Comparison of Insulins

Full update September 2021

(Information specific to U.S. products)

This chart compares insulins in regard to duration, usual frequency, and cost. It also provides information on route of administration, stability of in-use products at room temperature, and place in therapy. Other resources pertaining to insulin and injectable diabetes meds include our algorithm, Initiation and Adjustment of Insulin Regimens for Type 2 Diabetes, and our charts, How to Switch Insulin Products, Insulin Analogs vs Human Insulin, and Comparison of GLP-1 Agonists.

--Information in this chart is from U.S. product information (see footnote “a”) unless otherwise specified.--

Insulin, Mfr

Duration

Usual Frequency

Formulations/Costb,c

Stability, in-use, room temp

Rapid-acting: prandial human insulin analogs (rDNA origin). Onset 10 to 30 minutes (Fiasp, Lyumjev faster).2,12 For type 1 diabetes, recommended at each meal (three or more injections daily) with one or two injections of basal insulin.4 For type 2 diabetes, once daily at largest meal plus basal insulin, or basal-bolus regimen (i.e., two or three times daily with meals plus basal insulin).3 All are given via subcutaneous injection. Humalog 100 unit/mL, Lyumjev, NovoLog, Apidra, and Admelog can be given subcutaneously via insulin pump. Fiasp, Humalog 100 unit/mL, Apidra, NovoLog, Admelog, and Lyumjev 100 unit/mL can be given by intravenous infusion. All are clear and colorless.

 

Admelog
(insulin lispro),
Sanofi-Aventis

 

3 to 5 hours2

One to three (or more) times daily.3,4 Inject within 15 min before or immediately after a meal.

$130.76/10 mL vial
$39.23/3 mL vial
$50.49/3 mL SoloStar pen
$252.47/5 of 3 mL SoloStar pen

Vial, pen: 28 days
Pump reservoir: 7 days
IV infusion: 4 hours
(0.1 to 1 unit/mL in NS)

 

Humalog
(insulin lispro),
Eli Lilly
(authorized generic available for 10 mL vial, and 100 unit/mL pens)*

3 to 5 hours2

One to three (or more) times daily.3,4 Inject within 15 min before or immediately after a meal.

$137.35*/10 mL vial
$82.41/3 mL vial
$510.45/5 of 3 mL cartridge ($102.09 each)
$265.20*/5 of 3 mL
100 unit/mL KwikPen or KwikPen Junior ($53.04* each)
$424.32/2 of 3 mL KwikPen
200 unit/mL

 

Vial, cartridge, pen: 28 days
Pump reservoir
(Humalog 100 unit/mL): 7 days
IV infusion: 48 hours
(0.1 to 1 unit/mL in NS)

NovoLog
(insulin aspart),
Novo Nordisk

3 to 5 hours

One to three (or more) times daily.3,4 Inject within 5 to 10 min before a meal.

$289.36/10 mL vial
$537.47/5 of 3 mL Penfill cartridge
$558.83/5 of 3 mL FlexPen

Vial, cartridge, pen: 28 days
Pump reservoir: 6 days
IV infusion: 24 hours
(0.05 to 1 unit/mL in NS, others).
Diluted 1:1 (U-50) or 1:9 (U-10) with Insulin Diluting Medium for NovoLog: 28 days

 

Apidra
(insulin glulisine),
Sanofi-Aventis

3 to 5 hours2

One to three (or more) times daily.3,4 Inject within 15 min before a meal, or within 20 min after the start of the meal.

$283.95/10 mL vial
$548.52/5 of 3 mL SoloStar pen

Vial, pen: 28 days
Pump reservoir: 48 hours
IV infusion: 48 hours
(0.05 to 1 unit/mL in NS)

Fiasp
(insulin aspart),
Novo Nordisk

Formulated with niacinamide for faster absorption.7

 

3 to 5 hours2

One to three (or more) times daily.3,4 Inject at the start of the meal, or within 20 min after the start of the meal.

$289.36/10 mL vial
$558.83/5 of 3 mL FlexTouch pen
$537.47/5 of 3 mL PenFill cartridge

Vial, cartridge, pen: 28 days
IV infusion: 24 hours
(0.5 to 1 unit/mL in NS or D5W)

Lyumjev
(insulin lispro-aabc)
Eli Lilly

Formulated with treprostinil and citrate for faster absorption.12

Up to ~5 hours12

One to three (or more) times daily.3,4 Inject within 20 minutes after the start of the meal.

$274.7/10 mL vial

$530.40/5 of 3 mL 100 unit/mL KwikPen ($106.08 each)

$424.32/2 of 3 mL KwikPen
200 unit/mL ($212.16 each)

 

Vial, pen: 28 days
Pump reservoir: 9 days
IV infusion: 12 hours
(1 unit/mL in NS or D5W)

Short-acting (regular): regular human insulin of rDNA origin. Available OTC (100 unit/mL only). Onset about 30 minutes (<15 min for the 500 unit/mL concentration). Longer time to onset and longer duration than rapid-acting analogues. Regardless, lag time between regular insulin administration and meals may not be necessary for all patients with type 2 diabetes.1 For type 1 diabetes, non-preferred alternative to rapid-acting insulin at each meal (three or more injections daily) with one or two injections of basal insulin.4 For type 2 diabetes, once daily at largest meal plus basal insulin, or basal-bolus regimen (i.e., two or three times daily with meals plus basal insulin).3 Can be given via subcutaneous injection, or intravenous infusion (100 unit/mL concentration only). Clear and colorless.


Humulin R
100 units/mL,
Eli Lilly

 

About 8 hours (longer in obese patients)

One to three (or more) times daily.3,4 Inject about 30 min before the meal.

$148.70/10 mL vial
$44.61/3 mL vial

Vial: 31 days
IV infusion: 48 hours
(0.1 to 1 unit/mL in NS)

Humulin R
500 units/mL,
Eli Lilly


Mean 21 hours

Two or three times daily before a meal. Inject about 30 min before the meal.

$1,487/20 mL vial
$287.10/3 mL KwikPen
$574.20/2 of 3 mL KwikPen

Vial: 40 days
Pen: 28 days

Novolin R,
Novo Nordisk

About 8 hours

One to three (or more) times daily.3,4 Inject about 30 min before the meal.

$137.70/10 mL vial
$260.25/5 of 3 mL FlexPen
($52.05 each)

Vial: 42 days
Pen: 28 days
IV infusion: 24 hours
(0.05 to 1 unit/mL in NS, D5W, D10 with KCl 40 mEq/L)

 

Intermediate-acting (NPH): human insulin (rDNA origin) isophane suspension. Available OTC. For type 1 diabetes, may be used as the basal component of basal-prandial regimens (analogs preferred).4 An initial insulin option in type 2 diabetes, often as an add-on to oral agents.3 As type 2 diabetes progresses, may be used with mealtime rapid- or short-acting insulin with the largest meal.3 Onset 90 min.2 Administered via subcutaneous injection. Appears cloudy.


Novolin N,
Novo Nordisk

Up to 24 hours2

Once or twice daily.3

$137.70/10 mL vial
$260.25/5 of 3 mL FlexPen
($52.05 each)

 

Vial 42 days
Pen: 28 days

Humulin N,
Eli Lilly

Up to 24 hours2

Once or twice daily.3

$148.70/10 mL vial
$44.61/3 mL vial
$471.30/5 of 3 mL KwikPen ($94.26 each)

 

Vial: 31 days
Pen: 14 days

Long-acting: human insulin analogue (rDNA origin). For type 1 diabetes, preferred as the basal component of basal-prandial regimens.4 An initial insulin option in type 2 diabetes, often as an add-on to oral agents.3 As type 2 diabetes progresses, may be used with mealtime rapid- or short-acting insulin with the largest meal.3 Administered via subcutaneous injection. Appears clear and colorless.

 

Basaglar
(insulin glargine),
Eli Lilly

Not a generic for Lantus.

 

~24 hours

Once daily at the same time each day.

$326.36/5 of 3 mL KwikPen
$65.27/3 mL KwikPen

Pen: 28 days

Lantus
(insulin glargine),
Sanofi-Aventis

Median 24 hours (range 10.8 to >24 hours; sampling period 24 hours)

 

Once daily at the same time each day.

$283.56/10 mL vial
$425.31/5 of 3 mL SoloStar pen ($85.06 each)

Vial, pen: 28 days

Levemir
(insulin detemir),
Novo Nordisk

7.6 to >24 hours (sampling period 24 hours) (dose-dependent; binds to albumin)

 

Twice daily, or once daily with the evening meal or at bedtime.

$308.14/10 mL vial
$462.21/5 of 3 mL FlexTouch pen

Vial, pen: 42 days

Semglee
(insulin glargine-yfgn),d
Mylan Specialty

 


At least 24 hours

Once daily at the same time each day.

$98.65/10 mL vial
$147.98/5 of 3 mL pen ($29.60 each)

Vial, pen: 28 days

Toujeo
(insulin glargine),
Sanofi-Aventis

(300 units/mL)

>24 hours8

Once daily at the same time each day. First injection may provide insufficient coverage; may take ≥5 days to see maximum effect.

 

$388.72/3 of 1.5 mL SoloStar pen ($129.57 each)
$647.87/5 of 1.5 mL SoloStar
$518.30/2 of 3 mL Max SoloStar pen ($259.15 each)

Pen: 56 days

Ultra-Long-acting: human insulin analogue (rDNA origin). Administered via subcutaneous injection. Consider for patients with severe or nocturnal hypoglycemia on another basal analogue, or with hypoglycemia risk factors,9-11 or adherence problems. Appears clear and colorless.

 

Tresiba
(insulin degludec),
Novo Nordisk

At least 42 hours

Once daily at any time of day.

$338.95 vial (100 units/mL)
$508.43/5 of 3 mL
100 units/mL FlexTouch pen
$610.11/3 of 3 mL 200 unit/mL FlexTouch pen

 

Vial, pen: 56 days

Insulin Mixes: human insulin analogue (rDNA origin) solution and protamine-crystallized human insulin analogue suspension (NovoLog Mix 70/30, Humalog Mix 75/25, Humalog Mix 50/50). Others are human insulin (rDNA origin) solution and human insulin isophane suspension. Humulin 70/30 and Novolin 70/30 available OTC. Generally, not appropriate for type 1 diabetes due to lack of dose flexibiltiy.6 Typically started after failure of basal insulin plus non-insulin.3 Usually started pre-breakfast and pre-supper.3 Administered via subcutaneous injection. Cloudy.

 

NovoLog Mix 70/30 (70% insulin aspart protamine suspension/30% insulin aspart solution),
Novo Nordisk

 

Up to 24 hours

Typically given pre-breakfast and pre-supper.3 Give within 15 min before the meal, or after starting to eat (type 2 diabetes).

$300.12/10 mL vial
$558.83/5 of 3 mL FlexPen

Vial: 28 days
Pen: 14 days

Humalog Mix 75/25
(75% insulin lispro protamine suspension/25% insulin lispro solution), Eli Lilly
(authorized generic available for 100 unit/mL pens)*

 

See Humulin 70/30

Typically given pre-breakfast and pre-supper.3 Give within 15 min before the meal.

$284.70/10 mL vial
$265.20*/5 of 3 mL KwikPen ($53.04* each)

Vial: 28 days
Pen: 10 days

Humalog Mix 50/50
(50% insulin lispro protamine suspension, 50% insulin lispro solution), Eli Lilly

 

>22 hours

Typically given pre-breakfast and pre-supper.3 Give within 15 min before the meal.

$284.70/10 mL vial
$530.40/5 of 3 mL KwikPen ($106.08 each)

 

Vial: 28 days
Pen: 10 days

Humulin 70/30
(70% NPH/30% regular),
Eli Lilly


Mean about 23 hours (range: 18 to 24 hours)

Typically given pre-breakfast and pre-supper.3 Give about 30 to 45 min before the meal.

$148.70/10 mL vial
$44.61/3 mL vial
$471.30/5 of 3 mL KwikPen
$94.26/3 mL KwikPen

Vial: 31 days
Pen: 10 days

Novolin 70/30
(70% NPH/ 30% regular),
Novo Nordisk


Up to 24 hours

Typically given pre-breakfast and pre-supper.3 Give about 30 min before the meal.

$137.70/10 mL vial
$260.25/5 of 3 mL FlexPen ($52.05 each)

Vial: 42 days
Pen: 28 days

  1. Product information used in creation of this chart: Admelog (December 2020), Humalog (November 2019), NovoLog (March 2021), Apidra (December 2020), Fiasp (December 2019), Lyumjev (August 2021), Humulin R 100 units/mL (November 2019), Humulin R 500 units/mL (November 2019), Novolin R (November 2019), Novolin N (November 2019), Humulin N (November 2019), Basaglar (July 2021), Lantus (January 2021), Levemir (March 2020), Semglee (July 2021), Toujeo (December 2020), Tresiba (November 2019), NovoLog Mix 70/30 (April 2021), Humalog Mix 75/25 (November 2019), Humalog Mix 50/50 (November 2019), Humulin 70/30 (November 2019), Novolin 70/30 (November 2019).
  2. Wholesale acquisition cost (WAC), for generic if available. Medication pricing by Elsevier, accessed August 2021.
  3. Where prices are specifically listed for “each” pen or cartridge, this indicates that cartridges or pens can be purchased individually, not just in quantities of two, three, or five as packaged.
  4. Semglee (insulin glargine-yfgn): Pharmacists may automatically substitute for Lantus in many states (interchangeable biosimilar).5 See our Facts About Biosimilars for more information.

References

  1. Muller N, Frank T, Kloos C, et al. Randomized crossover study to examine the necessity of an injection-to-meal interval in patients with type 2 diabetes and human insulin. Diabetes Care 2013;36:1865-9.
  2. Clinical Pharmacology powered by Clinical Key. Tampa (FL): Elsevier. 2021. http://www.clinicalkey.com. (Accessed August 5, 2021).
  3. American Diabetes Association. Standards of medical care in diabetes – 2021. Diabetes Care 2021;44(Suppl 1):S1-232.
  4. Chiang JL, Kirkman MS, Laffel LM, et al. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014;37:2034-54.
  5. FDA. FDA approves first interchangeable biosimilar insulin product for treatment of diabetes. July 28, 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-first-interchangeable-biosimilar-insulin-product-treatment-diabetes. (Accessed August 9, 2021).
  6. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2018;42(Suppl 1):S1-S325.
  7. Kildegaard J, Buckley ST, Nielsen RH, et al. Elucidating the mechanism of absorption of fast-acting insulin aspart: the role of niacinamide. Pharm Res 2019;36:49.
  8. Becker RH, Nowotny I, Teichert L, et al. Low within- and between-day variability in exposure to new insulin glargine 300 U/mL. Diabetes Obes Metab 2015;17:261-7.
  9. Marso SP, McGuire DK, Zinman B, et al. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med 2017;377:723-32.
  10. Lane W, Bailey TS, Gerety G, et al. Effect of insulin degludec vs insulin glargine U100 on hypoglycemia in patients with type 1 diabetes: the SWITCH 1 randomized clinical trial. JAMA 2017;318:33-44.
  11. Wysham C, Bhargava A, Chaykin L. Effect of insulin degludec vs insulin glargine U100 on hypoglycemia in patients with type 2 diabetes: the SWITCH 2 randomized clinical trial. JAMA 2017;318:45-56.
  12. Linnebjerg H, Zhang Q, LaBell E, et al. Pharmacokinetics and glucodynamics of ultra rapid lispro (URLi) versus Humalog (lispro) in younger adults and elderly patients with type 1 diabetes mellitus: a randomised controlled trial. Clin Pharmacokinet 2020;59:1589-9.

Cite this document as follows: Clinical Resource, Comparison of Insulins. Pharmacist’s Letter/Prescriber’s Letter. September 2021. [370901]

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