Comparison of Insulins (United States)

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