Comparison of Insulins (Canada)

(Modified December 2022)

Click HERE to access the United States version of this resource.

This chart compares insulins in regard to duration, usual frequency, and cost. It also provides information on route of administration, stability of in-use products at room temperature, and place in therapy. See our toolbox, Improving Diabetes Outcomes, for more information on insulin and injectable diabetes meds.

--Information in this chart is from product monographs (see footnote a) unless otherwise specified.--

Insulin, Manufacturer

Duration

Usual Frequency

Formulations/Costb

Stability, in-use, room temp

Rapid-acting: prandial human insulin analogues (rDNA origin). Onset 10 to 20 minutes (Fiasp faster.). For type 1 diabetes, recommended at each meal as part of an intensive basal-prandial regimen.For type 2 diabetes, as part of a “basal plus” strategyc or basal-bolus intensive regimend.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 Humaloge

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 NovoRapide

 
3 to 5 hours 

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

 
$46/5 of 3 mL pre-filled pens  Vial, pen:  28 days 

Lyumjev

(insulin lispro),

Eli Lilly

Approved, but not yet marketed

 
3 to 5 hours  One to three times daily.1  Inject 0 to 2 min before a meal, or within 20 min after the start of the meal. 

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

Cost not available. 

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 NovoRapide

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.For type 2 diabetes, as part of a “basal plus” strategyc or basal-bolus intensive regimend.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 Torontoe

Approved but not yet marketed 
See Novolin ge Toronto 

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

(For emergencies
[e.g., diabetic coma and pre-coma], patients with diabetes undergoing surgery.)
 

IV infusion 1 unit/mL in
100 mL NS

Cost not available. 
IV infusion:  25 days 

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” strategyc or basal-bolus intensive regimend.Onset one to three hours.Administered via subcutaneous injection. Hypurin NPH can also be given IM (faster onset and shorter duration). All appear cloudy.

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” strategyc or basal-bolus intensive regimend.1 Administered via subcutaneous injection. All are clear and colourless.1

Basaglar

(insulin glargine),

Eli Lilly

Biosimilar of Lantuse

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 Lantuse

 
See Lantus  Once daily at the same time each day.  $69/5 of 3 mL pens  Pen:  28 days 

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. Consider for patients with severe or nocturnal hypoglycemia on another basal analogue, or with hypoglycemia risk factors,4-6 or adherence problems. All are clear and colourless.1

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,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

  1. Product monographs used in creation of this chart: Humalog (April 2021), Kirsty (October 2021), Lyumjev (September 2021), NovoRapid (August 2021), Apidra (December 2021), Fiasp (July 2021), Trurapi (July 2022), Admelog (December 2021), Humulin (March 2021), Entuzity (March 2021), Myxredlin (August 2022), Novolin ge (August 2021), Hypurin Regular (June 2017), Hypurin NPH (June 2017), Basaglar (March 2021), Lantus (December 2021), Levemir (August 2021), Semglee (September 2022), Toujeo (October 2019), Tresiba (July 2021), NovoMix 30 (August 2021).
  2. Wholesale acquisition cost (WAC).
  3. “Basal plus” strategy: rapid- or short-acting insulin once daily at main meal or breakfast plus basal insulin.1
  4. Basal-bolus intensive regimen: rapid- or short-acting insulin three times daily with meals plus basal insuilin.1
  5. Biosimilar products are not automatically interchangeable with the reference biologic drug. Each province/territory determines interchangeability.8

References

  1. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018 Apr;42 Suppl 1:S1-S325.
  2. Clinical Pharmacology powered by ClinicalKey. Tampa (FL): Elsevier. 2022. http://www.clinicalkey.com. (Accessed August 16, 2022).
  3. Senesh G, Bushi D, Neta A, Yodfat O. Compatibility of insulin Lispro, Aspart, and Glulisine with the Solo MicroPump, a novel miniature insulin pump. J Diabetes Sci Technol. 2010 Jan 1;4(1):104-10.
  4. Marso SP, McGuire DK, Zinman B, et al. Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes. N Engl J Med. 2017 Aug 24;377(8):723-732.
  5. Lane W, Bailey TS, Gerety G, et al. Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Patients With Type 1 Diabetes: The SWITCH 1 Randomized Clinical Trial. JAMA. 2017 Jul 4;318(1):33-44.
  6. Wysham C, Bhargava A, Chaykin L, et al. Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Patients With Type 2 Diabetes: The SWITCH 2 Randomized Clinical Trial. JAMA. 2017 Jul 4;318(1):45-56.
  7. Product information for Humulin 70/30. Eli Lilly and Company. Indianapolis, IN 46285. June 2022.
  8. Health Canada. Biosimilar biologic drugs in Canada: fact sheet. August 27, 2019. https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/applications-submissions/guidance-documents/fact-sheet-biosimilars.html. (Accessed August 15, 2022).

Cite this document as follows: Clinical Resource, Comparison of Insulins (Canada). Pharmacist’s Letter/Pharmacy Technician’s Letter. September 2022. [380917]

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