Insulin Options at a Glance
Insulin & Examples Typical Route Onset → Peak → Duration Use Case in Infusion Center Pros / Cons
Rapid-acting analogs
Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
Preferred 		Subcutaneous ~10–20 min → 1–2 h → 3–5 h Quick correction when you can wait ~60–90 min and recheck BG before infusion. Fast onset   Shorter tail → less late hypo; Peak ~1–2 h → plan recheck
Regular insulin
Humulin R, Novolin R 		Subcutaneous 30–60 min → 2–4 h → 6–8 h Not ideal for quick pre-infusion turnaround. Slower onset   Longer duration → higher late-hypo risk post-discharge
Regular insulin (IV)
IV bolus or short infusion 		Intravenous ~Immediate → N/A → minutes When very rapid correction is essential and monitoring protocols are feasible. Fastest effect with titratability; requires close monitoring & protocol
Suggested “Correction-Only” Workflow
  1. Screen for red flags: DKA/HHS symptoms, positive ketones, dehydration, altered mentation. If present → escalate/ED.
  2. If stable and proceeding in center, give rapid-acting analog SC:
    Typical correction dose: 0.05–0.1 units/kg SC (≈4–10 units) based on sensitivity, renal function, age, and steroid use.
    Use lower end (0.03–0.05 u/kg) in frail/renal impairment; consider higher end for high-dose steroids or marked resistance.
  3. Recheck BG in 60–90 minutes. Ensure clinic safety threshold (e.g., <300 mg/dL) before infusion.
  4. If response is inadequate, consider a small repeat dose (e.g., 2–4 u) or proceed with clinician approval; avoid insulin stacking without timed rechecks.
  5. Provide snack/juice PRN if BG is falling quickly; give discharge precautions about delayed hypoglycemia.

Consider causes (missed basal insulin, infection, steroids). If on chronic basal insulin, do not omit the usual basal dose.

Key Takeaways
  • Preferred: SubQ rapid-acting analog (lispro/aspart/glulisine) for pre-infusion correction.
  • Avoid SubQ regular insulin when timing is tight.
  • IV regular insulin is fastest but needs monitoring + protocol.
  • Always pair with a recheck plan (60–90 min) and clinic thresholds.

For trained healthcare professionals; use with institutional policies and clinical judgment.