Mixtard 40

Mixtard 40
R/Neutral/NPH/Isophane Mix by Novo Nordisk
intermediate-acting	r-DNA/GE/GM
U40, U100	isophane
Line	Novo
Also known as	Actraphane 40/60, Penmix 40
Similar to	Huminsulin Profil IV Humulin 40/60 Humulin 60/40 Humulin M4 Humulina 40/60 Humuline 40/60 Profil 40 Umuline Profil 40 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	30 months
When opened	6 weeks room temp.
In pen	6 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.

Time activity profile for Mixtard 40.

Note that some countries have the brand name in U40 strength.

An intermediate-acting, mixed insulin of 40% R/neutral insulin and 60% NPH/isophane insulin made by Novo Nordisk. Mixtard 40 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.

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