# STEROIDS FORUM > ANABOLIC STEROIDS - QUESTIONS & ANSWERS > EDUCATIONAL THREADS >  The Insulin Types and Comparison Charts and References

## thunderin

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*
DeWitt DE, Hirsch IB. Outpatient  insulin therapy in Type 1 and Type 2 diabetes mellitus. Scientific review. JAMA. 2003;289(17):2254-2264.Drug Facts and Comparisons. 2005 Wolters Kluwer Health, Inc. Accessed on 04/04/2006. Available at: http://www.efactsonline.com.McEvoy GE, Ed. Insulins general statement. American Hospital Formulary Service drug information 2005. Bethesda, MD: American Society of Health-System Pharmacists. 2005:3019-3027.Exubera inhaler [package insert]. New York, NY: Pfizer Labs, Division of Pfizer Inc.; March 2006.NovoLog [package insert]. Princeton, NJ: Novo Nordisk Pharmaceuticals, Inc.; October 21, 2005.Humalog [package insert]. Indianapolis, IN: Eli Lilly and Company; August 4, 2004.Apidra injection [package insert]. Kansas City, MO: Aventis Pharmaceuticals Inc.; November 2005.Lantus [package insert]. Bridgewater, NJ: Sanofi-Aventis U.S. LLC.; February 2006.Levemir  injection [package insert]. Princeton, NJ: Novo Nordisk Inc.; October 19, 2005.NovoLog Mix 70/30  injection [package insert]. Princeton, NJ: Novo Nordisk Inc.; November 21, 2005.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.Goldman-Levine J, Lee KW. Insulin detemir-a new basal  insulin analog. Ann Pharmacother. 2005;39:502-507.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.Hirsch IB. Drug Therapy: Insulin analogues. N Engl J Med. 2005;352(2):174-183.Retnakaran R, Zinman B. Using  insulin effectively in the management of diabetes. Endocrinology Rounds. 2004;4(6).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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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.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].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.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.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.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.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.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.Levemir? insulin detemir (rDNA origin) injection. AMCP Dossier. January 2006.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.Feczko J. Pfizer Announcement Regarding Exubera. October 18, 2007. Available at: https://www.pfizerpro.com/patient_ed...tor_letter.pdf.

----------


## thunderin

Attachments are up again.

----------

