Comparison of Insulins (Canada)

Rapid-acting: prandial human insulin analogues (rDNA origin). Onset 10 to 20 minutes (Fiasp faster.).¹  For type 1 diabetes, recommended at each meal as part of an intensive basal-prandial regimen.¹ For type 2 diabetes, as part of a “basal plus” strategy^c or basal-bolus intensive regimen^d.¹ All are given via subcutaneous injection. Humalog 100 unit/mL can be given intramuscularly but is not recommended. See chart below for those available for intravenous or subcutaneous infusions (pump). All are clear and colourless.¹

Humalog

(insulin lispro),

Eli Lilly

(Liprelog, an “authorized biosimilar” made by Eli Lilly, has been approved, but not yet marketed; no cost available)

3.5 to 4.75 hours

One to three times daily.¹ Inject within 15 min before a meal, or within 20 min after the start of the meal.

100 units/mL:

$34/10 mL vial

$67/5 of 3 mL cartridges

$67/5 of 3 mL KwikPen

$71/5 of 3mL Junior KwikPen

200 units/mL:

$125/5 of 3 mL KwikPen

Vial, cartridge, pen: 28 days

Pump reservoir (100 mL/mL): 14 days

IV infusion:² 48 hours

(0.1 to 1 unit/mL in NS)

Admelog

(insulin lispro),

Sanofi-Aventis

Biosimilar of Humalog^e

2 to 5 hours

One to three times daily.¹ Inject within 15 min before a meal, or within 20 min after the start of the meal.

$25/10 mL vial

$49/5 of 3 mL cartridges

$49/5 of 3 mL SoloSTAR pens

Vial, cartridge, pen: 28 days

Pump reservoir: 14 days

Kirsty

(insulin aspart),

BGP Pharma

Biosimilar of NovoRapid^e

One to three times daily.¹  Inject 5 to 10 min before a meal, or immediately after the meal.

Lyumjev

(insulin lispro),

Eli Lilly

Approved, but not yet marketed

100 units/mL:

10 mL vial

5 of 3 mL cartridges

5 of 3 mL KwikPen

5 of 3 mL Junior KwikPen

5 of 3 mL Tempo Pen

200 units/mL:

5 of 3 mL Kwik Pen

Vial, cartridge, pen:  28 days

IV infusion:  20 hours
(0.1 to 1 unit/mL in NS or D5W)

NovoRapid

(insulin aspart),

Novo Nordisk

3 to 5 hours

One to three times daily.¹ Inject within 5 to 10 min before a meal, or immediately after the meal.

$33/10 mL vial

$67/5 of 3 mL Penfill cartridge

$69/5 of 3 mL FlexTouch pens

Vial, cartridge, pen: 28 days

Pump reservoir: 6 days.³

IV infusion: 24 hours in D5W, D10W, or NS.²

Trurapi

(insulin aspart),

Sanofi-Aventis

Biosimilar of NovoRapid^e

3 to 5 hours

One to three times daily.Inject within 5 to 10 min before a meal, or immediately after the meal.

$49/5 of 3 mL cartridges

$49/5 of 3 mL SoloSTAR pens

Cartridge, pen: 28 days

Pump reservoir: 6 days³

IV infusion: 24 hours

(details in labeling)

Apidra

(insulin glulisine),

Sanofi-Aventis

4 hours

One to three times daily.¹ Inject within 15 min before a meal, or within 20 min after the start of the meal.

$29/10 mL vial

$57/5 of 3 mL cartridges

$57/5 of 3 mL SoloStarpens

Vial, cartridge, pen: 28 days

Pump reservoir: 48 hours

Fiasp 

(insulin aspart),

Novo Nordisk

Formulated with niacinamide for faster absorption.

3 to 5 hours

One to three times daily.¹ Inject within 2 min before a meal, or within 20 min after the start of the meal.

$32/10 mL vial

$66/5 of 3 mL Penfill cartridge

$68/5 of 3 mL FlexTouch pens

Vial, cartridge, pen: 28 days

Pump reservoir: 6 days

IV infusion: 24 hours (0.5 to 1 unit/mL in NS or D5W)

Short-acting (regular): regular human insulin of rDNA origin (Humulin R, Novolin ge Toronto, Entuzity), or pork insulin (Hypurin Regular). Onset about 15 minutes Entuzity, 30 minutes (Humulin R and Novolin ge Toronto), or up to 60 minutes for pork insulin. Longer time to onset and longer duration than rapid-acting analogues. For type 1 diabetes, recommended at each meal as part of an intensive basal-prandial regimen.¹ For type 2 diabetes, as part of a “basal plus” strategy^c or basal-bolus intensive regimen^d.¹ Can be given via subcutaneous or intramuscular injection, or intravenous infusion. All are clear and colourless.¹

Humulin R

100 units/mL,

Eli Lilly

6 to 8 hours

One to three times daily.¹ Inject 30 to 45 min before meal.¹

$28/10 mL vial

$55/5 x 3 mL cartridges

Vial, cartridge: 28 days

IV infusion:² 48 hours

(0.1 to 1 unit/mL in NS)

Entuzity

500 units/mL,

Eli Lilly

17 to 24 hours

Two to three times daily. Inject 30 minutes before meal.

$106/2 of 3 mL KwikPen

Pen: 28 days

Myxredlin

Baxter

Biosimilar of Novolin ge Toronto^e

0.3 to 1 unit/kg/day via IV infusion.

IV infusion 1 unit/mL in
100 mL NS

Novolin ge Toronto,

Novo Nordisk

8 hours

One to three times daily.¹ Inject 30 minutes before meal.

$26/10 mL vial

$51/5 of 3 mL Penfill cartridges

Vial, cartridge: 28 days

IV infusion: 24 hours (details in labeling)

Hypurin Regular,

Wockhardt UK

6 to 8 hours

One to three times daily.¹ Inject 30 to 45 min before meal.¹

$107/10 mL vial

Vial: 28 days

Intermediate-acting (NPH): human insulin (rDNA origin) isophane suspension (Humulin N, Novolin ge NPH), or pork insulin isophane suspension (Hypurin NPH). For type 1 diabetes, may be used as the basal component of basal-prandial regimens.¹ An initial insulin option in type 2 diabetes, often as a once-daily add-on to oral agents.¹ As type-2 diabetes progresses, may be used as part of a “basal plus” strategy^c or basal-bolus intensive regimen^d.¹ Onset one to three hours.¹ Administered via subcutaneous injection. Hypurin NPH can also be given IM (faster onset and shorter duration). All appear cloudy.¹ 

Novolin ge NPH,

Novo Nordisk

About 24 hours

Once or twice daily.

$26/10 ml vial

$52/5 of 3 mL Penfill cartridges

Vial, cartridge: 28 days

Humulin N,

Eli Lilly

up to 24 hours

Once or twice daily.¹

$28/10 mL vial

$55/5 of 3 mL cartridges

$55/5 of 3 mL KwikPen

Vial, cartridge, pen: 28 days

Hypurin NPH,

Wockhardt UK

18 to 24 hours

Once or twice daily.¹

$107/10 mL vial

Vial: 28 days

Long-acting: human insulin analogue (rDNA origin). For type 1 diabetes, may be used as the basal component of basal-prandial regimens.¹ An initial insulin option in type 2 diabetes, often as a once-daily add-on to oral agents.¹ As type-2 diabetes progresses, may be used as part of a “basal plus” strategy^c or basal-bolus intensive regimen^d.¹ Administered via subcutaneous injection. All are clear and colourless.¹

Basaglar

(insulin glargine),

Eli Lilly

Biosimilar of Lantus^e

See Lantus.

Once daily at the same time each day.

$78/ 5 of 3 mL cartridges

$78/ 5 of 3 mLKwikPen

Cartridge, 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.

$67/10 mL vial

$100/5 of 3 mL cartridges

$100/5 of 3 mLSoloStar pens

Vial, cartridge, pen: 28 days

Levemir

(insulin detemir),

Novo Nordisk

6 to 24 hours (dose-dependent; binds to albumin)

Once daily, or twice daily as part of a basal-bolus regimen, with the evening dose administered with the evening meal or at bedtime.

$117/5 of Penfill cartridges

$120/5 of 3 mL FlexTouch pens

Cartridge, pen: 42 days

Semglee

(insulin glargine)

BGP Pharma

Biosimilar to Lantus^e

Toujeo

(insulin glargine),

Sanofi-Aventis

(300 units/mL)

Up to 36 hours

Once daily at the same time each day. First injection may provide insufficient coverage; may take at least 5 days to see maximum effect.

$86/3 of 1.5 mL SoloStar pens

$143/5 of 1.5 mL SoloStar pens

$171/3 of 3 mL DoubleStar pen

Pen: 42 days

Ultra-Long-acting: human insulin analogue (rDNA origin). Administered via subcutaneous injection. May be beneficial for patients with adherence issues.  All are clear and colourless.¹

• Consider insulin degludec for patients with severe or nocturnal hypoglycemia on another basal analogue, or with hypoglycemia risk factors.⁴
• Consider avoiding insulin icodec in patients most at risk of hypoglycemia (e.g., impaired hypoglycemia awareness, history of severe and recurrent hypoglycemia) due to lack of data in these patients.

Awiqli

(insulin icodec)

Novo Nordisk

$85 /1.5 mL FlexTouch pen

Tresiba

(insulin degludec),

Novo Nordisk

42 hours

Once daily at the same time each day.

100 units/mL:

$120/5 of 3 mL FlexTouch pens

200 unit/mL:

$144/5 of 3 mL FlexTouch pens

Pen: 56 days

Insulin Mixes: human insulin analogue (rDNA origin) solution and protamine-crystallized human insulin analogue suspension (NovoMix 30, Humalog Mix 25, Humalog Mix 50). Others are human insulin (rDNA origin) solution and human insulin isophane suspension. Generally, not appropriate for type 1 diabetes due to lack of dose flexibiltiy.¹ Consider for elderly patients with type 2 diabetes due to ease of use.¹ Typically added to oral agents.¹ Given once or twice daily with breakfast and/or supper.¹ Administered via subcutaneous injection. All appear cloudy.¹

NovoMix 30

(30% insulin aspart solution, 70% insulin aspart protamine suspension),

Novo Nordisk

Up to 24 hours

Typically given pre-breakfast and/or pre-supper,¹ immediately (not more than 5 to 10 min) before the meal, or immediately after the meal.

$61/5 of 3 mL Penfill cartridges

Cartridge: 28 days

Humalog Mix 25
(25% insulin lispro solution/75% insulin lispro protamine suspension),

Eli Lilly

Up to 22 hours

Typically given pre-breakfast and/or pre-supper,¹ within 15 min before the meal.

$68/5 of 3 mL cartridges

$68/5 of 3 mL KwikPen

Cartridge, pen: 28 days

Humalog Mix 50

(50% insulin lispro solution, 50% insulin lispro protamine suspension),

Eli Lilly

Up to 22 hours

Typically given pre-breakfast and/or pre-supper,¹  within 15 min before the meal.

$67/5 of 3 mL cartridges

$67/5 of 3 mL KwikPen

Cartridge, pen: 28 days

Humulin 30/70

(30% regular, 70% NPH),

Eli Lilly

Mean: 23 hours (range: 18 to
24 hours)⁷

Typically given pre-breakfast and/or pre-supper, about 30 to
45 min before the meal.¹

$28/10 mL vial

$55/5 x 3 mL cartridges

Vial, cartridge: 28 days

Novolin ge 30/70

(30% regular, 70% NPH),

Novo Nordisk

About 24 hours

Typically given pre-breakfast and/or pre-supper,¹ within
30 minutes before meal.

$26/10 mL vial

$50/5 of 3 mL Penfill cartridges

Vial, cartridge: 28 days

Novolin ge 40/60

(40% regular, 60% NPH),

Novo Nordisk

About 24 hours

Typically given pre-breakfast and/or pre-supper,¹ within
30 minutes before the meal.

$50/5 of 3 mL Penfill cartridges

Cartridge: 28 days

Novolin ge 50/50

(50% regular, 50% NPH),

Novo Nordisk

About 24 hours

Typically given pre-breakfast and/or pre-supper,¹ within
30 minutes before the meal.

$50/5 of 3 mL Penfill cartridges

Cartridge: 28 days