Insuman Comb 30

Insuman Comb 30
R/Neutral/NPH/Isophane Mix by Aventis
intermediate-acting	r-DNA/GE/GM
U100	isophane
Line	Insuman
Also known as	Winthrop Comb 30
Similar to	Actraphane 30/70 Huminsulin Profil III Humulin 3/7 Humulin 30/70 Humulin 70/30 Humulin M3 Humulin Mix 30/70 Humulin ReliOn 70/30 Humulina 30/70 Humuline 30/70 Mixtard 30 Novolin 30R Novolin 70/30 Penmix 30 Profil 30 ReliOn/Novolin 70/30 Umuline Profil 30 Names of Lilly r-DNA/GE/GM insulins worldwide
Action in dogs	onset 0.5-3h, peak 2-10h, duration 4-24h
Use and Handling
Type	cloudy
Shelf Life	24 months
When opened	4 weeks room temp.
In pen	4 weeks room temp.
Notes	protect from light and heat Do Not Freeze Do not use if product does not re-suspend Roll Do not use intravenously Do not refrigerate in use cartridges/pens.

Insuman insulins in pen cartridge form.

This 70% NPH/isophane crystal and 30% R/neutral insulin mix is intermediate-acting and made by Aventis as part of its Insuman line of products.

While this type of Insuman insulin is approved and sold in the EU and elsewhere, it is the only one of the Insuman insulins not offered in the UK.

Mixed insulins cover a wide range as they can be animal origin, r-DNA/GE/GM origin or analog insulins. The non-analog mixed insulins are made up of intermediate-acting NPH/isophane insulin and short-acting R/neutral. normal insulin. The analog mixes are made from intermediate-acting protamine-suspended analog insulin (suspended similar to NPH/isophane insulin) and fast-acting analog insulin. 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, and in the percentage of fast/rapid-acting analog insulin and slower-acting protamine suspended analog insulin.

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. Regardless of how this is written, it means that the insulin is made up of 70% NPH/isophane insulin and 30% R/neutral insulin.

The most common mixes are 70/30 (30/70) (non analog) or 75/25 (25/75) (analog). 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. Here are the most common ones that could cause confusion:

Non-Analog Mixed Insulins
	All Intermediate-acting

Expressed As	Expressed As	Insulin Is
10/90	90/10	10% R/Neutral Insulin 90% NPH/Isophane Insulin
20/80	80/20	20% R/Neutral Insulin 80% NPH/Isophane Insulin
30/70	70/30	30% R/Neutral Insulin 70% NPH/Isophane Insulin
40/60	60/40	40% R/Neutral Insulin 60% NPH/Isophane Insulin
50/50	50/50	50% R/Neutral Insulin 50% NPH/Isophane Insulin

Why Lente doesn't equal 70/30

Direct comparison of insulin activity profiles for Lente and 70/30 insulins. The early strong action from the non-suspended R/neutral/normal insulin is seen at the "bump" from hours 0-6.

Let's look at the differences in the two insulins. Lente is comprised of 70 % long-acting Ultralente insulin and 30% short-acting Semilente insulin. So proportions of a long-acting and short-acting insulin are being combined to produce a intermediate-acting insulin. Both Ultralente and Semilente insulin are suspended by adding zinc and the size of their respective insulin crystals. The largest insulin crystals are those of Ultralente, while Semilente contains the smallest, or microcrystals. Simply put, you're combining a long insulin and a short insulin to make an intermediate-acting one.

70/30 insulin starts with 70% NPH/isophane insulin, an intermediate-acting insulin which is suspended by protamine. To that, 30% R/neutral/normal insulin, which is short-acting and soluble, meaning there is no suspension; nothing is added to this insulin to delay its action. In this case, you are taking an intermediate-acting insulin with a suspension and adding to it a short-acting one with no suspension to create an intermediate-acting insulin.

So we have an insulin (Lente), made up of a long-acting and short-acting insulin, both with zinc suspensions, and a mixed insulin (70/30), made from an intermediate-acting protamine suspended insulin and a short-acting one without any suspension. Because of these differences, the insulin action profile for these two insulins is going to be quite different, even though both insulins are classed as intermediate-acting.

More Information

• Yorkshire Diabetes-Chart of Insuman Insulin Ranges