Difference Between Insulins

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1

I found this information on Wikipedia today and thought it was interesting. I've always understood that Lantus was the same as Levemir, just a different company. And that Humalog was the same as Novolog, but different company. But looking at Wiki this morning, I noticed a few other differences.

BASALS:

In 1946, Nordisk was able to form crystals of protamine and insulin and marketed it in 1950 as NPH insulin. NPH insulin has the advantage that it can be mixed with an insulin that has a faster onset to complement its longer lasting action.

NPH has peaks and valleys and lasts for up to 12 hours. I used to be on this when I was first diagnosed 12 years ago, but because of the peaks (about 4 or 6 hours after injection), I would have to eat at certain times to avoid severe lows.

Sanofi-Aventis developed glargine as a longer lasting insulin analogue, and markets it under the trade name Lantus.

When the pH 4.0 solution is injected, most of the material precipitates and is not bioavailable. A small amount is immediately available for use, and the remainder is sequestered in subcutaneous tissue. As the glargine is used, small amounts of the precipitated material will move into solution in the bloodstream, and the basal level of insulin will be maintained up to 24 hours.

Wow. That totally explains why I would DIP into insulin shock comas while I was sleeping. And it also explains why Lantus burned. It's an acid based insulin.

Novo Nordisk created insulin detemir and markets it under the trade name Levemir as a long-lasting insulin analogue for maintaining the basal level of insulin.[5][6] The basal level of insulin may be maintained up to 20 hours, but the time is clearly affected by the size of the injected dose.

There aren't peaks in Levemir like there are in Lantus, but HELLO! how come my doctor never told me that Levemir only lasts UP TO 20 hours? I noticed it on my own. I split my Levemir dose (with the suggestions of you guys) on my own - against the doc's orders. Duh! It says it right there! Levemir is NOT a 24 hour basal... but it doesn't have peaks and valleys like Lantus does.

BOLUS:

Eli Lilly and Company had the first insulin analogue with "lispro" as a rapid acting insulin analogue. It is marketed under the trade name Humalog.

It's been documented that Humalog lasts from 4-6 hours in the blood stream. For me, it decreased in potency as time wore on. For the first hour, it would drop my BG relatively quick (depending on the dosage I took), but then its potency would taper off and it would become even slower before it was out of my bloodstream after 4 hours time.

Novo Nordisk created "aspart" and marketed it as NovoLog/NovoRapid (UK-CAN) as a rapid acting insulin analogue.

NovoLog works the same way, basically, as Humalog- but it is made with yeast.

Glulisine is a newer rapid acting insulin analog from Sanofi-Aventis, approved for use with a regular syringe, in an insulin pump or the Opticlik Pen [1]. Standard syringe delivery is also an option. It is sold under the name Apidra. The FDA-approved label states that it differs from regular human insulin by its rapid onset and shorter duration of action

Apidra seems to stay in the system for 2-3 hours and it works as soon as 15 minutes after injection. For me, it would lower my BG within 15 minutes, sometimes dropping it 100 points (depending on the dosage and correction factor). When I first started Apidra, I had to cut my correction factor and Insulin:Carb ratios in HALF versus when I was on Humalog. Apidra was twice as fast and twice as strong. Apidra is newest on the market and no known side effects.

2

So a key difference between Lantus and Levemir is that Lantus is an acid formulation and it forms these crystal precipitates when you inject. Levemir (detemir) is already bound up in a fatty acid and protein. If Lantus is injected into a muscle or a vein, it can be dispersed immediately and it can act much more like a rapid insulin. I am not clear what was happening with you. But Levemir is already bound and when injected it does not have that same risk of immediate release. Gretchen Becker has a good discussion of this here (http://www.healthcentral.com/diabetes/c/5068/11388/lantus-lows).

3

BSC- I think Lantus even says in their guide that it dispenses a larger amount in the beginning right after injection, and then it slows down. So it has a small peak in the first few hours. I don’t know if it’s true, but that’s what the guide says.

When I was injecting it, though, I even tried injecting in the morning and then again in the afternoon and I’d still go into insulin shocks while I was asleep. It was the strangest thing. And life threatening. I just did not react well to the drug.

And the other thing that really surprised me was Levemir was documented to only work for UP TO 20 hours. My Endo told me it was another 24 hour scrip. So, my BG going up after 20-21 hours was NORMAL. And my splitting the Levemir dosage was the smart thing to do- even though my Endo said it wouldn’t make a difference.

Ugh.

4

Thanks, Marps! This explains why I used to go ultra-low very soon after taking Lantus when I was doing MDI. It must have something to do with the failure of Lantus to precipitate consistently, especially in scar tissue. I always took my Lantus in the mornings and avoided severe hypoglycemia…I was alert and able to correct the hypoglycemia before it became too bad.

5

Thanks Marps, now I have confirmed what I was thinking about Humalog, it lasts a good 5 hrs on me and lowers me the entire time. Thought so! :slight_smile:

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Interesting stuff you found. I have been on Lantus and Novolog and Nph all at the same time. Lantus never lasted 24 hours in my system an I never had any peak or valleys on it. It was a good draft horse to keep my blood sugars level but as I am not the ususal diabetic have IR my body will hurk and jerk on its own. That is where the NPH and novolog came in. With Novolog I had to be careful not to “stack” because it took longer to work and lasted longer in my system than it average. If it stacked my afternoon sucked. The NPH takes a while to peak to I took it at bedtime to stop the morning rises. My blood sugars can rise in the morning by 100 pts at times and I haven’t even eaten anything. So what is in the text book isn’t always how it works in real life. I was shooting up about 6 to 8 times a day with all those insulins now I’m on Humulin 500 only made by lily. It is a heavy hitter and can last up to 5 hours but it can catch mr by “stacking” as well. I think insulin is by trial and error. You really need toknow thy self has Sheakspeare said.

7

I am not sure of the differences as I am not a chemist, but I know there are some. I had allergic reactions to Novolin and I am taking Humalog. If you are going to take Levemir once a day it should be in the morning so you can monitor how it works as low levels is the risk at bedtime even the manufacture says so on that one and you can adjust whatever else you are taking to get the high at the end. If you are like me on high levels it defiantly works better to split it up for even coverage. Everyone is different so it is always a matter of finding what is right for you no doctor can apply a one fixes all he has to work with you and you have to be aware of what is happening to you.

8

Thanks for doing my homework :slight_smile:
I’m currently using Novolog and was thinking of checking out Apidra because it’s faster & shorter acting

9

Carrie I am not an expert on this one but have been told by a family member that Apidra will be one to inject 3x preferable at meal time once you get a good schedule and Levemir 2x. Untill you get it just right then there will be some highs and lows but you can average after about 14 days which can be nice at times to just take a med and not count everything after taking bgL :slight_smile:

10

Children are way more active at times so insulin is a constant battle on top of the diabetes you are already fighting. Not to mention what kids want to eat as well.

11

Marp, Thank you for all the good information. I have often wondered how all these different brands function.

12

It’s been 60 years since NPH was introduced and we still can’t get a generic version…

13

Since insulin is needed why can’t the cost come down for everyone? I currently take/inject two types that cost $511.00 a month plus the supplies seems there could be some kind of bundle or some thing.

14

Wornout- I didn’t even think of using NPH to combat morning DP. How fascinating! I never even thought to use it’s basal “peaks” for my own good. That’s what I love about this place! Always learning! I’m glad you’ve found something to work for you!

Right now, I’m not going to try it, because I’m slowly figuring out how to combat morning DP on my own- still splitting Levemir into 2 doses a day, but also started Metformin a few days ago. It seems to be helping, but I can’t know for sure for another few weeks when It’s fully in my system. No side effects yet. Thankfully.

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Hi Phill Dill- I have tried everything when it came to changing the TIME, SITE, DOSAGE, etc for Levemir and Lantus. The only time it works for me is nighttime. And I had to split Levemir because it only lasted for UP to 20 hours. My biggest upset about this information is that it was right in the fine print, and EVERY doctor (I’ve had a few since going on Levemir) has stated that it was a 24 hour drug. And i though that i was going crazy because it wasn’t lasting 24 hours in me. And I was telling the Endos that it wasn’t lasting long enough, and they still insisted that it was lasting 24 hours. I was upset because NO doctor read the fine print. I had to find it out on my own- which I guess I’m fine with (I typically like to be “Hands On” when it comes to my health anyway) but… it just seems like I’ve found a few lazy doctors in my area. And I can’t get away from them.

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CourtneyV- Me too. Lantus (no matter what time I took it) would cause severe overnight lows that would put me in insulin shock comas. I’m still paying those bills because I was uninsured (crappy job- that’s my fault) at the time that was happening. I’ve been waking up BEFORE DP hits lately. haha. I found out if I wake up after only 5 hours of sleep, I beat DP to the punch and I can inject insulin before it hits. :slight_smile:

17

I hear ya Marps my doctor will tell you he does not have all the answers although he does have diabetes and everyone is different and will continue to learn as it changes as we get older because we change. I have a problem with his stagg which will be addressed again in just a few hours and the pharmacy is mad as well at his nurse that sends out the scripts. The one thing I love is I can change my meds to my needs till I get a balance then get a new script for it. In case no one has told you Levemir works best if can take less than 100 units a day as I take 40 at bedtime and 25 at breakfast. I await my new A1c today my meter says I have an average of 179 for 30 days it is not good but way better than before at 11.

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Dill - My A1c I hope is coming down too. Meter says 30 day average is 126 but I have the Dex which tells me when I have a problem. So, I’m still testing w my meter 10+ times per day, but only when I’m having “Problems”, so I don’t think I can trust that 126. We’ll see. :slight_smile:

I’m splitting 27u in the morning and 30u at night.

Hope yours comes out well! I’m struggling with a plateauing 8.5% And I’ve NEVER been below 7.5% since diagnosis 12 years ago.

19

Here is what is crazy but just a part of D in 2002 a1c was high when i was offically diagnosed over a 2 year period got it to 6 and I was so happy with that. 4 years ago it was a 10 worked on it got down to 8 on oral then came the hurricane and got of meds for a little while got me a trip to hospital i was at 10 or higher then I got on meds and got it to about a 7.5 feeling well then in a one month period i felt bad adn all the rest got to see doctor and the orals no longer working at all i was at 11 so i went on insulin as needed started off with 30 units novolog 2x daily had a reaction in 5 days and bgl was still at 450 so I got Levemir 50 units at bedtime and humalog 30 2x per day after 15 days see doc again i am down to 300 average and highs about 18 hours after injection he said change as needed in the next 30 days and test morning before and 1 hour after everytime i eat and before bed time so that is 10 times a day and a real pain, hahaha, we are trying to determine if i need to fo back on humalog R as well. enough for now as this can go on for days, lmao i am sure you know all about it.

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I had someone pull the 24-hour crap on me also. I keep telling them to read the prescribing information. Fortunately, the doctor that originally started me on Levemir knew it didn’t last 24 hours. I actually take it every 8 hours - it only lasts 7 hours for me. Every time someone questions that, I point out that according to the prescribing information, the duration can actually be less than 6 hours. I am not interested in adding more to extend the duration. I can do a 24-hour basal test and stay fairly flat so I know what I am doing works. You couldn’t pay me to go back to Lantus.

As for the Apidra, I have seen charts that say that it actually starts in 20 minutes. That is about what it does for me - I can see that with a CGMS. But it is way more consistent than Humalog or Novolog ever was. I also tier my insulin so having it get out of my system in 2 ½ hours is nice for me.