Category:Mixed

From Diabetes in Pets

There's a lot to cover in the category of mixed insulins, as they can be animal origin, r-DNA/GE/GM origin or analog insulins. They can also vary in the fraction (amount or percent) of the two types (R/neutral and NPH/isophane) of insulin used to make a non-analog mix.

For some reason, those in the US choose to list the slower, NPH/isophane based insulin fraction first, such as Humulin or Novolin 70/30. The rest of the world gives the faster insulin top billing and the result is 30/70^[1]. Regardless of how this is written, it means that the insulin is made up of 70% NPH/isophane type insulin and 30% R/neutral or analog insulin.

The most common mixes are 70/30 (30/70) or 75/25 (25/75). There are no currently-marketed mixes which combine insulins of different origins. Eli Lilly's form of beef/pork Iletin and Novo Nordisk's Lentard were discontinued some time ago.

Contents 1 Specifications of mixed insulins 2 Non-analog mixes 3 Analog mixes 4 Further Reading 5 References

[edit] Specifications of mixed insulins

British National Formulary^[2] classes all of them as biphasic insulins--having more than one activity or action. Regardless of their origin, the two actions are that of the fast/rapid or short acting insulin in combination with the intermediate-acting isophane or isophane-suspended analog insulin. The activity profiles of the mixed or biphasic insulins vary by whether they are analog or non-analog insulins and the fractions of the faster and slower insulins used in the mix.

[edit] Non-analog mixes

Non-analog mixed insulins
All intermediate acting
R-DNA/GE/GM 30% R/Neutral 70% NPH/isophane	Humulin 70/30, Humulin M3 Mixtard 30, Novolin 70/30 ReliOn/Novolin 70/30 Actraphane 30/70
R-DNA/GE/GM 50% R/Neutral 50% NPH/isophane	Humulin 50/50, Humulin M5 Mixtard 50, Insuman Comb 50 Actraphane 50/50
R-DNA/GE/GM 20% R/Neutral 80% NPH/isophane	Humulin M2, Mixtard 20 Actraphane 20/80
R-DNA/GE/GM 25% R/Neutral 75% NPH/isophane	Insuman Comb 25
R-DNA/GE/GM 15% R/Neutral 85% NPH/isophane	Insuman Comb 15
R-DNA/GE/GM 40% R/Neutral 60% NPH/isophane	Mixtard 40
R-DNA/GE/GM 10% R/Neutral 90% NPH/isophane	Mixtard 10
Porcine 30% R/Neutral 70% NPH/isophane	Hypurin Porcine 30/70 Mix Pork Mixtard 30

There are other various mixes (all human origin) on the market in other countries; the R/neutral fraction or percentage ranges from 10 to 50. In the US, only 50/50 and 70/30 remain on the market, with a wider range available in Canada, UK and Europe.

[edit] Analog mixes

These are not as widely varied. The "basics" are that they most commonly come in 70/30 (30/70) or 75/25 (25/75) fractions. Made of either insulin aspart (Novo) or insulin lispro (Lilly), they are a combination of the fast/rapid acting analog insulin and the same analog insulin which has been "slowed down" by a process of creating special crystals of either insulin aspart or insulin lispro with protamine suspension.

Analog mixed insulins
All intermediate acting
30% insulin aspart 70% insulin aspart, protamine suspension	Novolog Mix NovoMix 30
25% insulin lispro 75% insulin lispro, protamine suspension	Humalog 75/25 Humalog Mix 25
50% insulin lispro 50% insulin lispro, protamine suspension	Humalog 50/50 Humalog Mix 50

[edit] Further Reading

• Diabetes control in Siberian Husky Details about using mixed non-analog insulins with canine diabetes patient.

• Graph of Serum Insulin Concentrations Comparing Two Common Mixed Insulins (50/50) & (70/30-30/70) When Administered to Humans

[edit] References

1. ↑ Humulin 10/90-NPH;R Human Insulin Remedyfind.com
2. ↑ British National Formulary-Biphasic Insulins Defined