Insulin Therapy Components

Alan Moses

Dec 1, 2004 Issue

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

View/Print 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.

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.

†—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.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.