Effective Onset, Peak & Action Times

We love and respect our diabetes community. If someone reaches out and asks questions, we listen and investigate. Over the past few months, several of you emailed us, suggesting a needed change to the effective onset, peak and duration times for the very rapid and rapid acting analogs on our PocketCards.

Coach Beverly sprang into action and revisited the package inserts from the various insulin manufacturers in an attempt to solve the timing mystery and set things right.

After taking a closer look at the information, she realized where the confusion came in.
The effectiveness of insulin is not just based on pharmacokinetics, there is also a dose dependent response curve. In studies cited in the package inserts, there are tables with insulin timing based on different doses. In general, the larger the insulin dose, the faster the effective onset of action, but the longer duration of action (see the table for Fiasp below)

In addition, she discovered that terminology has evolved. For example, the onset of insulin (when it appears in the blood circulation) can be as short as a few minutes. However, the most important measurement for real life is time to first measurable effect (effective onset) or the amount of time it takes for the insulin to kick in and start lowering blood glucose levels. In addition, instead of using the term “duration” in the package inserts, they now use, “Time for effect to return to baseline”, which is more accurate but way too long to fit on our Pocketcard.

Called in the experts

To sort through all of this, Coach Beverly reached out to her favorite pharmacist and husband, Kristapor Thomassian, PharmD, BCPS for consultation. After reviewing all of the package inserts and online pharmacy resources, he recommended standardizing the card and using the term “effective” ranges for the action, onset and duration times of various insulins.

These updates are now posted on the latest version of our Insulin PocketCards, which are available for FREE download, or on our CDCES Coach App. You can also purchase your very own 2023 laminated version and they make perfect gifts for team members.

Insulin action has many variables

As we all know, these insulin timing charts just provide a general framework. Insulin absorption, onset, peak and duration results from a complex interplay between the insulin dose, injection site, circulating hormones, skin temperature, metabolic rate and so many other factors. The package inserts recognize that there is about at 20% day-to-day variability of insulins effectiveness and that was in a controlled research environment.

The famous chart by Adam Brown (below) and first posted on DiaTribe, clearly and succinctly highlights 42 factors that affect glucose. The bottom line is that insulin absorption timing varies within individuals. Over time, many people can determine the best time to inject the bolus of insulin or adjust their dose based on personal experience and blood glucose response.

Newly Approved Biosimilar Interchangeable Basal Insulin – PocketCard Update

Under basal insulin glargine, there are now 3 biosimilars listed; Basaglar, Semglee and Rezvoglar. The FDA just announced that Rezvoglar has also been approved as an interchangeable biosimilar along with Semglee. An “interchangeable biosimilar,” means that pharmacists can substitute a person’s Lantus prescription with these cheaper alternatives without needing to consult the healthcare prescriber.

Get Your Own PocketCard
These updates are now posted on the latest version of our Insulin PocketCards, which are available for FREE download, or on our CDCES Coach App. You can also purchase your very own 2023 laminated version and they make perfect gifts for team members.

A special thanks to those of you who alerted us to these needed updates. We love our community!

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Want to learn more about this topic? Join us for our

DiabetesEd Boot Camp 2023 Updates | Level 3
$279 | 12+ CEs

Updates air live between Feb 7, 2023-March 9, 2023, at 11:30 am PST

In each webinar, Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM highlights the critical content of each topic area so you can focus your study time most efficiently. She also launches multiple poll questions that highlight key concepts to help students assess their knowledge and learn the best test-taking strategies. 

2023 Webinar Dates

1. February 7, 2023 – Class 1 – Diabetes – Not Just Hyperglycemia 1.5 CEs
2. February 9, 2023 – Class 2 – Standards of Care & Cardiovascular Goals 1.5 CEs
3. February 14, 2023 – Class 3 – Meds for Type 2 – What you need to know 1.5
4. February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
5. February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
6. February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
7. February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
8. March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
9. March 9, 2023 – Class 9 – Test-Taking Coach Session (48 Questions) No CE

Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.

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