Changes: Monotard Pork

Revision as of 16:53, 30 November 2006

Use and Handling
Monotard Pork
Lente by Novo Nordisk
intermediate-acting	Porcine
U100	Zinc
Line	Novo
Also known as	N/A
Similar to	: Caninsulin U40, Vetsulin U40, Iletin II Lente
Action in cats	onset Xh, peak Xh duration: Xh
Action in dogs	onset <1h, peak 4-8h, duration 14-24h
Type	cloudy
Shelf Life	24 months
When opened	28 days
In pen	N/A
Notes	protect from light and heat store at 2-8C Do not use if product does not re-suspend Roll See Caninsulin/Vetsulin for current handling notes on pork lente insulin.

Monotard Pork was a U100, 100% porcine insulin made by Novo Nordisk. It was an intermediate-acting, lente-type.

Eli Lilly also made a comparable pork lente insulin, Iletin II Lente^[1]^[2].

As the other Lente insulins^[3], it was a suspension of crystalline (ultralente) and amorphous (semilente) insulin in a ratio of 7 crystalline parts to 3 amorphous parts.

Monotard Pork was also identical to Caninsulin^[4]^[5]/Vetsulin with the only exception being its strength: Pork Monotard was U100 strength, while Caninsulin/Vetsulin is U40.

What Lente Is Not

No Lente-type insulin regardless of species can contain any NPH/isophane insulin^[6] or any R/Neutral insulin^[7].

Both are chemically impossible: the phenol preservative present in NPH/isophane alters the action of Lente-type insulins, creating a mixture with an approximate action of R/Neutral.

The zinc suspension of Lente-type insulin binds R/Neutral, causing the short-acting insulin to slow, losing its short-acting effect^[8]^[9]^[10].

Combining Lente Family Insulins

Insulin manufacturers^[11] indicate that R/neutral and semilente, Lente, ultralente insulins are able to be combined in the same syringe, but only just before injection. In pre-filled syringes, the zinc suspension of the Lente-type insulins binds the R/neutral, causing it to lose its short-acting effect. Various studies have documented this, and some doctors advise against using R/neutral in the same syringe with the Lente family of insulins^[12]^[13]^[14].

None of the Lente family of insulins (semilente, Lente, Ultralente) can be combined with^[15] NPH/isophane insulins. The phenol preservatives present in NPH-type insulins alters the Lente-types to the point where they become a close approximation of R/neutral, with regard to action.

Keeping the phenol preservatives in mind, all protamine-suspended insulin mixes would be "off limits" regarding same syringe mixing with any Lente-type insulins.

References

[1] Drugs.com-Copy of Iletin II Lente Patient Information Leaflet

[2] US-FDA Iletin II Lente Discontinuation Material 2003

[3] EMEA Scientific Discussion-Monotard

[4] Horn Mitten Study-Refers to the Church Study Equating Caninsulin with Novo's old Pork Monotard

[5] Australian Veterinary Journal-More Re: Caninsulin Being Equivalent to Pork Monotard

[6] Combining Lente-type Insulins with Phenol-Preserved Insulins

[7] Lente Zinc Suspension Causes Loss Of R/Neutral Short-Acting Effect

[8] Intermediate-Acting Insulin Preparations: NPH (Isophane) & Lente Diabetes Care-1980
Note--in 1980, there was only beef Lente-type insulin--no pork or r-DNA/GE/GM Lente insulins

[9] Solubility Changes on Mixing Short- and Long-acting Insulin Preparations-South African Medical Journal-1988

[10] Resource Guide 2005-American Diabetes Association

[11] Insulin Producers vs Doctors Re:Combining R/Neutral & Lente-type Insulins

[12] Availability of Soluble (R/Neutral) Insulin in Mixed Preparations of Crystalline (Lente) & Ultralente GE Insulins-Clinical Therapeutics-1991

[13] Absorption Kinetics & Action Profiles-Single Subcutaneous Administration of Human Soluble (R/Neutral) & Lente Insulin-Diabetes Care-1987

[14] Delayed Onset of Action of Soluble (R/Neutral) Insulin After Premixing With Lente Insulin Diabetes Research & Clinical Practice-1983

[15] Phenol Preservatives & Lente-type Insulins--A Bad Combination

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@@ Line 49: / Line 49: @@
 Both are chemically impossible: the phenol [[preservatives|preservative]] present in [[NPH]]/[[isophane]] alters the action of Lente-type insulins, creating a  mixture with an approximate action of [[R]]/[[Neutral]].
-The zinc [[suspension]] of Lente-type insulin binds [[R]]/[[Neutral]], causing the [[short-acting]] insulin to slow, losing its short-acting effect<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=7192205 Intermediate-Acting Insulin Preparations: NPH (Isophane) & Lente Diabetes Care-1980]<br>Note--in 1980, there was only [[bovine|beef]] Lente-type insulin--no [[porcine|pork]] or [[r-DNA/GE/GM]][[Lente]] insulins</ref><ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3281288&dopt=Abstract Solubility Changes on Mixing Short- and Long-acting Insulin Preparations-South African Medical Journal-1988]</ref>.
+The zinc [[suspension]] of Lente-type insulin binds [[R]]/[[Neutral]], causing the [[short-acting]] insulin to slow, losing its short-acting effect<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=7192205 Intermediate-Acting Insulin Preparations: NPH (Isophane) & Lente Diabetes Care-1980]<br>Note--in 1980, there was only [[bovine|beef]] Lente-type insulin--no [[porcine|pork]] or [[r-DNA/GE/GM]][[Lente]] insulins</ref><ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3281288&dopt=Abstract Solubility Changes on Mixing Short- and Long-acting Insulin Preparations-South African Medical Journal-1988]</ref><ref>[http://www.diabetes.org/rg2005/insulin.jsp Resource Guide 2005-American Diabetes Association]</ref>.
 ==Combining Lente Family Insulins==