Editing Mixtard 40

{|class="wikitable"  align="right" width="300"  bgcolor="powderblue"|
! colspan="2" style="background:#ccc; width:300px;font-size:10pt" | Mixtard 40
|-
|colspan="2" style="background:aliceblue; width:300px; text-align:center;font-size:9pt" |[[Mixed insulins|R/Neutral/NPH/Isophane Mix]] by [[Novo Nordisk]]
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|colspan="2" style="background:#bcd2ee; width:300px; text-align:center;font-size:9pt"|[[intermediate-acting]]
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|colspan="2" style="background:#bcd2ee; width:300px; text-align:center;font-size:9pt"|[[r-DNA/GE/GM]]
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! colspan="1" style="background:#bcd2ee; width:150px; text-align:center;font-size:9pt" | U40,  U100
|colspan="1" style="background:#bcd2ee; width:150px;text-align:center;font-size:9pt"|[[isophane]]
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|colspan="2" style="background:aliceblue; width:300px;font-size:9pt; text-align:left" | '''Action in dogs:'''
*onset 0.5-3h, 
*peak 2-10h, 
*duration 4-24h
|-
| colspan="2" style="background:aliceblue; width:300px;font-size:9pt; text-align:left" | '''Line:''' [[Novo Nordisk|Novo]]
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| colspan="2" style="background:aliceblue; width:300px; font-size:9pt;text-align:left"| '''Also known as:''' [[Actraphane 40/60]],  [[Penmix 40]]

|-
| colspan="2" style="background:aliceblue; width:300px;font-size:9pt;text-align:left"| '''Similar to:''' [[Huminsulin Profil IV]], [[Humulin 40/60]],<br> [[Humulina 40/60]], [[Humuline 40/60]], [[Humulin M4]],<br>[[Umuline Profil 40]], [[Profil 40]], [[Humulin 60/40]]<br><br>[http://images3.wikia.nocookie.net/__cb20100602042136/diabetesindogs/images/2/23/WW_Humuline.pdf Names of Lilly r-DNA/GE/GM insulins worldwide]
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|colspan="2" style="background:#ccc; width:300px;text-align:center;font-size:9pt" | '''Use and Handling:'''
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|colspan="1" style="background:aliceblue; width:150px;font-size:9pt;text-align:left"|'''Shelf Life:''' 30 months
| colspan="1" style="background:aliceblue; width:150px;font-size:9pt;text-align:left" |'''Type:''' [[cloudy]] 
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| colspan="2" style="background:aliceblue; width:300px;font-size:9pt;text-align:left" | '''When Opened:''' 6 weeks room temp.
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|colspan="2" style="background:aliceblue; width:300px;font-size:9pt;text-align:left"| '''In Pen:''' 6 weeks room temp.
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|colspan="2" style="background:aliceblue; width:300px;font-size:9pt;text-align:left" | '''Notes:''' Protect from light and heat<br> Do Not Freeze,  [[Resuspending insulin|Resuspend]]<br> Do not use if product does not [[re-suspend]]<br>Do not use [[intravenously]]
|}

[[Image:40 60.jpg|thumb|left|250px|Time activity profile for Mixtard 40.]]
<br clear=left>
{|
|-valign="top"
|style="height:1px;border:0;" colspan="3"| 
|-valign="top"
|style="padding:5px;border:2px solid #b9f1f0;background-color:#f0f8ff;" width="100%"|
'''Note that some countries have the brand name in U40 strength.'''
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An intermediate-acting, mixed insulin <ref>{{cite web|url=http://web.archive.org/web/20080208084240/http://www.drgc.cwc.net/Care_pathway/Patient_information/Insulin/Novo_insulins.htm |title=Prescribing Novo Insulins}}</ref> of 40% R/neutral insulin and 60% NPH/isophane insulin <ref>{{cite web|url=http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20H)/HUMULIN.html|title= Humulin 40/60|publisher=RxMed.com}}</ref> made by [[Novo Nordisk]]. Mixtard 40 <ref>{{cite web|url=http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000428/WC500029819.pdf|title=Scientific Discussion-Mixtard|publisher=EMEA}}</ref> contains 60% [[isophane]] insulin crystals, as does [[Penmix 40]], [[Humuline 40/60]], [[Humulin M4]], [[Humulina 40/60]], and [[Huminsulin Profil IV]].

Mixtard 40 was discontinued December 31, 2007. <ref>{{cite web|url=http://www.ukmicentral.nhs.uk/therapeu/pace/PACE0604.pdf |title=Insulin Discontinuations-UK|publisher=NHS}}</ref><ref>{{cite web|url=http://www.yorkshirediabetes.com/downloads/A4Humandis.pdf |title=Chart of Discontinued Novo Human Insulins|publisher=Novo Nordisk}}</ref>

Lilly's [[Humulin 40/60]] for the North American market was similar, and is also discontinued.

[[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 [[:Category:Intermediate-acting|intermediate-acting]] [[NPH]]/isophane insulin and [[:Category:Short-acting|short-acting]] [[R]]/neutral. normal insulin.  The analog mixes are made from [[:Category:Intermediate-acting|intermediate-acting]] protamine-suspended analog insulin (suspended similar to NPH/isophane insulin) and [[:Category:Fast-acting|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:

{| class="collapsible collapsed"  align="center" width="500" border="1" bgcolor="powderblue"|
! bgcolor="BCD2EE" colspan="3" |Non-Analog Mixed Insulins
|-
! bgcolor="lightcyan" width="200" |[[Image:Intermediate_acting.jpg|200px]]
! bgcolor="#cae1ff" colspan="2" |All [[Intermediate-acting]]
|-
! colspan="1" bgcolor="aliceblue"|Insulin Is
! colspan="1" bgcolor="aliceblue"| Expressed As
!colspan="1" bgcolor="aliceblue"|Expressed As
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! colspan="1" bgcolor="ivory"|10% [[R|R/Neutral Insulin]]<br />90% [[NPH|NPH/Isophane Insulin]]
!colspan="1" bgcolor="ivory"|90/10
! colspan="1" bgcolor="ivory"|10/90
|-
! colspan="1" bgcolor="ivory"|20% [[R|R/Neutral Insulin]]<br />80% [[NPH|NPH/Isophane Insulin]]
!colspan="1" bgcolor="ivory"|80/20
! colspan="1" bgcolor="ivory"|20/80
|-
! colspan="1" bgcolor="ivory"|30% [[R|R/Neutral Insulin]]<br />80% [[NPH|NPH/Isophane Insulin]]
!colspan="1" bgcolor="ivory"|70/30
! colspan="1" bgcolor="ivory"|30/70
|-
! colspan="1" bgcolor="ivory"|40% [[R|R/Neutral Insulin]]<br />60% [[NPH|NPH/Isophane Insulin]]
! colspan="1" bgcolor="ivory"|60/40
! colspan="1" bgcolor="ivory"|40/60
|-
! colspan="1" bgcolor="ivory"|50% [[R|R/Neutral Insulin]]<br />50% [[NPH|NPH/Isophane Insulin]]
!colspan="1" bgcolor="ivory"|50/50
! colspan="1" bgcolor="ivory"|50/50
|}


==References==
{{Reflist|colwidth=30em}}


<center>'''Related pages'''</center>
{|align="center" width="600"

|<center>[[Image:40 60.jpg|120px]]</center>
|<center>[[Image:40 60.jpg|120px]]</center>
|<center>[[Image:40 60.jpg|120px]]</center>
|<center>[[Image:40 60.jpg|120px]]</center>

|-
|<center>[[Humulin M4]]</center>
|<center>[[Profil 40]]</center>
|<center>[[Humulin 40/60]]</center>
|<center>[[Penmix 40]]</center>

[[Category:40-60]]
[[Category:Insulins]]
[[Category:Mixed]]
[[Category:intermediate-acting]]
[[Category:Novo Nordisk]]
[[Category:r-DNA/GE/GM]]
[[Category:Intravenous use NO]]
[[Category:Meta-cresol]]
[[Category:Phenol]]
[[Category:Isophane]]
[[Category:Phosphate]]
[[Category:Content]]
[[Category:Discontinued insulins]]