Endocrinology Book

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Insulin

Aka: Insulin, Regular Insulin, NPH Insulin, Lispro, Insulin Lente, Ultralente Insulin, Novolin, Humulin, Novolog, Fiasp, Humalog, Admelog, Short-Acting Insulin, Bolus Insulin, Aspart, Apidra, Glulisine, Insulin-Related Errors, Insulin Pen
  1. See Also
    1. Insulin Dosing
    2. Insulin Simulation
    3. Glucose Metabolism
  2. Technique
    1. Injection sites: Abdomen, outer thigh, back of arm, flank and buttocks
    2. Insert needle at 90 degree angle into skin
    3. Insulin injection is subcutaneous (not intramuscular)
      1. Intramuscular Injection results in rapid absorption and risk of Hypoglycemia
      2. Prevent too deep of injection (esp. longer needles) by pinching an inch of skin at the injection site
    4. Hold needle in place for 5-10 seconds after injection to prevent leakage of Insulin
    5. Rotate injection sites to prevent lipohypertrophy (see adverse effects below)
  3. Preparations: Insulin Selection
    1. New Insulin anologues are preferred
      1. More consistent absorption than traditional Insulin
      2. Bolus analogues have more rapid onset
      3. Basal agents release at more constant rate
    2. New anologues are however 10 fold more expensive than Regular Insulin and NPH
      1. Very high cost results in patients stopping Insulin, resulting in hospitalization and even death
      2. Vials of NPH Insulin and Regular Insulin are each $26 per vial OTC at Walmart as of 2017
        1. Contrast with $250 per vial for analogues (e.g. Insulin Lispro, Insulin Glargine)
      3. Outcomes are similar with newer analogues versus older NPH Insulin and Regular Insulin
      4. (2015) Presc Lett 22(11):61-2
      5. (2019) Presc Lett 26(8): 43-4
    3. Combination agents are discouraged unless noncompliant
      1. Insulin 70/30 is also $26 OTC at Walmart as of 2017 (Reli-On)
      2. Reduces flexibility in meal and activity timing
  4. Preparations: Syringes and needles
    1. Needle length
      1. Longer needles risk deeper, intramuscular penetration, with more rapid absorption and Hypoglycemia risk
      2. Insulin Pen needles 4 mm are sufficiently long
      3. Insulin syringe needles should be at least 6 mm long to clear the syringe stopper
    2. Needle gauge
      1. Smaller needles (higher gauge) 30 or 31 are preferred for the least discomfort on insertion
    3. Syringe volume
      1. Select smallest Insulin syringe that will hold each of the Insulin doses, allowing for added coverage
      2. Prescribe syringes in number of boxes (100 syringes per box)
      3. Syringes are sized at 100 units Insulin/ml
        1. Insulin 30 units per 0.3 ml syringe
        2. Insulin 50 units per 0.5 ml syringe
        3. Insulin100 units per 1 ml syringe
    4. References
      1. (2014) Presc Lett 22(1): 4
  5. Preparations: Insulin Pens
    1. Supplied
      1. Insulin Pens are supplied in boxes of 5 pens each containing 3 ml at 100 units Insulin per ml
    2. Precautions
      1. Insulin Pens appear similar to one another despite containing different Insulins (basal or bolus)
      2. Read each syringe carefully (and note its color) prior to each injection to prevent Overdose errors
      3. Prepare cloudy Insulins (e.g. NPH) by gently rolling and inverting the pen 10 times prior to injection
      4. Confirm proper use by asking the patient to demonstrate preparation and injection at clinic visits
    3. Technique
      1. Attach a new needle to Insulin Pen before each use
      2. Prime the new needle with 2 units prior to use (removes air bubbles)
      3. Dial the dose
      4. Apply to pen to injection site, press the button, and hold in place for 5-10 seconds
      5. Discard the used needle
  6. Drug Interactions: Diabetes Agents
    1. Agents safe to use with Insulin
      1. Metformin
      2. Thiazolidinediones
      3. Alpha-glucosidase Inhibitors
      4. Sitagliptin (Januvia)
    2. Agents safe to use with basal Insulin (Lantus, Levemir); avoid or use caution if used with Bolus Insulin (Lispro, Aspart)
      1. Sulfonylureas
      2. Glitinides
  7. Agents: Intravenous Regular Insulin
    1. Note that all other Insulins listed on this page are subcutaneous
    2. See Insulin Drip
    3. Onset: Immediate
    4. Half-life: 5-10 minutes
  8. Precautions: Insulin-Related Errors
    1. Insulin errors result in >100,000 emergency visits (typically Hypoglycemia related) annually in United States
    2. Wrong Insulin (Bolus Insulin mistakenly taken)
      1. Prescribers should carefully check prescriptions and home instructions for errors
        1. Example: Lispro prescribed instead of Lantus
      2. Patients should check Insulin label everytime they inject
        1. Bolus Insulin in vials and pen devices may be easily mistaken for basal Insulin devices
    3. Wrong time
      1. Patients must eat following Bolus Insulin (e.g. Lispro) or do not take Bolus Insulin if plan to skip the meal
    4. Wrong dose
      1. Decrease Insulin for anticipated decreased oral intake
      2. Assist patients with poor vision or dexterity who have difficulty drawing the correct dose
        1. Consider syring magnifier, pen device which click per unit, count-a-dose syringe
    5. Wrong technique
      1. Mix Insulin suspensions before use (e.g. NPH Insulin, Premixed Insulin such as Insulin 70/30)
        1. Roll vials or pens 10 times to mix
      2. Clinic staff should periodically observe patient's technique
        1. Obtaining fingerstick Glucose
        2. Calculating their Insulin dose with expected oral intake
        3. Drawing up Insulin dose
        4. Injecting Insulin
    6. References
      1. (2014) Presc Lett 21(7): 40
  9. Preparations: Bolus Insulins (Meal-time Insulin)
    1. Traditional Insulins
      1. Regular Insulin (Novolin R, Humulin R)
        1. Onset: 15 to 30 minutes
        2. Peak: 2.5 to 5 hours
        3. Duration: 6 to 8 hours
        4. Avoid in Stage IV or Stage V significant Chronic Kidney Disease
        5. Avoid if history of severe Hypoglycemia
        6. Available concentrations
          1. Humulin R U-100 (100 units/ml, orange)
          2. Humulin R U-500 (500 units/ml, green)
            1. Indicated for those with very high Insulin requirements
            2. High risk for dosing errors
            3. Activity is similar to 70/30
              1. Onset in 30 minutes
              2. Longer duration (>12 hours) than other Bolus Insulins
            4. Divide dosing twice to three times daily
            5. Do not combine with other Insulins (i.e. basal Insulins)
            6. Specific U-500 syringes are available as of 2016 to reduce dosing errors
    2. Analogue Insulins (Rapid, consistent absorption)
      1. Glulisine (Apidra)
        1. Onset: 5 to 15 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 5 hours
        4. Similar to other bolus analogues
        5. FDA approved to take after meal
          1. Other analogues expected with same effect
      2. Lispro (Humalog, Admelog)
        1. Onset: 5 to 15 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 5 hours
        4. Concentrations
          1. Humalog U-100 (100 units/ml) vial or KwikPen
          2. Humalog U-200 (200 units/ml) KwikPen - for patients using >20 units/day
      3. Aspart (Novolog, Fiasp)
        1. Onset: 5 to 15 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 5 hours
  10. Preparations: Basal Insulins
    1. Traditional Insulins
      1. NPH Insulin, Novolin N, Humulin N, Humulin L (Lente)
        1. Onset: 1 to 2 hours
        2. Peak: 6 to 8 hours
          1. Peak time is higher risk of hypoglcemia
          2. Consider snack at 6 hours after dose
        3. Duration: 10 to 16 hours (Lente slightly longer)
        4. Humulin L (Lente) discontinued in U.S. in 2006
        5. Increased risk of Hypoglycemia (esp nocturnal) compared with newer analogues
        6. NPH is much less expensive than analogues (still $25/vial as of 2016 at Walmart)
      2. Ultralente Insulin (extended Insulin zinc suspension)
        1. Discontinued in U.S. in 2006
        2. Significant inconsistent effect even in same person
        3. Onset: 6-10 hours
        4. Peak: No peak
        5. Duration: 18 to 24 hours
    2. Analogue Insulins
      1. Detemir (Levemir)
        1. Onset: 2-4 hours
        2. Peak: 6-8 hours
        3. Duration: 12 to 20 hours (varies by dosage)
      2. Glargine (Lantus, Basaglar)
        1. Onset: 1-2 hours
        2. Duration: 21 to 24 hours
        3. Peak: No peak (flat action curve mimics continuous Insulin Infusion)
  11. Preparations: Combination Agents (Type II Diabetes if poor compliance)
    1. NPH 50/Regular 50
    2. NPH 70/Regular 30 (Humulin 70/30 or Novolin 70/30)
    3. NPL 75/Lispro 25 (Humalog Mix 75/25)
    4. NPH 70/Aspart 30 (Novolog Mix 70/30)
  12. Adverse Effects
    1. Hypoglycemia
      1. Increased risk when Hemoglobin A1C <7.4%
      2. Decreased risk with analogue Insulins
      3. Higher risk with severe Renal Insufficiency
        1. Insulin is excreted by the Kidney (30% of total)
        2. Gluconeogenesis occurs in the Kidney (30% of total)
    2. Weight gain (Excess of 4 kg over 10 years)
      1. Countered with Metformin in type 2 diabetics
      2. Countered with diet and Exercise
      3. Benefits of Glucose control outweigh weight risks
    3. Lipohypertrophy
      1. Localized fat hypertrophy and scar tissue from repeated injections in the same area
      2. Results in variable Insulin absorption as below
      3. Prevent by rotating injection sites (see below)
      4. Medical providers should examine injection sites
    4. Variable Insulin absorption
      1. Insulin absorption varies by body site
        1. Abdomen (best absorption)
        2. Arms
        3. Thigh
        4. Buttocks (least absorption)
      2. Variable absorption at lipohypertrophy sites
        1. Poor absorption causes early postprandial Hyperglycemia
        2. Depot formation causes delayed Hypoglycemia
      3. Site rotation (prevents lipohypertrophy - see above)
        1. Rotate injections within same body region
          1. Avoids Insulin absorption variability
        2. Rotate to widely different sites within region
          1. Example: Abdomen rotate to LUQ, RUQ, LLQ, RLQ
  13. Reources
    1. FDA Insulin storage and emergency switching
      1. https://www.fda.gov/Drugs/EmergencyPreparedness/ucm085213.htm
  14. References
    1. (2014) Presc Lett 21(12): 69
    2. Lepore (2000) Diabetes 49:2142-8 [PubMed]
    3. Mayfield (2004) Am Fam Physician 70(3):489-512 [PubMed]
Medication Costs
novolin (on 4/19/2017 at Medicaid.Gov Pharmacy Drug pricing)
NOVOLIN 70-30 100 UNIT/ML VIAL OTC $13.44 per ml
NOVOLIN N 100 UNITS/ML VIAL OTC $13.46 per ml
NOVOLIN R 100 UNITS/ML VIAL OTC $13.47 per ml
humulin (on 5/2/2017 at Medicaid.Gov Pharmacy Drug pricing)
HUMULIN 70/30 KWIKPEN OTC $30.07 per ml
HUMULIN 70-30 VIAL OTC $14.49 per ml
HUMULIN N 100 UNITS/ML KWIKPEN OTC $30.73 per ml
HUMULIN N 100 UNITS/ML VIAL OTC $14.52 per ml
HUMULIN R 100 UNITS/ML VIAL OTC $14.52 per ml
HUMULIN R 500 UNITS/ML KWIKPEN $92.47 per ml
HUMULIN R 500 UNITS/ML VIAL $71.86 per ml
novolog (on 2/23/2017 at Medicaid.Gov Pharmacy Drug pricing)
NOVOLOG 100 UNIT/ML CARTRIDGE $32.98 per ml
NOVOLOG 100 UNIT/ML VIAL $26.46 per ml
NOVOLOG 100 UNITS/ML FLEXPEN $34.15 per ml
NOVOLOG MIX 70-30 FLEXPEN SYRN $34.13 per ml
NOVOLOG MIX 70-30 VIAL $27.46 per ml
humalog (on 5/2/2017 at Medicaid.Gov Pharmacy Drug pricing)
HUMALOG 100 UNITS/ML CARTRIDGE $32.51 per ml
HUMALOG 100 UNITS/ML KWIKPEN $34.03 per ml
HUMALOG 100 UNITS/ML VIAL $26.42 per ml
HUMALOG 200 UNITS/ML KWIKPEN $68.07 per ml
HUMALOG MIX 50-50 KWIKPEN $33.94 per ml
HUMALOG MIX 50-50 VIAL $27.76 per ml
HUMALOG MIX 75-25 KWIKPEN $34.21 per ml
HUMALOG MIX 75-25 VIAL $27.49 per ml
apidra (on 10/19/2016 at Medicaid.Gov Pharmacy Drug pricing)
APIDRA 100 UNITS/ML VIAL $24.50 per ml
APIDRA SOLOSTAR 100 UNITS/ML $31.57 per ml
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Humulin insulin (C0020171)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
SnomedCT 350348002
English insulin, human (Humulin), insulin humulin, humulin, humulin insulin, Humulin insulin, Humulin insulin (substance)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Insulin (C0021641)

Definition (NCI) A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04)
Definition (NCI) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism.
Definition (CSP) protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose and is also an important regulator of protein and lipid metabolism; insulin is used as a drug to control insulin-dependent diabetes mellitus.
Definition (MSH) A 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (GLYCOGENOLYSIS; GLUCONEOGENESIS) and indirectly by suppressing GLUCAGON secretion and LIPOLYSIS. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Insulin is used as a drug to control insulin-dependent diabetes mellitus (DIABETES MELLITUS, TYPE 1).
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D007328
SnomedCT 325014006, 67866001, 39487003, 412222002
LNC LP70329-5, LP16325-0, LP14676-8, LP32542-0, MTHU002108, MTHU019392, LA15805-7
English Insulin, insulin, Regular Insulin, Soluble insulin, Insulin Regular, insulin preparations, insulin preparations (medication), insulin regular, Insulin [Chemical/Ingredient], insulin products, insulin preparation, insulin product, regular insulin, insulins, Insulin, Soluble, Soluble Insulin, Soluble insulin (substance), Insulin regular, Insulin, Regular, Insulin product, Insulin (substance), Insulin preparation, Insulin product (product), Regular insulin product, Unmodified insulin product, Insulin preparation, NOS, Regular insulin preparation, Unmodified insulin preparation, Insulin preparation (substance), Regular insulin (substance), Regular insulin, INSULIN
Swedish Insulin
Finnish Insuliini
French Insuline ordinaire, Insuline soluble, Insuline
Russian INSULIN, ИНСУЛИН
Spanish producto con insulina (producto), preparado insulínico, insulina (producto), producto con insulina, insulina (sustancia), insulina, preparado de insulina (producto), preparado de insulina (sustancia), preparado de insulina cristalina de cinc, preparado de insulina cristalina de zinc, preparado de insulina no modificada, preparado de insulina, insulina regular (sustancia), insulina regular, Insulina
Italian Insulina regolare, Insulina
Croatian INZULIN
Polish Insulina
Japanese インスリン, インスリン亜鉛水性懸濁液, インシュリン
Czech inzulin, insulin
Norwegian Insulin, Oppløselig insulin
German Insulin
Portuguese Insulina
Sources
Derived from the NIH UMLS (Unified Medical Language System)


NPH Insulin (C0021658)

Definition (MSH) An intermediate-acting INSULIN preparation with onset time of 2 hours and duration of 24 hours. It is produced by crystallizing ZINC-insulin-PROTAMINES at neutral pH 7. Thus it is called neutral protamine Hagedorn for inventor Hans Christian Hagedorn.
Definition (NCI) An intermediate-acting insulin used in the treatment of diabetes mellitus. Administered once or twice daily, NPH (neutral protamine hagedorn) insulin lowers blood glucose within 1 to 2 hours after administration and exerts a peak effect at 6 to 10 hours. Endogenous insulin, a pancreatic hormone composed of two polypeptide chains, is important in the normal metabolism of carbohydrates, proteins and fats, promoting glucose utilization and protein synthesis; it has anabolic effects on many types of tissues. (NCI04)
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D007336
SnomedCT 126217003, 66384003, 412219004, 412220005, 412221009
LNC LP16324-3, MTHU019391
English Hagedorn Insulin, Protamine, Insulin, Isophane, Isophane Insulin, Protamine Hagedorn Insulin, Insulin Isophane, Isophane insulin injection, Isophane protamine insulin inj, Isophane protamine insulin injection, Insulin Isophane NPH, NPH Insulin, insulin isophane, Neutral Protamine Hagedorn Insulin, insulins nph, isophane insulin, nph insulin isophane, nph isophane insulin, nph insulin, protamine hagedorn insulin, insulin nph, Insulin, NPH, Insulin, Isophane [Chemical/Ingredient], Isophane insulin preparation (substance), Isophane insulin preparation, Insulin NPH, Isophane Insulin, Regular, Regular Isophane Insulin, Isophane insulin, NPH insulin, Neutral protamine hagedorn insulin, Isophane insulin (substance), Isophane insulin (product), Isophane insulin NPH, Isophane insulin nph (product), Isophane insulin nph (substance), Isophane insulin nph
Finnish Isofaani-insuliini
Russian INSULIN, IZOFAN, INSULIN NPH, INSULIN-IZOFAN, ИНСУЛИН, ИЗОФАН, ИНСУЛИН NPH, ИНСУЛИН-ИЗОФАН
French Insuline neutre protamine Hagedorn, Insuline isophane ordinaire, Insuline NPH, Insuline isophane
Italian Insulina protamina di Hagedorn, Insulina protamina neutra di Hagedorn, Insulina NPH, Insulina isofano
Swedish Insuliln, NPH
Czech NPH insulin, insulin NPH, insulin isofan
Spanish insulina NPH isofánica (producto), insulina isófana (sustancia), insulina isófana, insulina isófana NPH (sustancia), insulina isófana NPH, insulina NPH (sustancia), insulina isofánica, insulina NPH isofánica, insulina NPH isofánica (sustancia), insulina isófana NPH (producto), insulina protamina neutra, Insulina Isófana, Insulina NPH, preparado de insulina isofánica (sustancia), preparado de insulina isofánica, Insulina PNH, insulina NPH, insulina NPH (producto)
Polish Insulina izofanowa wołowo-wieprzowa, Insulina NPH wieprzowa, Insulina NPH ludzka, Insulina izofanowa wołowa, Insulina izofanowa wieprzowa, Insulina NPH wołowa, Insulina izofanowa ludzka, Insulina NPH wołowo-wieprzowa, Insulina izofanowa
Japanese NPHインスリン, イソフェンインスリン, イソファンインシュリン, イソフェンインスリン水性懸濁液, イソファンインスリン, インスリン-イソフェン
Portuguese Insulina NPH, Insulina Isofana
Norwegian Insulin NPH, NPH-insulin, Insulin med middels lang virketid, Insulin, isofant
German Insulin, Isophan-
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Insulin, Lente (C0021659)

Definition (MSH) An insulin, zinc chloride preparation in the form of a suspension of crystals and amorphous material in a ratio of approximately 7:3. Typically, lente insulin has a duration of activity that lasts between 13-20 hours after dosage.
Definition (NCI) A long-acting crystalline insulin often used in combination with a short-acting insulin in the treatment of diabetes mellitus. This type of insulin may be derived from porcine or recombinant sources. Administered once daily, insulin Lente starts to lower blood glucose within 1 to 3 hours after injection and exerts its peak effect 7 to 15 hours after injection. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04)
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D061405
SnomedCT 126218008, 10329000
LNC LP16323-5, MTHU019388
English IZS - insulin zinc suspension, Insulin zinc suspension, Insulin zinc suspension(mixed), Insulin Zinc, insulin zinc, lente insulin, zinc insulin, insulin lente, Lente Insulin, Insulin, Lente, Insulin, Lente [Chemical/Ingredient], Zinc insulin preparation, Zinc insulin preparation (substance), Insulin Lente, Zinc insulin, Zinc insulin (substance)
French Insuline lente
Portuguese Insulina Lenta, Insulina de Ação Lenta
Russian ИНСУЛИН ЛЕНТЕ, ИНСУЛИН МОНОТАРД, INSULIN LENTE, INSULIN MONOTARD
Spanish Insulina Lenta, preparado de insulina cinc (sustancia), preparado de insulina cinc, Insulina de Acción Lenta, insulina cinc (sustancia), insulina cinc, insulina zinc
Czech inzulin Lente
Polish Insulina o przedłużonym działaniu, Insulina lente
Italian Insulina lenta
German Insulin, Lente-, Insulin Lente, Lente-Insulin
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Novolin (C0028467)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D007328
French Novolin
English novolin, NovoLIN, Novolin
Norwegian Novolin
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Ultralente Insulin (C0041616)

Definition (MSH) A preparation of insulin and zinc chloride in the form of a crystalline suspension. Typically the duration of ultralente insulin activity lasts between 18-30 hours after dosage.
Definition (NCI) A long-acting form of crystalline insulin often used in combination with a short-acting insulin in the treatment of diabetes mellitus. Administered once daily, this type of insulin may be derived from porcine, bovine, or recombinant sources. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04)
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D061406
SnomedCT 325097003, 126220006, 54708003, 39487003
LNC LP16327-6, MTHU019398
English IZS - crystalline, Insulin Zinc Extended, Ultralente Insulin, insulin zinc extended, Insulin zinc suspension (crys), Insulin zinc suspension (crystalline), ultralente insulin, insulin ultralente, Insulin, Ultralente, Insulin, Ultralente [Chemical/Ingredient], Insulin zinc, extended, Insulin zinc suspension (crystalline) (substance), Extended zinc insulin preparation, Extended zinc insulin preparation (substance), Insulin ultralente, Extended zinc insulin, Crystalline zinc insulin product, Extended zinc insulin (substance), Crystalline zinc insulin preparation, Insulin Zinc Injectable Suspension
Spanish insulina zinc extendida, insulina zinc de acción prolongada, insulina cinc de acción prolongada (sustancia), insulina cinc extendida (sustancia), insulina cinc de acción prolongada, insulina cinc extendida, Insulina Ultralenta, preparado extendido de insulina cinc, preparado extendido de insulina cinc (sustancia)
French Insuline ultralente
Portuguese Insulina Ultralenta
Russian ИНСУЛИН УЛЬТРАЛЕНТЕ, INSULIN UL'TRALENTE
Czech inzulin Ultralente
Polish Insulina ultralente
Italian Insulina ultralenta
German Insulin Ultralente, Ultralente-Insulin
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Insulin, Aspart, Human (C0123677)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
SnomedCT 388452006, 325072002
English insulin aspart, INSULIN ASPART, human insulin aspart, human insulin aspart (medication), aspart insulin, Insulin, Aspart, Human, Insulin aspart (substance), Insulin aspart, Aspart insulin (product), Aspart insulin, INSULIN,ASPART,HUMAN/rDNA, Insulin Aspart
Spanish insulina aspart, insulina asparta, insulina aspártica, insulina asparta (sustancia), insulina asparta (producto), insulina aspart (producto), insulina aspart (sustancia)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Insulin Lispro (C0293359)

Definition (MSH) Insulin that has been modified so that the B-chain contains a LYSINE at position 28 instead of a PROLINE and a PROLINE at position 29 instead of a LYSINE.
Definition (NCI) A recombinant therapeutic agent which is chemically identical to or similar to endogenous human insulin. In lispro insulin, the amino acid proline at B-28 and the amino acid lysine at B-29 are reversed, resulting in the rapid dissolution of this insulin to a monomer that is absorbed rapidly after subcutaneous administration. Lispro insulin is equipotent to human insulin on a molar basis but its effects are faster and of shorter duration. Endogenous insulin, a pancreatic hormone composed of two polypeptide chains, is important in the normal metabolism of carbohydrates, proteins and fats, promoting glucose utilization and protein synthesis; it has anabolic effects on many types of tissues. (NCI04)
Concepts Hormone (T125) , Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSH D061268
SnomedCT 388454007, 412210000, 125703000
English Insulin Lispro, Insulin lispro, insulin lispro, insulin human lispro, lispro human insulin, lispro insulin, lispro, Lispro, 28(B)-Lys-29(B)-Pro-Insulin, LYSPRO, Lispro, Insulin, 28(B)-Lysine-29(B)-Prolineinsulin, Insulin, Lysyl(28B)-Prolyl(28B)-, Insulin, Lys(28B)-Pro(29B)-, Insulin Lispro [Chemical/Ingredient], INSULIN LISPRO, Lispro insulin (product), Lispro insulin, Lispro insulin (substance), INSULIN,LISPRO,HUMAN/rDNA
French Insuline Lysyl(28B)-Prolyl(28B), Insuline Lispro, LYSPRO, Insuline 28(B)-Lys-29(B)-Pro, Insuline Lys(28B)-Pro(29B), Insuline 28(B)-Lysine-29(B)-Proline, Lispro
Portuguese Insulina Lispro
Russian LIZPRO, ЛИЗПРО, INSULIN LIZPRO, ИНСУЛИН ЛИЗПРО, 28(B)-ЛИЗИН-29(B)-ПРОЛИНИНСУЛИН, 28(B)-LIZIN-29(B)-PROLININSULIN
Spanish Insulina Lispro, insulina lispro (producto), insulina lispro, insulina lispro (sustancia)
Czech inzulin Lispro
Polish Insulina lispro
Italian Insulina lispro
German 28(B)-Lys-29(B)-Pro-Insulin, Insulin, Lysyl(28B)-Prolyl(28B)-, Insulin lispro, Insulin, Lys(28B)-Pro(29B)-, Lys-Pro-Insulin, Lyspro
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Insulin, Short-Acting (C0356365)

Definition (MSH) Insulin derivatives and preparations that are designed to induce a rapid HYPOGLYCEMIC EFFECT.
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D061266
SnomedCT 126213004, 8780003, 325013000, 411531001
English Rapid-acting insulin preparation, Rapid-Acting Insulin, Short-Acting Insulin, Insulin, Rapid-Acting, Insulin, Rapid Acting, Insulin, Short-Acting, Insulin, Short Acting, Insulin, Short-Acting [Chemical/Ingredient], Rapid-acting insulin product (product), Rapid-acting insulin, Rapid-acting insulin product, Rapid-acting insulin (substance), Short-acting insulin, Short-acting insulin (product), Rapid-acting insulin, NOS, Rapid-acting insulin preparation (substance), Short-acting insulin (substance), Insulin, Rapid-acting, Insulin, Short-acting
French Insuline à action rapide, Insuline rapide, Insuline à courte durée d'action, Insuline à effet rapide
Portuguese Insulina de Ação Curta
Russian ИНСУЛИН БЫСТРОДЕЙСТВУЮЩИЙ, ИНСУЛИН КОРОТКОГО ДЕЙСТВИЯ, INSULIN BYSTRODEISTVUIUSHCHII, INSULIN KOROTKOGO DEISTVIIA
Spanish Insulina de Acción Corta, insulina de acción rápida, insulina de acción rápida (sustancia), producto con insulina de acción rápida (producto), producto con insulina de acción rápida, Insulina de Acción Inmediata, insulina de acción corta (producto), insulina de acción corta, preparado insulínico de acción rápida (producto), preparado insulínico de acción rápida (sustancia), preparado insulínico de acción rápida, insulina de acción corta (sustancia)
Czech krátkodobě působící inzuliny, krátkodobě působící insuliny, krátkodobě působící inzulíny
Polish Insulina krótkodziałająca, Insulina krótko działająca, Analog insuliny krótko działający
Italian Insulina rapida
German Insulin, kurzwirkendes, Kurz wirkendes Insulin, Kurzwirkendes Insulin, Insulin, schnellwirkendes, Schnell wirkendes Insulin, Schnellwirkendes Insulin
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Humalog (C0528249)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D061268
English humalog, HumaLOG, Humalog, Eli Lilly brand of Insulin Lispro
French Humalog, Insuline Lispro de marque Eli Lilly
German Humalog, Liprolog
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Regular Insulin, Human (C0795635)

Definition (MSH) Regular insulin preparations that contain the HUMAN insulin peptide sequence.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D061386
SnomedCT 126210001, 96367001, 126216007
LNC LP17001-6
English Insulin Reg Human Semi-Syn, Insulin Reg, Hum S-S Buff, insulin human, Insulin Regular,Human Buffered, Regular Insulin, Human, Human insulin preparation, Insulin human, regular human insulin (Humulin-R), regular human insulin, regular human insulin (medication), insulin regular human recombinant, human insulin, human insulin (medication), INSULIN HUMAN, Insulin, Regular, Human [Chemical/Ingredient], insulin human regular, human regular insulin, Insulin, Regular, Human, insulin regular, human, insulin (human), Semisynthetic human insulin preparation (substance), Semisynthetic human insulin preparation, Human insulin (substance), Human insulin product (product), Human insulin product, Human insulin, Human insulin, NOS, Human insulin preparation (substance), INSULIN,REGULAR,HUMAN BUFFERED, INSULIN,REGULAR,HUMAN/SEMISYNTHETIC, INSULIN,REGULAR,HUMAN/rDNA, Insulin Human
Spanish preparado de insulina humana (producto), insulina humana (producto), preparado de insulina humana, Insulina Regular Humana, preparado de insulina humana semisintética (sustancia), preparado de insulina humana semisintética, insulina humana (sustancia), insulina humana, preparado de insulina humana (sustancia)
French Insuline ordinaire humaine, Insuline régulière humaine
Portuguese Insulina Regular Humana, Insulina Humana Regular
Russian ИНСУЛИН ЧЕЛОВЕЧЕСКИЙ РЕГУЛЯР, ХУМУЛИН, INSULIN REGULIAR CHELOVECHESKII, ИНСУЛИН РЕГУЛЯР ЧЕЛОВЕЧЕСКИЙ, KHUMULIN, INSULIN CHELOVECHESKII REGULIAR
Czech insulin humánní, inzulin lidský, insulin lidský
Polish Insulina zwykła ludzka
Italian Insulina regolare umana
German Humanes Altinsulin, Humanes Normalinsulin, Insulin, normal, human
Sources
Derived from the NIH UMLS (Unified Medical Language System)


NovoLog (C0939412)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH D061267
English Novolog, novolog, novorapid, NovoLOG, NovoRapid, Novo Nordisk Brand of Insulin Aspart, NovoLog
French NovoLog, Insuline Asparte de la marque Novo Nordisk, NovoRapid
Czech NovoLog, NovoRapid
Italian NovoRapid, NovoLog, Insulina aspart Novo Nordisk
German NovoRapid, NovoLog
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Apidra (C1654827)

Concepts Hormone (T125) , Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
English Apidra
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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