Vascular effects of rapid-acting insulin analogs in the diabetic patient: a review

Figures & data

Table 1 Comparison of rapid-acting insulin analogs with regular insulin

Regular insulin
Time of onset 30–60 minutes
Peak action 50–120 minutes
Duration of action 5–8 hours
Effects on vascular system
Improved outcomes in diabetic subjects with decreased
Intima-media thickness        Cardiovascular risk        Risk of non-fatal stroke        Risk of myocardial infarction        Risk of cardiovascular death        Mortality post-acute myocardial infarction
Vasodilation
Increases
Nitric oxide
Suppresses
Adhesion molecules        E-selectin        MCP-1        Nf-kB        NADPH oxidase        Plasma tissue factor        Matrix metalloproteinase        C-reactive protein        Serum amyloid A        Plasminogen activator inhibitor-1
Lispro (Humalog^®)
Time of onset 5–15 minutes
Peak action 30–90 minutes
Duration of action 3–5 hours
Difference from regular insulin
Produced from Escherichia coli
Lysine and proline at positions 28 and 29 transposed
Lower postprandial glucose
Effects on vascular system
Improved postprandial blood flow
Glulisine (Apidra^®)
Time of onset 5–15 minutes
Peak action 34–91 minutes
Duration of action 55–149 minutes
Difference from regular insulin
Produced from Escherichia coli
Asparaginase at B3 replaced with lysine and lysine at B29 replaced with glutamic acid
Lower postprandial glucose
Effects on vascular system
Improved blood flow postprandially
Aspart (Novolog^®)
Time of onset 5–15 minutes
Peak action 40–50 minutes
Duration of action 3–5 hours
Difference from regular insulin
Produced from Saccharomyces cervisiae
Proline replaced with aspartic acid at B28
Lower postprandial glucose
Effects on vascular system
No changes in fasting lipid profile, apolipoproteins, fibrinogen, plasminogen activator inhibitor-1, E-selectin, or homocysteine when compared to regular insulin.

Note: Time values assume subcutaneous bolus injection.