Letters to the Editor

Insulin Therapy Components

Am Fam Physician. 2004 Dec 1;70(11):2081.

to the editor: The following errors appear in Table 1 of the article “Insulin Therapy for Type 2 Diabetes: Rescue, Augmentation, and Replacement of Beta-Cell Function.”1

TABLE 1

Description of Onset, Peak, and Duration of Insulins

Insulin Onset Peak (hours) Usual effective duration (hours) Usual maximum duration (hours) Cost*

Bolus or mealtime insulin

Aspart (NovoLog)

5 to 10 minutes

1 to 3

3 to 5

4 to 6

$59

Lispro (Humalog)

< 15 minutes

0.5 to 1.5

2 to 4

4 to 6

59

Regular (Humulin R, Novolin R)

30 to 60 minutes

2 to 3

3 to 6

6 to 10

28

Basal insulin

NPH (Humulin N, Novolin N)

2 to 4 hours

4 to 10

10 to 16

14 to 18

28

Lente (insulin zinc suspension)

3 to 4 hours

4 to 12

12 to 18

16 to 20

Ultralente (extended insulin zinc suspension)

6 to 10 hours

Peakless

18 to 20

20 to 24

28

Glargine (Lantus)

1 hour, 6 minutes

Peakless

24

24

51

Combinations

50% NPH/50% regular

30 to 60 minutes

Dual

10 to 16

14 to 18

70% NPH/30% regular (Humulin R 70/30, Novolin R 70/30)

30 to 60 minutes

Dual

10 to 16

14 to 18

28

75% NPL/25% lispro (Humalog 75/25)

< 15 minutes

Dual

10 to 16

14 to 18

59†

70% APS/30% aspart (NovoLog Mix 70/30)

10 to 20 minutes

2.4 ± 0.80

24

24

59


NPH = neutral protamine Hagedorn; NPL = neutral protamine lispro; APS = aspart protamine suspension.

*—Estimated cost to the pharmacist for one 10-ml vial based on average wholesale prices in Red book. Montvale, N.J.: Medical Economics Data, 2004. Cost to the patient will be higher, depending on prescription filling fee.

†—20-mL volume only—cost shown is one half of the cost of a 20-mL vial.

Adapted with permission from Resource guide 2004. Insulin. Diabetes Forecast 2004;57:RG16.

TABLE 1   Description of Onset, Peak, and Duration of Insulins

View Table

TABLE 1

Description of Onset, Peak, and Duration of Insulins

Insulin Onset Peak (hours) Usual effective duration (hours) Usual maximum duration (hours) Cost*

Bolus or mealtime insulin

Aspart (NovoLog)

5 to 10 minutes

1 to 3

3 to 5

4 to 6

$59

Lispro (Humalog)

< 15 minutes

0.5 to 1.5

2 to 4

4 to 6

59

Regular (Humulin R, Novolin R)

30 to 60 minutes

2 to 3

3 to 6

6 to 10

28

Basal insulin

NPH (Humulin N, Novolin N)

2 to 4 hours

4 to 10

10 to 16

14 to 18

28

Lente (insulin zinc suspension)

3 to 4 hours

4 to 12

12 to 18

16 to 20

Ultralente (extended insulin zinc suspension)

6 to 10 hours

Peakless

18 to 20

20 to 24

28

Glargine (Lantus)

1 hour, 6 minutes

Peakless

24

24

51

Combinations

50% NPH/50% regular

30 to 60 minutes

Dual

10 to 16

14 to 18

70% NPH/30% regular (Humulin R 70/30, Novolin R 70/30)

30 to 60 minutes

Dual

10 to 16

14 to 18

28

75% NPL/25% lispro (Humalog 75/25)

< 15 minutes

Dual

10 to 16

14 to 18

59†

70% APS/30% aspart (NovoLog Mix 70/30)

10 to 20 minutes

2.4 ± 0.80

24

24

59


NPH = neutral protamine Hagedorn; NPL = neutral protamine lispro; APS = aspart protamine suspension.

*—Estimated cost to the pharmacist for one 10-ml vial based on average wholesale prices in Red book. Montvale, N.J.: Medical Economics Data, 2004. Cost to the patient will be higher, depending on prescription filling fee.

†—20-mL volume only—cost shown is one half of the cost of a 20-mL vial.

Adapted with permission from Resource guide 2004. Insulin. Diabetes Forecast 2004;57:RG16.

NovoLog Mix 70/30 is incorrectly identified as “NovoLog 70/30” and is incorrectly described as 70 percent neutral protamine Hagedorn (NPH) insulin and 30 percent aspart. NovoLog Mix 70/30 does not contain NPH insulin, but rather 70 percent insulin aspart (rDNA origin) protamine suspension and 30 percent insulin aspart (rDNA origin) injection. NovoLog Mix 70/30 is a single solution containing a premixed formulation of 70 percent insulin aspart in the crystalline protamine form and 30 percent insulin aspart in the soluble form.

The table states that NovoLog Mix 70/30 has a dual peak. The glucose-lowering effects for this insulin begin as early as 10 to 20 minutes after subcutaneous injection and are maximal at 2.4 ± 0.80 hours; the duration of action may be as long as 24 hours because of the protaminated insulin aspart. However, examination of the pharmacokinetic profile of NovoLog Mix 70/30 reveals only one peak.

editor’s note: The online version of this article has been corrected, and the corrected table is reprinted above.

ALAN MOSES, M.D.

Associate Vice President, Medical Affairs

Novo Nordisk Pharmaceuticals, Inc.

REFERENCE

1. Mayfield JA, White RD. Insulin therapy for type 2 diabetes: rescue, augmentation, and replacement of beta-cell function. Am Fam Physician. 2004;70:489–500511–2.

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