The 2023 guideline of the UK Joint British Diabetes Societies instead gives fluids alone first and starts insulin only once glucose stops falling, unless ketones are above 3.0 mmol/L.
When does a DKA insulin drip stop?
The 2024 consensus defines resolution as beta-hydroxybutyrate below 0.6 mmol/L with a venous pH of 7.3 or higher or bicarbonate of 18 mmol/L or higher. Subcutaneous insulin is then given, and the drip runs for another 1 to 2 hours so the two overlap.
Sources
- Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycemic Crises in Adults With Diabetes: A Consensus Report. Diabetes Care. 2024;47(8):1257-1275. ADA, EASD, JBDS, AACE, and DTS.
- American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes, 2026. Diabetes Care. 2026;49(Suppl 1).
- Donner T, Sarkar S. Insulin: Pharmacology, Therapeutic Regimens and Principles of Intensive Insulin Therapy. Endotext, updated February 2023 (insulin time-action table).
- Novo Nordisk. FDA approval of Awiqli (insulin icodec-abae), March 26, 2026.
- Mustafa OG, Haq M, Dashora U, Castro E, Dhatariya KK. Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group. Diabet Med. 2023;40(3):e15005.