Comparison of Insulins and Injectable Diabetes Meds

Home , Insulin lispro, NPH insulin

Detail-Document #260304 −This Detail-Document accompanies the related article published in− PHARMACIST’S LETTER / PRESCRIBER’S LETTER March 2010 ~ Volume 26 ~ Number 260304

Comparison of Insulins and Injectable Diabetes Meds -Information for the non-insulin injectables Byetta, Symlin, and Victoza is located at the end of the chart- Rapid-acting (Information specific to U.S. products) Brand (generic), Humalog (insulin lispro), NovoLog (insulin aspart), Apidra (insulin glulisine), Maker Eli Lilly Novo Nordisk Sanofi-aventis Availability Prescription only1 Description Human insulin analog (rDNA origin)2,4,6 Onsetd 15 to 30 minutes3 10 to 20 minutes5 25 minutes3 Peakd 30 minutes to 2.5 hours3 40 to 50 minutes5 45 to 48 minutes3 Durationd 3 to 6.5 hours3 3 to 5 hours5 4 to 5.3 hours3 Administration FDA-approved for SC injection and SC infusion.2,4,6 NovoLog and Apidra approved for IV infusion in clinical settings.4,6 Meal Timing Give SC injection within 15 minutes before or immediately Give 5 to 10 minutes before meals.5 Give SC injection within 15 after meals.2 minutes before or within 20 minutes after starting a meal.6 Formulations 100 units/mL. 10 mL vial, 3 mL cartridge, disposable pen 100 units/mL. 10 mL vial, 3 mL PenFill 100 units/mL. 10 mL vial, 3 and KwikPen, all latex-free50 cartridge, 3 mL disposable FlexPen; all mL cartridge, 3 mL disposable latex-free9 SoloStar pen Appearance Clear1 Compatibilitya • Can mix with NPH (Humulin N). Draw insulin lispro into • Can mix with NPH. Draw aspart into • Can mix with NPH. Draw syringe first and inject immediately.2 syringe first and inject immediately after insulin glulisine into syringe • Mixture with NPH stable in vials for 28 days at room mixing.4 first and inject immediately.6 temperature and refrigeration. Prefilled syringes stable for 14 • Can mix with Insulin Diluting Medium for days refrigerated.51 NovoLog to dilutions of 1:2 (U-50) or 1:10 • Can mix Humalog in vial with Lilly diluent to dilutions of (U-10). Diluted solutions stable for 28 days 1:2 (U-50) or 1:10 (U-10). Diluted solutions stable for 28 at <30°C (86°F).4,c days at 5° C (41°F) and 14 days at 30° C (86°F).2,c Stability of in- Vial, cartridge, pens: 28 days2 Vial, cartridge, pen: 28 days4 Vial, cartridge, pen: 28 days6 use products at External pump: 48 hours; 7 days for 3 mL cartridge in D- External pump: 6 days (reservoir), 3 days External pump: 48 hours. Do room temp TRON or D-TRON plus. Discard pump insulin exposed to (infusion set/insertion site).4 Discard pump not expose to >37oC (98.6ºF).6 o o 2 6 >37 C (98.6 F). insulin exposed to >37°C (98.6oF).4 Infusion bags: 48 hours Infusion bags: 24 hours4 Costb $118.24/10 mL vial $111.20/10 mL vial (AWP) $105.95/10 mL vial $213.95/5 of 3 mL cartridge $216.19/5 of 3mL PenFill cartridge $203.64/5 of 3 mL cartridges $223.87/5 of 3 mL pen, $221.47/5 of 3 mL KwikPen $235.74/5 of 3 mL FlexPen $201.01/5 of 3 mL SoloStar More. . . Copyright © 2010 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.pharmacistsletter.com ~ www.prescribersletter.com (Detail-Document #260304: Page 2 of 10)

Short-acting (i.e., Regular insulin) Brand, Maker Humulin R, Eli Lilly Novolin R, Novo Nordisk Availability Non-prescription (except 500 units/mL Humulin R)1 Description Human insulin (rDNA origin)1 Onset 30 to 60 minutes3 (30 minutes U-500)56 Around 30 minutes7 Peak 1 to 5 hours3 (1 to 3 hours U-500)56 2.5 to 5 hours7 Duration 4 to 12 hours8 (longer with U-500; up to 24 hours)10 Around 8 hours7 Administration SC8,10 SC; IM or IV infusion in clinical settings7 (SC infusion is off-label, 100 units/mL)3 IM, IV (unlabeled uses)3 (500 unit/mL SC only)54,55 Meal timing Most commonly recommended 30 minutes before meals.11 Formulations 100 units/mL: 10 mL vial, latex-free50 100 units/mL: 10 mL vial, latex-free9 500 units/mL: 20 mL vial, latex-free50 Appearance Clear and colorless7.8 Compatibilitya • Can mix with NPH. Draw regular insulin into syringe first.3 Mixtures stable in syringe at room temp for 28 days but must consider possibility of microbial contamination; refrigeration recommended.3,49 • Diluent available for Humulin R and Humulin R U-500c Stability of in-use products at room temperature • Vial (100 units/mL): 28 days51 • Vial: 42 days12 • Infusion bags: 24 hours3 • Infusion bags: 24 hours3,7 Costb $62.11/10 mL vial (U-100) $73.19/10mL vial $284.22/20 mL vial (U-500)

Intermediate-acting (i.e., NPH) Brand, Maker Humulin N, Eli Lilly Novolin N, Novo Nordisk Availability Non-prescription1 Description Human (rDNA) isophane suspension1 Onset 1 to 2 hours3 90 minutes14 Peak 6 to 14 hours3 4 to 12 hours14 Duration Up to 24 hours13 Up to 24 hours14 Administration SC3 Formulations 100 units/mL. 10 mL vial, 3 mL disposable pen, 100 units/mL. 10 mL vial, latex-free9 both latex-free50 Appearance Cloudy1 Compatibilitya • Can mix with aspart, glulisine, lispro, and regular insulins. See above for details. • Diluent available for Humulin Nc Stability of in-use products at room temperature Vial: 28 days51 Vial: 42 days14 3 mL pen: 14 days1 Costb $62.11/10 mL vial $73.19/10 mL vial $167.92/5 of 3 mL disposable pen More. . . Copyright © 2010 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.pharmacistsletter.com ~ www.prescribersletter.com

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Long-acting Brand (generic), Maker Lantus (insulin glargine), Sanofi-aventis Levemir (insulin detemir), Novo Nordisk Availability Prescription only15,16 Description Human insulin analog (rDNA origin)1 Onset 1.1 hour3 1.1 to 2 hours3 Peak No significant peak15 Relatively flat16 Duration 10.8 to >24 hours (median 24 hours; sampling period Mean 5.7 to 23.2 hours (dose-dependent; binds to 24 hours)15 albumin; sampling period 24 hours)16 Administration • SC once daily at same time each day15 • SC once or twice daily. Give once-daily dose • Convert 1:1 from once daily NPH, but reduce Lantus with evening meal or at bedtime. If twice daily by 20% dose if converting from twice daily NPH15 dosing needed for glucose control, give evening • No need to shake before administration.15 dose with evening meal, at bedtime, or 12 hours • Pain at injection site reported more commonly than after morning dose.16 with NPH (2.7% vs 0.7%)3 • Convert 1:1 from another basal insulin.16 • Type 2 diabetes: Some patients may need higher doses of Levemir than NPH. Insulin-naïve patients with poor control on oral drugs: 0.1 to 0.2 units/kg once daily in evening or 10 units once or twice daily.16 Meal timing Not applicable See “Administration” above. Formulations 100 units/mL. 10 mL vial, 3 mL cartridge for Opticlik, 100 units/mL. 10 mL vial, 3 mL disposable 3 mL disposable SoloStar pen FlexPen, both latex-free9 Appearance Clear, colorless15 Clear, colorless16 Compatibilitya • Do not mix with other insulins or dilute.15 • Do not mix with other insulins or dilute. Mixing Preliminary evidence shows mixing glargine with with Levemir reduced levels of insulin aspart lispro or aspart did not adversely affect glycemic substantially.16 control.17-19 The mixture was cloudy.17,19 • Has neutral pH.16 • Has acidic pH (about 4)3 Stability of in-use products at room 10 mL vial: 28 days15 10 mL vial: 42 days16 temperature 3 mL cartridge: 28 days15 FlexPen: 42 days16 SoloStar pen: 28 days15 Costb $111.88/10 mL vial $110.49/10 mL vial $206.09/5 of 3 mL cartridges $199.27/5 of 3 mL FlexPens (AWP) $202.71/5 of 3 mL SoloStar pen

More. . . Copyright © 2010 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.pharmacistsletter.com ~ www.prescribersletter.com

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Insulin Mixtures 70% insulin aspart 75% insulin lispro 50% insulin lispro 70% NPH, 30% Regular protamine suspension, protamine suspension, protamine suspension, 30% insulin aspart solution 25% insulin lispro solution 50% insulin lispro solution Brand, Maker NovoLog Mix 70/30, Humalog Mix 75/25, Humalog Mix 50/50, Humulin 70/30 Novolin 70/30 Novo Nordisk Eli Lilly Eli Lilly Eli Lilly Novo Nordisk Availability Prescription only1 Non-prescription1 Description Human insulin analog (rDNA origin) solution Human insulin (rDNA origin) and human insulin analog protamine suspension20,22,24 solution and isophane suspension23,25 Onset 10 to 20 minutes3 15 to 30 minutes3 15 to 30 minutes3 Usually within 30 minutes3 Peak 1 to 4 hours20 1 to 6.5 hours (2.6 hours 0.8 to 4.8 hours (mean 2.3 1.5 to 16 hours 2 to 12 hours mean)22 hours)24 (mean 4.4 (mean 4.2 hours)22 hours)20,25 Duration Up to 24 hours20 Similar to Humulin 70/30 (up 22 hours or more3 Up to 24 hours23,25 to 24 hours)22,23 Administration SC only20,22,23,24 Meal timing Within 15 minutes before a Within 15 minutes before a Within 15 minutes before a Approximately 30 minutes meal20 meal22 meal24 30 minutes before meals20 before meals22 Formulations 100 units/mL. 10 mL vial, 3 100 units/mL. 10 mL vial, 3 100 units/mL. 10 mL vial, 3 100 units/mL. 100 units/mL. mL disposable FlexPen, both mL disposable pen and mL disposable pen and 10 mL vial, 10 mL vial, latex-free9 KwikPen, all latex-free50 KwikPen, all latex-free50 3 mL pen latex-free9 (disposable), both latex- free50 Appearance Cloudy1 Compatibilitya Do not mix with other insulins.20 Diluent available for Humulin 70/30.c Stability of in-use products at Vial: 28 days20 Vial: 28 days22 Vial: 28 days24 Vial: 28 days51 Vial: 42 room temperature FlexPen: 14 days20 Pens: 10 days22 Pens: 10 days24 Pen: 10 days1 days25 Costb $117.97/10 mL vial $111.24/10 mL vial (AWP) $111.24/10 mL vial (AWP) $143.34/ $73.19/10 mL $221.15/5 of 3 mL FlexPen $201.63/5 of 3 mL pen $214.80/5 of 3 mL pen 10 mL vial vial $215.01/5 of 3 mL KwikPen (AWP) (AWP) $215.01/5 of 3 mL KwikPen $158.51/5 of 3 mL pen

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Insulin Administration Devices Device Description Dosage range Insulin used Stability of Costb Comments Manufacturer and precision in-use pens at room temp Autopen 24 Reusable pen AN4210: 1-21 3 mL Sanofi-aventis Per insulin $44 (AWP) Compatible with all AN4210 and AN4200 units in 1-unit cartridges27 cartridge pen needles. Cannot Owen Mumford increments26 specifications correct “over-dialed” www.owenmumford.com dose; must expel 1-800-421-6936 AN4200: 2-42 insulin and re-dial.27 units in 2-unit Automatic side increments26 injection button.26

Autopen Classic Reusable pen AN3810: 1-21 3 mL Eli Lilly Humalog: $44 (AWP) Comes with Unifine AN3810 and AN3800 units in 1-unit cartridges (i.e., 28 days2 Pentip needles but Owen Mumford increments28 Humalog)26 can use other needles. www.owenmumford.com Automatic side 1-800-421-6936 AN3800: 2-42 injection button.26 units in 2-unit Cannot correct “over- increments28 dialed” dose; must expel insulin and re- dial.39 FlexPen Prefilled 1-60 units in 1-unit Levemir 42 days16 $217.99/5 Uses NovoFine Novo Nordisk disposable pen increments16,30 needles or BD www.novonordiskcare.com NovoLog 28 days4 $235.74/5 needles.29,31 Can dial 1-800-727-6500 back to correct “over- NovoLog Mix 70/30 14 days20 $221.15/5 dialed” dose.29 Resets to zero after shot.52 Large window.32 Humalog KwikPen Prefilled 1-60 units in 1-unit Humalog 28 days2 $221.47/5 Compatible with BD www.lillydiabetes.com disposable pen increments40 pen needles.31 Can 1-800-545-5979 Humalog Mix 75/25 10 days22 $215.01/5 correct dose without wasting insulin. Humalog Mix 50/50 10 days24 $215.01/5 Resets to zero after shot.40 Lightweight.41

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Device Description Dosage range Insulin used Stability of Costb Comments Manufacturer and precision in-use pens at room temp HumaPen Luxura HD Reusable pen 1-30 units in ½-unit 3 mL Humalog Humalog: Free with For precise dosing Eli Lilly increments33 after cartridges33 28 days2 coupon on (e.g., for pediatrics). www.lillydiabetes.com 1st unit34 web site Audible clicks (but 1-800-545-5979 not recommended for unassisted use by the visually impaired). Can correct dose without wasting insulin.33 Resets to zero after shot. Compatible with BD pen needles. Three year lifespan.34 Do not refrigerate pen.34

HumaPen Memoir Reusable pen 1-60 units in 1-unit 3 mL Humalog Humalog: Free with Pen with memory; Eli Lilly increments35 cartridges35 28 days2 coupon on can display last 16 www.lillydiabetes.com web site doses. Can correct 1-800-545-5979 dose without wasting insulin. Audible clicks (but not recommended for unassisted use by the visually impaired).35 Resets to zero after shot. Compatible with BD pen needles. Three year lifespan.36 Do not refrigerate pen.36

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Device Description Dosage range Insulin used Stability of Costb Comments Manufacturer and precision in-use pens at room temp Lilly original prefilled pen Prefilled 1-60 units in 1-unit Humalog 28 days2 $213.95/5 Can use with BD pen www.lillydiabetes.com disposable pen increments37 needles.31 1-800-545-5979 Humalog Mix 75/25 10 days22 $201.63/5 Magnifying dose window. Can correct Humalog Mix 50/50 10 days24 $214.80/5 dose without wasting (AWP) insulin.37 Audible clicks (but not Humulin N 14 days1 $167.92/5 recommended for unassisted use by the Humulin 70/30 10 days1 $158.51/5 visually impaired).37,38

Novo Pen 3 Reusable pen 2-70 units in 1-unit 3 mL NovoLog 28 days4 $12 Uses NovoFine or BD Novo Nordisk increments42 cartridges (AWP) pen needles.31,42 Can www.novonordiskcare.com add Penmate 1-800-727-6500 attachment to hide needle during injection.43

Novo Pen Junior Reusable pen 1-35 units in ½ unit 3 mL NovoLog 28 days4 $35.99 Uses NovoFine or BD Novo Nordisk increments44 cartridges (AWP) pen needles.31,44 Can www.novonordiskcare.com add Penmate 1-800-727-6500 attachment to hide needle during injection.43,44

Opticlik Reusable pen 1-80 units in 1-unit 3 mL Lantus cartridges 28 days15 Free Digital display. Sanofi-aventis increments45 Three-year lifespan.45 www.opticlik.com 3 mL Apidra 28 days6 Compatible with BD 1-800-981-2491 cartridges pen needles.31 Do not refrigerate pen.53 More. . . Copyright © 2010 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.pharmacistsletter.com ~ www.prescribersletter.com

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Device Description Dosage range Insulin used Stability of Costb Comments Manufacturer and precision in-use pens at room temp Solostar Prefilled 1-80 units in 1-unit Apidra 28 days6 $201.01/5 Can use BD pen Sanofi-aventis disposable pen increments45 needles.6,31 www.sanofi-aventis.us Lantus 28 days15 $202.71/5 1-800-981-2491

Misc. Non-Insulin Injectable Agents Brand (generic), Therapeutic Class Administration Meal Timing Formulation Stability (in-use Costb Maker at room temp) Byetta Incretin mimetic Subcutaneous Within 60 minutes 5 mcg dose, 60 30 days $245.02 (5 mcg, (exenatide)46 (glucagon-like injection before morning and doses, 1.2 mL 1.2 mL pen) Amylin peptide-1 [GLP-1] evening meals, or prefilled pen www.byetta.com receptor agonist) the two main meals, $271.45 (10 mcg, at least 6 hours 10 mcg dose, 60 2.4 mL pen) apart doses, 2.4 mL prefilled pen Victoza Incretin mimetic Subcutaneous Once daily, any 6 mg/mL, 3 mL 30 days $240.80/2 of (liraglutide)47 (glucagon-like injection time of day, multi-dose pen 3 mL pen) (WAC) Novo Nordisk peptide-1 [GLP-1] independent of www.victoza.com receptor agonist) meals $361.20/3 of 3 mL pen) (WAC) Symlin Synthetic amylin Subcutaneous Immediately before 5 mL vial 30 days $201.04/2 of (pramlintide)48 analog injection major meals (i.e., (0.6 mg/mL) SymlinPen 60 Amylin >250 kcal or >30 g www.symlin.com carbohydrates) SymlinPen 60 $311.56/2 of (1.5 mL; 1 mg/mL) SymlinPen 120

SymlinPen 120 $227.69/5 mL vial (2.7 mL; 1 mg/mL) a. Novo Nordisk does not recommend the storage of insulin products in pre-drawn syringes12 or mixing insulins from different manufacturers in the same syringe.21 No data provided for stability of insulin mixtures in vials.12 b. From www.drugstore.com at time of writing, unless otherwise noted. AWP = Average Wholesale Price; WAC = Wholesale Average Cost c. A diluent is available for Humalog, Humulin R, Humulin N, Humulin 70/30, and Humulin R U-500 (800-821-0528); and for NovoLog (800-727-6500). d. Based on subcutaneous administration. More. . . Copyright © 2010 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.pharmacistsletter.com ~ www.prescribersletter.com

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Users of this document are cautioned to use their own 17. Kaplan W, Rodriguez LM, Smith OE, et al. Effects of professional judgment and consult any other necessary mixing glargine and short-acting insulin analogs in or appropriate sources prior to making clinical glucose control. Diabetes Care 2004;27:2739-40. judgments based on the content of this document. Our 18. Hassan K, Rodriguez LM, Johnson SE, et al. A randomized, controlled trial comparing twice-a-day editors have researched the information with input from insulin glargine mixed with rapid-acting insulin experts, government agencies, and national analogs versus standard neutral protamine organizations. Information and Internet links in this Hagedorn (NPH) therapy in newly diagnosed type 1 article were current as of the date of publication. diabetes. Pediatrics 2008;121:e466-72. 19. Fiallo-Scharer R, Horner B, McFann K, et al. Mixing Project Leader in preparation of this Detail- rapid-acting insulin analogues with insulin glargine in Document: Melanie Cupp, Pharm.D., BCPS children with type 1 diabetes mellitus. J Pediatr 2006;148:481-4. 20. Product information for NovoLog Mix 70/30. Novo Nordisk Inc. Princeton, NJ 08540. July 2009. References 21. Personal communication. M. Kathari. Medical 1. Assemi M, Morello CM. Diabetes mellitus. In: Information Dept. Novo Nordisk. Princeton, NJ Berardi RR, Ferreri SP, Hume AL, et al., editors, 08540. February 17, 2010. Handbook of nonprescription drugs. 16th ed. 22. Product information for Humalog Mix 75/25. Eli Lilly Washington, DC: American Pharmacists and Company. Indianapolis, IN 46285. March 2009. Association; 2009. p. 837-67. 23. Patient product information for Humulin 70/30 pen. 2. Product information for Humalog. Eli Lilly and Eli Lilly and Company. Indianapolis, IN 46285. Company. Indianapolis, IN 46285. March 2009. March 2009. 3. McEvoy GK, editor. AHFS drug information. 24. Product information for Humalog Mix 50/50. Eli Lilly Bethesda, MD: American Society of Health-System and Company. Indianapolis, IN 46285. March 2009. Pharmacists; 2009. 25. Patient product information for Novolin 70/30. Novo 4. Product information for NovoLog. Novo Nordisk Inc. Nordisk Inc. Princeton, NJ 08540. June 2009. Princeton, NJ 08540. October 2009. 26. Owen Mumford. 5. Novo Nordisk. NovoLog pharmacology. http://www.owenmumford.com/en/range/6/autopen.ht http://www.novomedlink.com/products/novolog/phar ml. (Accessed February 7, 2010). macology.aspx. (Accessed February 3, 2010). 27. Product instructions for Autopen 24. Owen Mumford 6. Product information for Apidra. Sanofi-aventis U.S. Ltd. Oxford, England OXO20 1TU. April 2006. LLC. Bridgewater, NJ 08807. February 2009. 28. Product instructions for Autopen Classic. Owen 7. Product information for Novolin R. Novo Nordisk Inc. Mumford Ltd. Oxford, England OXO20 1TU. Princeton, NJ 08540. June 2009. 29. Novo Nordisk. Common questions about FlexPen. 8. Patient product information for Humulin R. Eli Lilly http://www.novonordiskcare.com/flexpen-common- and Company. Indianapolis, IN 46285. September questions/. (Accessed February 7, 2010). 2009. 30. Novo Nordisk. Our prefilled insulin pen. 9. Personal communication. M. Kathari, Medical http://www.novolog.com/devices- Information Dept. Novo Nordisk. Princeton, NJ flexpen.asp?s=ds&h=150. (Accessed February 7, 08540. February 18, 2010. 2010). 10. Product information for Humulin R U-500 31. BD. Compatibility chart. BD pen needles. (concentrated). Eli Lilly and Company. Indianapolis, http://www.bd.com/resource.aspx?IDX=10818. IN 46285. September 2007. (Accessed February 8, 2010). 11. American Diabetes Association. Insulin 32. Novo Nordisk. Answers to your most FAQ about administration. Diabetes Care 2004;27(Suppl Novolog. http://www.novolog.com/questions- 1):S106-9. default.asp?s=faqs#q16. (Accessed February 9, 12. Personal communication. C. Lum. Drug information 2010). Dept. Novo Nordisk. Princeton, NJ 08540. 33. Eli Lilly. HumaPen Luxura HD. September 2, 2009. http://www.humalog.com/humalog-insulin- 13. Patient product information for Humulin N pen. Eli pens/humapen-luxura-insulin-pen.jsp. (Accessed Lilly and Company. Indianapolis, IN 46285. March February 9, 2010). 2009. 34. User manual for HumaPen Luxura HD. Eli Lilly and 14. Patient product information for Novolin N. Novo Company. Indianapolis, IN 46285. November 2006. Nordisk Inc. Princeton, NJ 08540. June 2009. 35. Eli Lilly. HumaPen Memoir. 15. Product information for Lantus. Sanofi-aventis U.S. www.humalog.com/humalog-insulin-pens/humapen- LLC. Bridgewater, NJ 08807. September 2009. memoir-insulin-pen.jsp. (Accessed February 9, 16. Product information for Levemir. Novo Nordisk Inc. 2010). Princeton, NJ 08540. July 2009. 36. User manual for HumaPen Memoir. Eli Lilly and Company. Indianapolis, IN 46285. November 2006.

37. Eli Lilly. Original prefilled pen. 48. Product information for Symlin. Amylin http://www.humalog.com/humalog-insulin- Pharmaceuticals, Inc. San Diego, CA 92121. July pens/humalog-prefilled-insulin-pen.jsp. (Accessed 2008. February 9, 2010). 49. Tarr BD, Campbell RK, Workman TM. Stability and 38. User manual for prefilled insulin delivery device. Eli sterility of biosynthetic human insulin stored in plastic Lilly and Company. Indianapolis, IN 46285. April syringes for 28 days. Am J Hosp Pharm 2009. 1991;48:2631-4. 39. Personal communication. A. Giles. Customer 50. Personal communication. Lilly Answers Center. Lilly service. Owen Mumford Inc. Marietta, GA 30062. USA, LLC. February 15, 2010. February 9, 2010. 51. Personal Communication. Lilly Answers Center. 40. User manual for Humalog KwickPen. Eli Lilly and Lilly USA, LLC. February 16, 2010. Company. Indianapolis, IN 46285. September 2007. 52. Novo Nordisk. FlexPen FAQ. 41. Eli Lilly. Insulin pens. http://www.novonordisk.com/diabetes/public/insulinp http://www.humalog.com/humalog-insulin- ens/flexpen/faq.asp. (Accessed February 15, 2010). pens/humalog-insulin-pens.jsp. (Accessed February 53. Opticlik. Answers to your questions. Sanofi-aventis 9, 2010). U.S. 42. User manual for NovoPen 3. Novo Nordisk Inc. http://www.opticlik.com/questions_answers.aspx. Princeton, NJ 08540. 2001. (Accessed February 23, 2010). 43. Novo Nordisk. Penmate. 54. Crasto W, Jarvis J, Hackett E, et al. Insulin U-500 in http://www.novonordisk.com/diabetes/public/insulinp severe insulin resistance in type 2 diabetes mellitus. ens/novopen3/penmate/default.asp. (Accessed Postgrad Med J 2009;85:219-22. February 9, 2010). 55. Patient information Humulin R U-500 (concentrated). 44. User manual for NovoPen Junior. Novo Nordisk Inc. Eli Lilly & Co. Indianapolis, IN 46285. September Princeton, NJ 08540. 2002. 2007. 45. Gebel E. Insulin pens. Diabetes Forecast. 2010 56. Garg R, Johnston V, McNally PG, et al. U-500 Consumer Guide. insulin: why, when and how to use in clinical http://forecast.diabetes.org/files/images/v63n01_p52 practice. Diabetes Metab Res Rev 2007;23:265-8. v4.pdf. (Accessed February 9, 2010). 46. Product information for Byetta. Amylin Pharmaceuticals, Inc. San Diego, CA 92121. October 2009. 47. Product information for Victoza. Novo Nordisk Inc. Princeton, NJ 08540. January 2010.

Cite this Detail-Document as follows: Comparison of insulins and injectable diabetes meds. Pharmacist’s Letter/Prescriber’s Letter 2010;26(3):260304.

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