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Rapid-Acting Analogues
Aspart - Novolog ®
Onset:  5-15 min Peak: 1-3 hours Duration: 3-5 hours (max: 4-6hrs) Solution:  Clear
Comments: NovoLog should generally be given immediately before a meal (start of meal within 5-10 minutes after injection) because of its fast onset of action.  NovoLog is homologous with regular human insulin with the exception of a single substitution of the amino acid proline by aspartic acid in position B28 (beta chain).  Insulin lispro (Humalog) and insulin aspart (Novolog), when administered intravenously, show pharmacodynamic parameters similar to regular insulin. 
Mixing
NPH:  If NovoLog is mixed with NPH human insulin, NovoLog should be drawn into the syringe first. The injection should be made immediately after mixing.   
Lente / Ultralente
:   Because there are no data on the compatibility of NovoLog and crystalline zinc insulin preparations, NovoLog should not be mixed with these preparations. ADA Note: Rapid-acting insulin can be mixed with NPH, lente, or ultralente.
Regular insulin
: Compatible - but NO support clinically for such a mixture.  Draw up Novolog first before drawing up Regular Insulin.

Mixtures should not be administered intravenously.   When used in external subcutaneous infusion pumps for insulin, NovoLog should not be mixed with any other insulins or diluent.  When rapid-acting insulin is mixed with either an intermediate- or long-acting insulin, the mixture should be injected within 15 min before a meal. 
Lispro - Humalog®
Onset:  5-15 min Peak: 0.5 - 1.5 hrs Duration: 2-4 hours  (max: 4-6hrs) Solution:  Clear
Comments: Must be taken just before or immediately after eating.  Chemically, insulin lispro Lys(B28), Pro(B29) is created when the amino acids at positions 28 and 29 on the insulin Beta-chain are reversed. Insulin lispro (Humalog) and insulin aspart (Novolog), when administered intravenously, show pharmacodynamic parameters similar to regular insulin.  A dose of lispro insulin peaks in one half the time and double the concentration of a comparable subcutaneous injection of human regular insulin.    Lispro insulin should be injected immediately prior to eating (or less than 15 minutes before the meal). Injecting lispro 30-60 minutes before the meal can result in hypoglycemia.
Mixing
NPH:  If Humalog is mixed with NPH human insulin, Humalog should be drawn into the syringe first. The injection should be made immediately after mixing.   
Lente / Ultralente
:   If Humalog is mixed with Lente/Ultralente human insulin, Humalog should be drawn into the syringe first. The injection should be made immediately after mixing.   
Regular: Compatible - but NO support clinically for such a mixture.  Draw up Humalog first before drawing up Regular Insulin.

If Humalog is mixed with a longer-acting insulin, such as Humulin N or Humulin U, Humalog should be drawn into the syringe first to prevent clouding of the Humalog by the longer-acting insulin. Injection should be made immediately after mixing. Mixtures should not be administered intravenously. Mixing Humalog with Humulin N or U does not decrease the absorption rate or the total bioavailability of Humalog.   Mixing Lispro: Lispro insulin may be mixed with NPH, Lente or Ultralente. Any mixture should be given 15 minutes before the meal and immediately after mixing.  


Short Acting (Regular Insulin)
Regular Insulin
Onset30-60 min Peak: 2-3 hours Duration: 3-6 hours  (max: 6-10 hrs) Solution:  Clear
Comments: Best if administered 30 minutes before a meal.
Mixing
NPH:  If Regular insulin is mixed with NPH human insulin, the Regular insulin should be drawn into the syringe first. 
Lente / Ultralente
:   If Regular insulin is mixed with lente or ultralente human insulin, the Regular insulin should be drawn into the syringe first.  Mixing of short-acting and lente insulins is not recommended except for patients already adequately controlled on such a mixture. If short-acting and lente mixtures are to be used, the patient should standardize the interval between mixing and injection.
Aspart - Nov
olog ®: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin.
Lispro
- Humalog ®: Compatible - but NO support clinically for such a mixture.  Draw up Humalog first before drawing up Regular Insulin.

Mixtures should not be administered intravenously.  When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Nov
olog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin. 



Intermediate-Acting Insulins
NPH (Novolin N,  Humalin N)
Onset2-4 hours Peak: 4-10 hours Duration: 10-16 hours  (max: 14-18 hrs) Solution:  Cloudy
Comments: Human Insulin Isophane Suspension. Cloudy/ milky suspension of human insulin with protamine and zinc.   
Mixing
NPH + Aspart (Novolog ®): Compatible - NovoLog should be drawn into the syringe first. The injection should be made immediately after mixing.   
NPH + Lispro (Humalog ®): Compatible - Humalog should be drawn into the syringe first. The injection should be made immediately after mixing.   
NPH +Regular insulin: Always draw the Regular (clear) insulin into the syringe first.

Phosphate-buffered insulins ( NPH insulin) should NOT be mixed with lente insulins. Zinc phosphate may precipitate, and the longer-acting insulin will convert to a short-acting insulin to an unpredictable extent.  Currently available NPH and short-acting insulin formulations when mixed may be used immediately or stored for future use.
Lente
Onset3-4 hours Peak: 4-12 hours Duration: 12-18 hours (max: 16-20 hrs) Solution:  Cloudy
Comments: Lente is a crystalline suspension of human insulin with zinc providing an intermediate-acting insulin with a slower onset and a longer duration of activity (up to 24 hours) than regular insulin.
Mixing
Lente + Lispro (Humalog ®): Compatible - Humalog should be drawn into the syringe first. The injection should be made immediately after mixing.   
Lente
+ Regular insulin: Always draw the Regular (clear) insulin into the syringe first. R
egular and Lente mixtures should be injected immediately after mixing.  Some doctors advise against mixing regular insulin with lente or ultralente insulins because such mixtures may lead to unpredictable results. However, some people have achieved good control with these mixtures.



Long-Acting Insulins
Ultralente (U)
Onset6-10 hours Peak: Minimal Duration: 18-24 hours (max: up to 36 hrs) Solution:  Cloudy
Comments: crystalline suspension of human insulin with zinc providing a slower onset and a longer and less intense duration of activity (up to 28 hours)
Mixing
Ultralente + Lente:  Compatible. Always draw the Lente insulin into the syringe first. 
Ultralente + Lispro (Humalog ®): Compatible - Humalog should be drawn into the syringe first. The injection should be made immediately after mixing.
Ultralente + Regular insulin
: Always draw the Regular (clear) insulin into the syringe first. Some doctors advise against mixing regular insulin with lente or ultralente insulins because such mixtures may lead to unpredictable results. However, some people have achieved good control with these mixtures.
Insulin glargine (Lantus)
Onset1-2 hours Peak: No peak Duration: 22-24 hours Solution:  Clear
Comments:  Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-hour duration of action). Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the Beta-chain. 
Mixing
LANTUS must NOT be diluted or mixed with any other insulin or solution.


Insulin Combinations
Novolin 70/30     -    Humulin  70/30
Onset30-60 min Peak: 2-12 hours Duration: 12-18 hours  (Max: up to 24hrs) Solution:  Cloudy
Comments: Mixture of 70% NPH, Human Insulin Isophane Suspension and 30% Regular, Human Insulin Injection.    Recommended interval between dosing and meal initiation: 30 minutes.
Mixing
You should not attempt to change the ratio of this product by adding additional NPH or Regular insulin to the vial. If the physician has prescribed insulin mixed in a proportion other than 70% NPH and 30% Regular, you should use the separate insulin formulations (e.g.  NPH and Regular insulin ) in the amounts recommended by the physician.
Humulin® 50/50    -   Novolin® 50/50 
Onset0-5 - 1 hr Peak: 2-12 hrs Duration: 18-24hrs Solution:  Cloudy
Comments:  Humulin 50/50 is a mixture of 50% Human Insulin Isophane Suspension and 50% Human Insulin Injection. It is an intermediate-acting insulin combined with the more rapid onset of action of regular insulin. The duration of activity may last up to 24 hours following injection. Recommended interval between dosing and meal initiation: 30 minutes.
Mixing
You should not attempt to change the ratio of this product by adding additional NPH or Regular insulin to the vial. If the physician has prescribed insulin mixed in a proportion other than 50% NPH and 50% Regular, you should use the separate insulin formulations (e.g.  NPH and Regular ) in the amounts recommended by the physician.
Novolog® Mix 70/30 
Onset5-15 min Peak: 1-4 hours Duration: 10-18 hours  (Max: up to 24hrs) Solution:  Cloudy
Comments NovoLog® Mix 70/30 (70% insulin aspart protamine suspension and 30% insulin aspart injection) is a human insulin analog suspension containing 70% insulin aspart protamine crystals and 30% soluble insulin aspart.  Recommended interval between dosing and meal initiation: 10-20 minutes.
Mixing
Manufacturer:  NovoLog Mix 70/30 should not be mixed with any other insulin product.
Humalog® Mix 75/25 
Onset5-15 min Peak: 0.5 - 4 hrs
(median: 1 hr)
Duration: 10-14 hours Solution:  Cloudy
Comments Humalog® Mix 75/25 has a duration of activity similar to that of Humulin 70/30.  Humalog® Mix75/25™ [75% insulin lispro protamine suspension and 25% insulin lispro injection] is a mixture of insulin lispro solution, a rapid-acting blood glucose-lowering agent and insulin lispro protamine suspension, an intermediate-acting blood glucose-lowering agent. Administer immediately before a meal (within 15 minutes).
Mixing
Humalog® Mix75/25™ should not be mixed with any other insulin product.

 

References
Primary source: package insert data.

 

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