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Endocrine

Diabetes

How Well Do You Know YOUR Insulin?

If you have diabetes and take insulin, you know that insulin can be a fickle thing. Some insulins are picky about which other insulins they are mixed with. Other insulins have special storage needs and all insulins have instructions on when and how often during the day they should be taken. How well do you know your insulin? Take a look at the chart below to find out.

Rapid-acting

	Lispro	Aspart	Glulisine
Brand	Humalog	NovoLog	Apidra
Onset	15 to 30 minutes	10 to 20 minutes	10 to 15 minutes
Peak	30 minutes to 2.5 hours	1 to 3 hours	1 to 1.5 hours
Duration	3 to 6.5 hours	3 to 5 hours	3 to 5 hours
Meal timing	Take within 15 minutes before or immediately after meals. Take pump bolus immediately before meal.	Take 5 to 10 minutes before meals.	Take within 15 minutes before or within 20 min. after starting a meal.
Formulations	100 units/mL.-10 mL vials, 3 mL cartridge and disposable pen.	100 units/mL-10 mL vials, 3 mL cartridge, 3ml disposable FlexPen.	100 units/mL-10 mL vials, 3 mL cartridge
Appearance	Clear
Compatibility	Can mix with NPH or ultralente (draw Humalog into syringe first and inject immediately). Mixture with NPH (Humulin N) stable in vials for 28 days at room temperature and refrigeration (prefilled syringes stable for 14 days refrigerated). Do not mix with Lantus Discard pump insulin if exposed to >37Â°C.	Can mix with NPH (draw Novolog into syringe first and inject immediately after mixing). No data on mixing with regular, Humulin or Humulin U. Discard pump insulin if exposed to >37Â°C. Do not mix with Lantus.	Can mix with NPH only (draw Apidra into syringe first and inject immediately).
How long can I keep it at room temp after the first use?	Vial, cartridge, pen: 28 days External pump: 48 hours for most parts; 7 days for 3 mL cartridge in D-TRON or D-TRON plus.	Vial, cartridge, pen: 28 days External pump: 48 hours.	Vial, cartridge: 28 days. External pump: 48 hours.

Short-acting (ie, Regular insulin)

Brand	Humulin R	Novolin R,	Iletin II Regular
Availability	Non-prescription (except 500 units/mL Humulin R)
Onset	30 to 60 minutes
Peak	1 to 5 hours
Duration	6 to 10 hours		4 to 12 hours
Meal timing	SC injection: 30 minutes before meals. Pump bolus: 20 to 30 minutes before a meal.
Formulations	100 units/mL- 10 mL vial. 500 units/mL- 20 mL vial.	100 units/mL- 10 mL vial, 3 mL cartridge, 3 mL Innolet.	100 units/mL-10 mL vial.
Appearance	Clear and colorless.
Compatibility	Can mix with NPH; can use immediately or store for future use. Mixture in vials stable at room temperature for 1 month, refrigerator for 3 months. Mixing with Humulin or Humulin U can delay onset of regular so this is not recommended but may mix with Humulin only if your already stabilized on regimen (check with your doctor). Humulin R stable for 1 month at room temp after dilution with Lilly insulin diluent. Do not mix with Lantus. Can mix with Water for Injection or 0.9% Sodium Chloride for Injection for use in SC infusion pump. Use within 24 hours.		Can mix with NPH. Can mix with Humulin U. Do not mix with Lantus.. Diluent no longer available for Iletin II Regular.
How long can I keep it at room temp after first use?	Vial: 28 days	Vial: 30 days 3 mL cartridge & Innolet: 28 days	Vial: 28 days

Intermediate-acting

	Lente	NPH
Brand	Humulin L	Novolin N	Humulin N	Iletin II NPH
Availability	Non-prescription.
Onset	1 to 3 hours	1 to 2 hours
Peak	6 to 14 hours	6 to 14 hours
Duration	16 to 24 hours	16 to 24 hours or more
Meal timing	Inject within 15 minutes before meals when NPH mixed with rapid-acting insulin. Usually injected 30 minutes before meals when mixed with regular.
Formulations	100 units/mL- 10 mL vial.	100 units/mL-. 10 mL vial, 3 mL cart, 3 mL Innolet.	100 units/mL-. 10 mL vial, 3 mL cartridge.	100 units/mL-. 10 mL vial.
Appearance	Cloudy
Compatibility	Mixing with regular insulin is not recommended unless you are stabilized on this regimen (check with your doctor). Can mix with Humulin U. Do not mix with NPH or Lantus.	Can mix with Novolog or Humalog. Draw up Novolog or Humalog first and inject immediately. Can mix with regular. Draw up regular insulin first; can be used immediately or stored for future use. Mixture in vials stable at room temperature for 1 month and in refrigerator for 3 months. Lilly NPH products stable for 1 month at room temperature after dilution with Lilly insulin diluent. Do not mix with Humulin, Humulin U, or Lantus.
How long can I keep it at room temp after the first use?	Vial: 28 days	Vial: 30 days 3 mL cart, Innolet: 14 days	Vial: 28 days 3 mL pen: 14 days	Vial: 28 days

Long-acting

	Glargine	Ultralente	Detemir
Brand, maker	Lantus,¹²Aventis	Humulin U, Lilly	Levemir,³⁴ Novo Nordisk
Availability	Prescription only.	Non-prescription.	Prescription only.
Onset	1.1 hours	4 to 6 hours	0.8 to 2 hours
Peak	No real peak	8 to 20 hours	No real peak
Duration	24 hours	24 to 28 hours	12 hours to 20 hours
Meal timing	Not applicable.	Inject within 15 minutes before meals if mixed with Novolog or Humalog.. Usually injected 30 minutes before meals if mixed with regular.	Evening dose can be given at dinner or at bedtime (check with your doctor).
Formulations	100 units/mL-10 mL vial, 3 mL cart for Opticlik.	100 units/mL-10 mL vial.	100 units/mL.-10 mL vial, 3 mL disposable FlexPen.
Appearance	Clear	Cloudy	Clear
Compatibility	Do not mix with other insulins.	Can mix with Humalog, regular Humulin L. Do not mix with NPH. Diluent no longer available for Humulin U.	Do not mix with other insulins or diluent.
How long can I keep it at room temp after first use?	10 mL vial-28 days 3 mL cartridge-28 days	10 mL vial- 28 days	10 mL vial, 3 mL cart, 3 mL Innolet, 3 mL FlexPen--42 days.

Insulin Mixtures

	30% aspart, 70% aspart protamine	25% lispro, 75% lispro protamine	70% NPH, 30% regular		50% NPH, 50% regular
Brand	Novolog Mix 70/30	Humalog Mix 75/25	Humulin 70/30	Novolin 70/30	Humulin 50/50
Availability	Prescription only		Non-prescription
Onset	10 to 20 minutes	30-60 minutes	30 to 60 minutes	30 to 60 minutes	30 to 60 minutes
Peak	1 to 4 hours	1 to 6.5 hours	1.5 to 16 hours	2 to 12 hours	2 to 5.5 hours
Duration	15 to 18 hours	Up to 24 hours.	10 to 16 hours	10 to 16 hours	10 to 16 hours
Meal timing	Give within 15 minutes of a meal.		Give approx. 30 minutes before meals.
Formulations	100 units/mL-. 10 mL vial, 3 mL cart, 3 mL disposable FlexPen	100 units/mL-. 10 mL vial, 3 mL disposable pen	100 units/mL-. 10 mL vial, 3 mL disposable pen	100 units/mL.- 10 mL vial, 3 mL cartridge, 3 mL Innolet	100 units/mL-. 10 mL vial
Appearance	Cloudy
Compatibility	Do not mix with other insulins. Humalog Mix 75/25, Humulin 70/30, and Humulin 50/50 stable for 1 month at room temperature after dilution with Lilly insulin diluent.¹⁸
How long can I keep it at room temp after the first use?	Vial: 28 days Pen: 14 days 3 mL cart: 14 days	Vial: 28 days Pen: 10 days	Vial: 28 days 3 mL pen: 10 days	Vial: 30 days 3 mL cart, Innolet: 10 days	Vial: 28 days

Inhalation Insulin

Brand	Onset	Peak	Duration	Meal timing	Formulation	How long can I keep it at room temp after the first use?
Exubera	10 to 20 minutes	30 to 90 minutes	6 hours	Within 10 minutes of eating.	1 mg, 3 mg unit dose blisters pack	U.D. blister: 3 months after opening foil overwrap

Misc. Non-insulin Injectable Agents

Brand

Meal Timing

Stability (in-use)

Byetta

Within 60 minutes before meals

Pen must be refrigerated. Discard 30 days after first use.

May be kept at room temperature for a TOTAL of 6 days.

Symlin

Immediately before meals

Discard 28 days after first use. May be refrigerated or kept at room temperature.

All charts are based on product labeling per the package insert.

Author: Christi Larson, Pharm. D.

Dr. Larson is a Clinical Infusion Pharmacist, author of Empowered Medicine; A Guide for Consumers and creator of www.empoweredmedicine.com. You can read more about her by visiting www.EmpoweredMedicine.com and clicking on the 'About Us' tab. EmpoweredMedicine.com is committed to providing evidence-based medical information.