Diabetes in Pets

Novolin Mixed 70/30 insulin-30% R/Neutral and 70% NPH/isophane.

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.

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.

Non-analog mixes

Non-analog mixed insulins

All intermediate acting

30% R/Neutral
70% NPH/isophane

Humulin 70/30, Humulin M3
Mixtard 30, Novolin 70/30
ReliOn/Novolin 70/30
Actraphane 30/70
Penmix 30

50% R/Neutral
50% NPH/isophane

Humulin 50/50, Humulin M5
Mixtard 50, Insuman Comb 50
Actraphane 50/50
Penmix 50

20% R/Neutral
80% NPH/isophane

Humulin M2, Mixtard 20
Actraphane 20/80
Penmix 20

25% R/Neutral
75% NPH/isophane

Insuman Comb 25

15% R/Neutral
85% NPH/isophane

Insuman Comb 15

40% R/Neutral
60% NPH/isophane

Mixtard 40
Penmix 40

10% R/Neutral
90% NPH/isophane

Mixtard 10
Penmix 10

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.

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

Further Reading




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