Comparison of Insulins (United States)
Click HERE to access the Canadian version of this resource.
(Full update September 2021)
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
|
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 |
Vial,
pen: 28 days
|
Humalog |
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
|
Vial,
cartridge, pen: 28 days |
NovoLog |
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 |
Vial,
cartridge, pen: 28 days
|
Apidra |
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 |
Vial,
pen: 28 days |
Fiasp 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 |
Vial,
cartridge, pen: 28 days |
Lyumjev 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
|
Vial,
pen: 28 days |
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
|
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 |
Vial: 31 days |
Humulin R
|
Mean 21 hours |
Two or three times daily before a meal. Inject about 30 min before the meal. |
$1,487/20
mL vial |
Vial: 40 days |
Novolin R, |
About 8 hours |
One to three (or more) times daily.3,4 Inject about 30 min before the meal. |
$137.70/10
mL vial |
Vial: 42 days
|
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, |
Up
to 24 hours2 |
Once
or twice daily.3 |
$137.70/10
mL vial
|
Vial 42 days |
Humulin N, |
Up
to 24 hours2 |
Once
or twice daily.3 |
$148.70/10
mL vial
|
Vial: 31 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 Not a generic for Lantus.
|
~24 hours |
Once daily at the same time each day. |
$326.36/5
of 3 mL KwikPen |
Pen: 28 days |
Lantus |
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 |
Vial, pen: 28 days |
Levemir |
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 |
Vial, pen: 42 days |
Semglee
|
At least 24 hours |
Once daily at the same time each day. |
$98.65/10
mL vial |
Vial, pen: 28 days |
Toujeo (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) |
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 |
At least 42 hours |
Once daily at any time of day. |
$338.95
vial (100 units/mL)
|
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),
|
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 |
Vial: 28 days |
Humalog Mix 75/25
|
See
Humulin 70/30 |
Typically given pre-breakfast and pre-supper.3 Give within 15 min before the meal. |
$284.70/10
mL vial |
Vial: 28 days |
Humalog Mix
50/50
|
>22
hours |
Typically given pre-breakfast and pre-supper.3 Give within 15 min before the meal. |
$284.70/10
mL vial
|
Vial: 28 days |
Humulin 70/30
|
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 |
Vial: 31 days |
Novolin 70/30
|
Up to 24 hours |
Typically given pre-breakfast and pre-supper.3 Give about 30 min before the meal. |
$137.70/10
mL vial |
Vial: 42 days |
- 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).
- Wholesale acquisition cost (WAC), for generic if available. Medication pricing by Elsevier, accessed August 2021.
- 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.
- 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
- 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.
- Clinical Pharmacology powered by Clinical Key. Tampa (FL): Elsevier. 2021. http://www.clinicalkey.com. (Accessed August 5, 2021).
- American Diabetes Association. Standards of medical care in diabetes – 2021. Diabetes Care 2021;44(Suppl 1):S1-232.
- 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.
- 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).
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 (United States). Pharmacist’s
Letter/Prescriber’s Letter. September
2021. [370901]
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