Insulin

Where Does Commercial Insulin Come From?

The first successful insulin preparations came from cows (and later pigs). The pancreatic islets and the insulin protein contained within them were isolated from animals slaughtered for food in a similar but more complex fashion than was used by our doctor and med-student duo. The bovine (cow) and porcine (pig) insulin were purified, bottled, and sold. Bovine and porcine insulin worked very well (and still do!) for the vast majority of patients, but some could develop an allergy or other types of reactions to the foreign protein (a foreign protein is a protein which is not native to humans).

In the 1980's technology had advanced to the point where we could make human insulin. The advantage would be that human insulin would have a much lower chance of inducing a reaction because it is not a foreign protein (all humans have the exact same insulin, so we do not "see" this as a foreign protein).

The technology which made this approach possible was the development of recombinant DNA techniques. In simple terms, the human gene which codes for the insulin protein was cloned (copied) and then put inside of bacteria. A number of tricks were performed on this gene to make the bacteria want to use it to constantly make insulin. Big vats of bacteria now make tons of human insulin. From this, pharmaceutical companies can isolate pure human insulin.

Insulin may be a key part of your treatment if you suffer from Diabetes. Insulin enables your body to use glucose. Different types of insulin can act very differently in different people. Insulin regime suitable for individual patients are tailored by your diabetes care team. Type or dosage of insulin can be changed if required to meet the individual needs of the patient.

The Insulin can be packaged in vials (bottles), cartridges or prefilled pens. The vials are used with syringes, whereas the cartridges are used with pen injectors. Prefilled pens are disposable pen injectors, which contain insulin. Prefilled pens are useful for people with dexterity or visual problems.

Insulin type	Name of insulin	Manufacturer	Source	Vial, cartridge or prefilled pen
Rapid-acting analogue	Humalog	Lilly	analogue	vial & cartridge
	Humalog	Lilly	analogue	prefilled pen
	Novorapid	Novo Nordisk	analogue	vial
	Novorapid Penfill	Novo Nordisk	analogue	cartridge
	Novorapid Novolet	Novo Nordisk	analogue	prefilled pen

Long-acting analogue	Lantus	Aventis	analogue	vial, cartridge & prefilled pen
	Levemir	Novo Nordisk	analogue	cartridge

Short-acting	Human Actrapid	Novo Nordisk	human	vial
	Actrapid Pen	Novo Nordisk	human	prefilled pen
	Actrapid Penfill	Novo Nordisk	human	cartridge
	Human Velosulin	Novo Nordisk	human	vial
	Pork Actrapid	Novo Nordisk	pork	vial
	Humaject S	Lilly	human	prefilled pen
	Humulin S	Lilly	human	vial & cartridge
	Hypurin Bovine Neutral	CP Pharmaceuticals	beef	vial & cartridge
	Hypurin Porcine Neutral	CP Pharmaceuticals	pork	vial & cartridge
	Insuman Rapid	Aventis Pharma	human	vial & cartridge
	Insuman Rapid Opti Set	Aventis Pharma	human	prefilled pen

Medium and long-acting	Humulin I	Lilly	human	prefilled pen
	Humulin I	Lilly	human	vial & cartridge
	Humulin Lente	Lilly	human	vial
	Humulin ZN	Lilly	human	vial
	Human Insulatard	Novo Nordisk	human	vial
	Insulatard Penfill	Novo Nordisk	human	cartridge
	Human Insulatard Pen	Novo Nordisk	human	prefilled pen
	Human Monotard	Novo Nordisk	human	vial
	Pork Insulatard	Novo Nordisk	pork	vial
	Human Ultratard	Novo Nordisk	human	vial
	Hypurin Bovine Isophane	CP Pharmaceuticals	beef	vial & cartridge
	Hypurin Bovine Lente	CP Pharmaceuticals	beef	vial
	Hypurin Bovine Protamine Zinc	CP Pharmaceuticals	beef	vial
	Hypurin Porcine Isophane	CP Pharmaceuticals	pork	vial & cartridge
	Insuman Basal	Aventis Pharma	human	vial & cartridge
	Insuman Basal OptiSet	Aventis Pharma	human	prefilled pen

Analogue mixtures	Humalog Mix25	Lilly	analogue	cartridge
	Humalog Mix25	Lilly	analogue	prefilled pen
	Humalog Mix50	Lilly	analogue	prefilled pen
	NovoMix 30	Novo Nordisk	analogue	prefilled pen & cartridge

Mixtures	Humaject M3	Lilly	human	prefilled pen
	Humulin M2	Lilly	human	cartridge
	Humulin M3	Lilly	human	vial & cartridge
	Humulin M5	Lilly	human	vial
	Human Mixtard 30	Novo Nordisk	human	vial
	Human Mixtard 50	Novo Nordisk	human	vial
	Human Mixtard 10 Pen	Novo Nordisk	human	prefilled pen
	Human Mixtard 20 Pen	Novo Nordisk	human	prefilled pen
	Human Mixtard 30 Pen	Novo Nordisk	human	prefilled pen
	Human Mixtard 40 Pen	Novo Nordisk	human	prefilled pen
	Human Mixtard 50 Pen	Novo Nordisk	human	prefilled pen
	Mixtard 10 Penfill	Novo Nordisk	human	cartridge
	Mixtard 20 Penfill	Novo Nordisk	human	cartridge
	Mixtard 30 Penfill	Novo Nordisk	human	cartridge
	Mixtard 40 Penfill	Novo Nordisk	human	cartridge
	Mixtard 50 Penfill	Novo Nordisk	human	cartridge
	Pork Mixtard 30	Novo Nordisk	pork	vial
	Hypurin Porcine Isophane 30/70 mix	CP Pharmaceuticals	pork	vial & cartridge
	Insuman Comb 15	Aventis Pharma	human	vial & cartridge
	Insuman Comb 15 OptiSet	Aventis Pharma	human	prefilled pen
	Insuman Comb 25	Aventis Pharma	human	vial & cartridge
	Insuman Comb 25 OptiSet	Aventis Pharma	human	prefilled pen
	Insuman Comb 50	Aventis Pharma	human	vial & cartridge
	Insuman Comb 50 OptiSet	Aventis Pharma	human	prefilled pen

There are three main types of insulin, which are also available in various combinations in pre–mixed form, however there are many Brand names.

Rapid-acting analogue insulin can be injected 5 to 15 minutes before eating, when eating or immediately after eating. Being very short-acting, they can last for between 2 and 5 hours, however, they may not last quite long enough to control blood glucose levels between meals and may need to be mixed with a longer acting insulin,( see below). These insulins are clear. Since these Insulins are clear, if ‘frosting’ is seen around the bottle or particles in the insulin, Insulin should NOT be used.

Long-acting analogue insulin is a longer acting insulin form. Since this Insulin is more slowly absorbed and its effect last longer, up to 24 hrs in duration. It’s taken only once a day, in the evening. This Insulin has a clear appearance, as opposed to cloudy like other long acting insulin. Should any sediment be seen in the insulin, it should be discarded and not used.

Short–acting, or soluble insulin, works quickly to lower blood glucose and is usually taken 15 to 30 minutes before a meal to compensate for the rise in blood glucose that occurs after a meal. Its optimum effectiveness is within two to six hours after injecting and can last for up to eight hours. This insulin should always appear clear. If Insulin is cloudy or contains sediment, please discard and do not use.

Medium and long-acting insulin work maintain your blood glucose under control between meals over a period of several hours. The peak activity is normally between 4 and 12 hours after injecting and can last from 8 to 30 hours. They are often used in combination with short-acting insulin. These insulins usually look cloudy, however, If the cloudiness is uneven, or if there are clumps seen floating in the bottle, please discard and do not use.

Mixtures are combinations of both short and longer acting insulins in various proportions. Mixtures are taken normally 15 to 30 minutes before a meal to compensate for the rise in blood glucose that occurs after a meal. The longer acting proportion will continue to work in between meals. These insulins are usually cloudy in appearance.

If you are using medium, long-acting or pre-mixed insulin, you need to ensure you tip (upend) the bottle about 20 times to ensure the cloudy layer is mixed with the clear layer.

Please note that this information is for general use only. Question about Insulin, Diabetes or its care please consult your diabetes care team.

Diabetes--------

Insulin