I love the exciting story of the journey that Banting, Best, Collip and Macleod had in their Canadian laboratories to discover insulin. I ​first read their story in detail a number of years ago in the book: The Discovery of Insulin by Michael Bliss. I think of the book often. I felt like standing up and cheering when I read the part where patients who were staring at certain death from diabetes miraculously rallying with the use of this wonderful new medication, known as insulin, that had been extracted from animals. It’s hard to believe that this happened in the early 1920’s - not even 100 years ago.

Since that time, there have been many changes. Currently we have many different kinds of insulin available in the United States. For a ​complete list, click here.

As a diabetes educator I often get questions regarding the differences between the types of insulin, the most frequent of which pertains to rapid acting insulin.

What follows are answers to five of the most common questions about each insulin. The answers are quotes from each manufacturer. This is followed by a slightly abbreviated chart to make comparisons easier.

Question 1:
Are mealtime recommendations the same for all the brands of rapid acting insulin as to when to give the injection?

Answer:
While some of the times are similar, the recommended time insulin may be given is not identical for different brands of insulin. Please read below what is recommended by the different manufacturers.  

Insulin Glulisine Apidra: When used as mealtime insulin, Apidra should be given within 15 minutes before or within 20 minutes after starting a meal. (1) 

Insulin Lispro Humalog: Administer within 15 minutes before a meal or immediately after a meal. Use in a regimen with an intermediate - or long-acting insulin. (2)

Insulin Aspart NovoLog: Eat a meal within 5-10 minutes after using Novolog, a fast acting insulin, to avoid low blood sugar. Do not inject Novolog if you do not plan to eat right after your injection or bolus pump infusion. (3)

Question 2:
Has rapid acting insulin been studied in children? Are there any special recommendations for using rapid acting insulin in children?

Answer:
Insulin Glulisine Apidra: Apidra® has not been studied in children with type 2 diabetes or in children younger than four years of age with type 1 diabetes. (1)

Insulin Lispro Humalog: Humalog is approved for use in children for subcutaneous daily injections and for subcutaneous continuous infusion by external insulin pump. Humalog has not been studied in pediatric patients younger than three years of age. Humalog has not been studied in pediatric patients with type 2 diabetes. (2).

Insulin Aspart NovoLog: NovoLog® has not been studied in children with type 2 diabetes, or in children with type 1 diabetes under the age of 2. NovoLog® is safe and effective for pump use in pediatric patients with type 1 diabetes. (4)

Question 3: 
Is rapid acting insulin approved in pregnancy? Are there any studies in pregnant women using this kind of insulin?

Answer:
Insulin Glulisine Apidra
: This insulin fall under pregnancy category C*.  There are no well-controlled clinical studies of the use of Apidra in pregnant women. (5)

Insulin Lispro Humalog: This insulin falls under pregnancy category B*.  Although there are limited clinical studies of the use of humalog in pregnancy, published studies with human insulins suggest that optimizing overall glycemic control, including postprandial control, before conception and during pregnancy improves fetal outcome.(6)

Insulin Aspart NovoLog: This insulin falls under pregnancy category B*. One study on the Novolog website was reported. The study had a total of 322 pregnant type 1 women. It compared 157 subjects on Novolog versus 165 subjects on human insulin. The study was not able to evaluate the risk of congenital malformations because only one-third of the participants enrolled before conception. The mean HbA1c was approximately 6.0 in both groups. (7)

*The safest pregnancy category is A followed by B then C then X. Click here to review the differences between the categories.

Question 4:
Is there a difference in manufacturer recommendations for storing Rapid Acting Insulin?

Answer:
Insulin Glulisine Apidra:
Unopened Apidra® vials, cartridge systems and Apidra® SoloSTAR® should be stored in a refrigerator, 36°F-46°F (2°C-8°C). Protect from light. Apidra® should not be stored in the freezer and it should not be allowed to freeze. Discard if it has been frozen.

Unopened vials/cartridge systems not stored in a refrigerator must be used within 28 days.

Open (in use vials) must be used within 28 days. If refrigeration is not available it can be unrefrigerated for up to 28 days away from heat and light as long as the temperature is not greater than 77°F (25°C).

The opened (in-use) Apidra® SoloSTAR® pen should NOT be refrigerated, but should be kept below 77°F (25°C) away from direct heat and light. The opened (in-use) Apidra® SoloSTAR® kept at room temperature must be discarded after 28 days. Do not store Opticlik with or without cartridge system in a refrigerator at any time. (1)

Insulin Lispro Humalog: Store all unopened (unused) Humalog in the original carton in a refrigerator at 36°F to 46°F (2°C to 8°C). Do not freeze. Do not use Humalog if it has been frozen. Keep unopened Humalog in the carton to protect from light.

After starting use (open)

Vials:
Keep in the refrigerator or at room temperature below 86°F (30°C) for up to 28 days. Keep vials away from direct heat or light.  Throw away an opened vial after 28 days of use, even if there is insulin left in the vial.

Unopened vials can be used until the expiration date on the Humalog carton and label, if the medicine has been stored in a refrigerator.

Cartridge and Prefilled Pens:
Keep at room temperature below 86°F (30°C) for up to 28 days. Do not store a cartridge or prefilled pen that you are using in the refrigerator. Keep cartridges and prefilled pens away from direct heat or light. A cartridge used in the D-Tron1 or D-Tronplus1 pump may be used for up to 7 days. Throw away a used cartridge or prefilled pen after 28 days, even if there is insulin left in the cartridge or the pen. (8)

Insulin Aspart NovoLog:
Unused NovoLog® should be stored in a refrigerator between 2° and 8°C (36°to 46°F). Do not store in the freezer or directly adjacent to the refrigerator cooling element. Do not freeze NovoLog® and do not use NovoLog® if it has been frozen. NovoLog® should not be drawn into a syringe and stored for later use.

Vials: After initial use a vial may be kept at temperatures below 30°C (86°F) for up to 28 days, but should not be exposed to excessive heat or sunlight. Opened vials may be refrigerated. Unpunctured vials can be used until the expiration date printed on the label if they are stored in a refrigerator. Keep unused vials in the carton so they will stay clean and protected from light.

PenFill® cartridges or NovoLog® FlexPen®: Once a cartridge or a NovoLog® FlexPen® is punctured, it should be kept at temperatures below 30°C (86°F) for up to 28 days, but should not be exposed to excessive heat or sunlight. A NovoLog® FlexPen® or cartridge in use must NOT be stored in the refrigerator. Keep the NovoLog® FlexPen® and all PenFill® cartridges away from direct heat and sunlight. Unpunctured NovoLog® FlexPen® and PenFill® cartridges can be used until the expiration date printed on the label if they are stored in a refrigerator. Keep unused NovoLog® FlexPen® and PenFill® cartridges in the carton so they will stay clean and protected from light. (7)
 
Question 5:
Where can I learn more about my rapid acting insulin?

Answer:
Ask your medical team questions that you have. If you would like to read about your insulin, the website of the manufacturer is a great place to look. Links to the websites are provided below:

Insulin Glulisine Apidra
Insulin Lispro Humalog
Insulin Aspart NovoLog


The following table summarizes and compares the above information for questions 1-4:
       
  Glulisine Apidra Lispro Humalog Aspart NovoLog
Mealtime Recommendations Apidra should be given within 15 minutes before or within 20 minutes after starting a meal.  Administer within 15 minutes before a meal or immediately after a meal. Use in a regimen with an intermediate- or long-acting insulin. Eat a meal within 5-10 minutes after using Novolog, to avoid low blood sugar. Do not inject Novolog if you do not plan to eat right after your injection or bolus pump infusion.
Studied in children? Type 2-No
Type 1- Not younger than age 4.
Type 2-No
Type 1-Not younger than age 3.
Type 2-No
Type 1- Not younger than age 2.
Approved in pregnancy? Pregnancy Category C   Pregnancy Category B Pregnancy Category B 
Storage 1. Do not freeze.

2. Unopened refrigerate at-
36°F-46°

3. Open vials be must be used within 28 days. If not refrigerated must be kept away from heat and light and below  77°F (25°C).

4. Open pens should not be refrigerated but  kept away from heat and light and below  77°F (25°C) - discard after 28 days.
1. Do not freeze.

2. Unopened refrigerate at 36°F-46°

3. Open vials be must be used within 28 days. If not refrigerated must be kept away from heat and light and below  86°F (30°C).

4. Open pens /cartridges should not be refrigerated but kept away from heat and light and below  86°F (30°C) - discard after 28 days. A cartridge used in the D-Tron1 or D-Tronplus1 pump may be used for up to 7 days.
 
1. Do not freeze.

2. Unopened refrigerate at 36°F-46°

3. Open vials be must be used within 28 days. If not refrigerated must be kept away from heat and light and below  86°F (30°C).

4. Open pens /cartridges should not be refrigerated but  kept away from heat and light and below  86°F (30°C) - discard after 28 days.
     
 
At DiabetesCare.net, we hope some of your questions about rapid acting insulin are now answered. Please discuss all information with your medical team to decide what is best for you. Look at the manufacturer’s websites for more information and to see if there are any changes. Do not hesitate to ask DiabetesCare.net any questions you may have about other types of insulin. We look forward to hearing from you.
 
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