The Insulin Types and Comparison Charts and References

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See the attached Insulin Types and Comparison Chart from:

http://http://www.musc.edu/pharmacyservices/medusepol/InsulinComparisonChart.pdf

And the following reference from:

http://www.drugdigest.org/DD/Compari...,40-12,00.html

Insulins

Insulin is a natural substance that is produced in the human body by the pancreas. Insulin helps control the use of glucose (sugar) in the body. Insulin is also involved in the processes that break down carbohydrates, fats, and proteins received from the diet into substances the body can use.
Drugs in this Class
Insulin - Mixed (Humalog Mix 75/25, Humulin 50/50, Humulin 70/30, Iletin II Mixed, NovoLog Mix, Novolin 70/30)
Insulin Aspart injection (Novolog)
Insulin Lispro Protamine Injection (Humalog Mix 50/50)
Insulin inhalation powder (Exubera)
Insulin Detemir Injection (Levemir)
Insulin injection (Humulin, Iletin II, Novolin, Velosulin)
Insulin Glulisine Injection (Apidra)
Insulin regular (Humulin R, Novolin R, Regular Iletin II, Regular insulin)
Insulin Aspart; Insulin Aspart Protamine injection (Novolog 70/30, Novolog Mix 70/30)
Insulin Lispro (Humalog)
Insulin Glargine injection (Lantus)
Summarizing the Evidence

• Historically, insulin was derived from animal sources, mainly the cow and pig. With advances in medicine over the past few decades, namely recombinant DNA technology, human insulin can now be manufactured or synthesized. Synthetic human insulin is identical to natural insulin that is made in human body and is now the most common form of insulin used.
• Various formulations of injectable human insulin are available including regular insulin (R), isophane insulin (NPH), lente insulin (L), and ultralente insulin (U). To decrease the number of injections for those individuals who require more than one kind of insulin, insulins have also been combined into one product. These combined insulin products include 70/30 insulin (comprised of 70% NPH / 30% R), 50/50 insulin (comprised of 50% NPH / 50% R), and Humalog 75/25 insulin (comprised of an insulin lispro mix).
• The newest forms of injectable insulin include insulin lispro (Humalog), insulin aspart (Novolog), insulin glargine (Lantus), insulin glulisine (Apidra), and insulin determir (Levemir). These forms of insulin were created in hopes to lessen side effects, improve effectiveness, and have differing onsets, peaks, and duration of activity over the previous human insulin formulations. To see how the various insulins compare with regard to their onset of blood sugar-lowering activity, their peak time of effect, and their duration of effect on blood sugar-lowering, please see the table directly below.
• In addition to injectable forms of insulin, in 2006, an inhalable form of insulin (Exubera) was FDA-approved for us. However, in October 2007, the maker of Exubera announced that it will no longer make the inhaled insulin available for patients. This decision was based on lower than expected sales of the product and was not due to any safety concerns.
• Since the different types of insulin vary in onset of action, time to peak effect, and duration of action, your doctor will decide what type of insulin is best for you. In general, Humulin and Novolin brands of regular, NPH, lente, and 70/30 insulin are equally effective. Humulin is the only available brand of ultralente insulin.
• Clinical studies have compared insulin aspart (NovoLog) and insulin lispro (Humalog), and insulin glulisine (Apidra) to regular insulin (R), and they were found to have similar effectiveness to regular insulin (R). However, insulin aspart (NovoLog) and insulin lispro (Humalog) may be associated with fewer low blood sugar episodes (called hypoglycemia) than regular insulin (R). Additionally, insulin lispro (Humalog) may offer more flexibility than regular insulin (R) in regards to timing the dose with meals. Insulin aspart (NovoLog), insulin lispro (Humalog) and insulin glulisine (Apidra) appear to be similarly effective.
• Insulin glargine (Lantus) was compared to NPH insulin in clinical trials, and no differences were seen in overall effectiveness. However, fewer low blood sugar episodes (especially nighttime episodes) were seen with insulin glargine (Lantus). There are no published clinical trial results comparing insulin glargine (Lantus) to ultralente insulin (U). In clinical studies comparing insulin glargine (Lantus) to insulin detemir (Levemir) in adults, both insulins showed similar effectiveness as measured by hemoglobin A1C (HbA1C--a blood test that measures diabetes control). Dosing and Administration
  
  • Insulin regimens must be customized to each individual. Some patients may require one injection daily; other patients may require two to four injections daily. Slight differences do exist in the timing of insulin injections. Most insulin doses are injected approximately 30 minutes prior to a meal. Insulin lispro is recommended to be given 15 minutes before or immediately after a meal whereas insulin aspart should generally be given immediately before a meal (start of meal within 5 to 10 minutes after injection).
  
  Generic Availability
  
  • None of the human insulin products are available in generic formulations at this time.
  
  Drug Interactions
  
  Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.
  Side Effects
  
  To view specific side effect information, please use our Side Effect Checker.
  Additional Information
  
  References
  
  1. DeWitt DE, Hirsch IB. Outpatient insulin therapy in Type 1 and Type 2 diabetes mellitus. Scientific review. JAMA. 2003;289(17):2254-2264.
  2. Drug Facts and Comparisons. 2005 Wolters Kluwer Health, Inc. Accessed on 04/04/2006. Available at: http://www.efactsonline.com.
  3. McEvoy GE, Ed. Insulins general statement. American Hospital Formulary Service drug information 2005. Bethesda, MD: American Society of Health-System Pharmacists. 2005:3019-3027.
  4. Exubera inhaler [package insert]. New York, NY: Pfizer Labs, Division of Pfizer Inc.; March 2006.
  5. NovoLog [package insert]. Princeton, NJ: Novo Nordisk Pharmaceuticals, Inc.; October 21, 2005.
  6. Humalog [package insert]. Indianapolis, IN: Eli Lilly and Company; August 4, 2004.
  7. Apidra injection [package insert]. Kansas City, MO: Aventis Pharmaceuticals Inc.; November 2005.
  8. Lantus [package insert]. Bridgewater, NJ: Sanofi-Aventis U.S. LLC.; February 2006.
  9. Levemir injection [package insert]. Princeton, NJ: Novo Nordisk Inc.; October 19, 2005.
  10. NovoLog Mix 70/30 injection [package insert]. Princeton, NJ: Novo Nordisk Inc.; November 21, 2005.
  11. Diabetes: types of insulin. WebMD Medical Reference in collaboration with The Cleveland Clinic. Edited February 2006. Accessed on 12/29/2006. Available at: http://www.webmd.com/content/article...?printing=true.
  12. Goldman-Levine J, Lee KW. Insulin detemir-a new basal insulin analog. Ann Pharmacother. 2005;39:502-507.
  13. Danne T, Becker RHA, Heise T, Bittner C, Frick AD, Rave K. Pharmacokinetics, prandial glucose control, and safety of insulin glulisine in children and adolescents with type 1 diabetes. Diabetes Care. 2005;28(9):2100-2105.
  14. Hirsch IB. Drug Therapy: Insulin analogues. N Engl J Med. 2005;352(2):174-183.
  15. Retnakaran R, Zinman B. Using insulin effectively in the management of diabetes. Endocrinology Rounds. 2004;4(6).
  16. Bode B, Weinstein R, Bell D, et al. Comparison of insulin aspart with buffered regular insulin and insulin lispro in continuous subcutaneous insulin infusion: a randomized study in type 1 diabetes. Diabetes Care. 2002;25(3):439-444.
  17. Raskin P, Guthrie RA, Leiter L, Riis A, Jovanovic L. Use of insulin aspart, a fast-acting insulin analog, as the mealtime insulin in the management of patients with type 1 diabetes. Diabetes Care. 2000;23(5):583-588.
  18. Home PD, Lindholm A, Riis A, European Insulin Aspart Study Group. Insulin aspart vs. human insulin in the management of long-term blood glucose control in Type 1 diabetes mellitus: a randomized controlled trial. Diabet Med. 2000;17(11):762-770.
  19. Anderson JH Jr, Brunelle RL, Keohane P, et al. Mealtime treatment with insulin analog improves postprandial hyperglycemia and hypoglycemia in patients with non-insulin-dependent diabetes mellitus. Multicenter Insulin Lispro Study Group. Arch Intern Med. 1997;157(11):1249-1255.
  20. Hedman CA, Lindstrom T, Arnqvist HF. Direct comparison of insulin lispro and aspart shows small differences in plasma insulin profiles after subcutaneous injection in Type 1 diabetes. Diabetes Care. 2001;24(6):1120-1121.
  21. Homko C, Deluzio A, Jimenez C, Kolaczynski JW, Bodgen G. Comparison of insulin aspart and lispro: pharmacokinetic and metabolic effects. Diabetes Care. 2003;26(7):2027-2031.
  22. Plank J, Wutte A, Brunner G, et al. A direct comparison of insulin aspart and insulin lispro in patients with type 2 diabetes. Diabetes Care. 2002;25(11):2053-2057.
  23. Dreyer M, Prager R, Robinson A, et al. Efficacy and safety of insulin glulisine in patients with type 1 diabetes. Horm Metab Res. 2005;37(11):702-707.
  24. Dailey G, Rosenstock J, Moses RG, Ways K. Insulin glulisine provides improved glycemic control in patients with type 2 diabetes. Diabetes Care. 2004;27:2363-2368.
  25. Hanaire-Broutin H, Schumicki DM, Hoogma RPLM, Souhami E. Safety of insulin glulisine compared with insulin aspart administered by continuous subcutaneous insulin infusion (CSII) [abstract 15-OR]. Diabetes. 2004;53(2):A4.
  26. Rosenstock J, Park G, Zimmerman J, for the U.S. Insulin Glargine (HOE 901) Type 1 Diabetes Investigator Group. Basal insulin glargine (HOE 901) versus NPH insulin in patients with Type 1 diabetes on multiple daily insulin regimens. Diabetes Care. 2000;23(8):1137-1142.
  27. Pieber TR, Eugene-Jolchine I, Derobert E, and the European Study Group of HOE 901 in Type 1 diabetes. Efficacy and safety of HOE901 versus NPH insulin in patients with Type 1 diabetes. Diabetes Care. 2000;23(2):157-162.
  28. Raskin P, Klaff L, Bergenstal R, et al. A 16-week comparison of the novel insulin analog insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with Type 1 diabetes. Diabetes Care. 2000;23(11):1666-1671.
  29. Ratner RE, Hirsch IB, Neifing JL, et al., for the U.S. Study Group of Insulin Glargine in Type 1 Diabetes. Less hypoglycemia with insulin glargine in intensive insulin therapy for Type 1 Diabetes. Diabetes Care. 2000;23(5):639-643.
  30. Yki-Harvinen H, Dressler A, Ziemen M, for the HOE 901/3002 Study Group. Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in Type 2 Diabetes. Diabetes Care. 2000;23(8):1130-1136.
  31. HOE 901/2004 Study Investigators Group. Safety and efficacy of insulin glargine (HOE 901) versus NPH insulin in combination with oral treatment in type 2 diabetic patients. Diabet Med. 2003;20(7):545-551.
  32. Massi Benedetti M, Humurg E, Dressler A, Zieman M. A one-year, randomized, multicenter trial comparing insulin glargine with NPH insulin in combination with oral agents in patients with type 2 diabetes. Horm Metab Res. 2003;35(3):189-196.
  33. Hershon KS, Blevins TC, Blevins TC, Blevins TC. Once-daily insulin glargine compared with twice-daily NPH insulin in patients with type 1 diabetes. Endocr Pract. 2004;10(1):10-17.
  34. Riddle MC, Rosenstock J, Gerich J; Insulin Glargine 4002 Study Investigators. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care. 2003;26(11):3080-3086.
  35. Home PD, Rosskamp R, Forjanic-Klapproth J, Dressler A. A randomized multicenter trial of insulin glargine compared with NPH insulin in people with type 1 diabetes. Diabetes Metab Res Rev. 2005;July 15:[Epub ahead of print].
  36. Fonseca V, Bell DS, Berger S, Thomson S, Mecca TE. A comparison of bedtime insulin glargine with bedtime neutral protamine hagedorn insulin in patients with type 2 diabetes: subgroup analysis of patients taking once-daily insulin in a multicenter, randomized, parallel group study. Am J Med Sci. 2004;328(5):274-280.
  37. Rossetti P, Pampanelli S, Fanelli C, et al. Intensive replacement of basal insulin in patients with type 1 diabetes given rapid-acting insulin analog at mealtime: a 3-month comparison between administration of NPH insulin four times daily and glargine insulin at dinner or bedtime. Diabetes Care. 2003;26(5):1490-1496.
  38. Porcellati F, Rossetti P, Pampanelli S, et al. Better long-term glycemic control with the basal insulin glargine as compared with NPH in patients with Type 1 diabetes mellitus given meal-time lispro insulin. Diabet Med. 2004;21(11):1213-1220.
  39. Fulcher GR, Gilbert RE, Yue DK. Glargine is superior to neutral protamine Hagedorn for improving glycated haemoglobin and fasting blood glucose levels during intensive insulin therapy. Intern Med J. 2005;35(9):536-542.
  40. Malone JK, Bai S, Campaigne BN, Reviriego J, Augendre-Ferrante B. Twice-daily pre-mixed insulin rather than basal insulin therapy alone results in better overall glycemic control in patients with type 2 diabetes. Diabet Med. 2005;22(4):374-381.
  41. Raskin P, Allen E, Hollander P, et al. Initiating insulin therapy in type 2 diabetes: a comparison of biphasic and basal insulin analogs. Diabetes Care. 2005;28(2):260-265.
  42. Levemir? insulin detemir (rDNA origin) injection. AMCP Dossier. January 2006.
  43. Pieber TR, Treichel H-C, Robertson LI, Mordhorst L, Gall M-A. Insulin detemir plus insulin aspart is associated with less risk of major as well as nocturnal hypoglycemia than insulin glargine plus insulin aspart at comparable levels of glycaemic control in type 1 diabetes [abstract 242]. Diabetologia. 2005;48(Suppl 1):A92.
  44. Feczko J. Pfizer Announcement Regarding Exubera. October 18, 2007. Available at: https://www.pfizerpro.com/patient_ed...tor_letter.pdf.
  
  

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