Effectiveness of NovoLog vs Humalog in a pump

This was brought up on a different thread yesterday. Actually it’s brought up quite often in discussion. So I wanted to post it here for reference and I thought it would be good to have all the studies referenced easily.

Here are some studies comparing the effectiveness of NovoLog vs Humalog in a pump. For each link I highlighted a bit of the relevant text.

(By the way, in all of these studies they use the insulin names rather than the brand names. So Aspart means “NovoLog”, and Lispro means “Humalog”. )

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Results:
“A series of chemical and covalent changes affecting the primary structure of an insulin preparation, however, may cause decomposition during storage, handling, and use, diminishing the potency of the insulin molecule while contained in an insulin pump. Precipitation, fibrillation, and occlusion may ensue, undermining compatibility for CSII pump use. Aspart has demonstrated the greatest chemical and physical stability in the insulin pump, with the lowest rates of overall occlusion in comparison with lispro and glulisine.”
Conclusion: “Aspart is the most compatible of the 3 RAIAs [rapid-acting insulin analogues] for pump use.”

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Conclusions:
“Resistance towards isoelectric precipitation is highest for IAsp [insulin aspart], lowest for ILis [insulin lispro], and intermediate for BHR [buffered human regular insulin]. Isoelectric precipitation will alter the pharmacokinetic properties of the insulin and could lead to occlusion of the infusion catheter, causing elevated blood glucose and ultimately causing diabetic ketoacidosis if no intervention is made.”

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Results:
“Not all insulins are equally suited for use in CSII [continuous subcutaneous insulin infusion] treatment.…The overall adverse-effect score was significantly lower (P<0.005) with insulin aspart than with insulin lispro, as were scores for pain/burning and inflammation (both, P<0.01) and dermal redness (P<0.001).”

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Results:
“Postprandial blood glucose was more stable with insulin aspart than insulin lispro”
Conclusions: “Postprandial glucose was more stable when insulin aspart was infused as a pre-meal bolus compared with insulin lispro, indicating a more favorable effect of insulin aspart on postprandial glucose.”

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“Daily insulin dose (units per kilogram) was significantly lower at week 16 for subjects treated with aspart compared with those treated with lispro (0.86 ± 0.237 vs. 0.94 ± 0.233, P = 0.018).”

https://care.diabetesjournals.org/content/31/2/210

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Case Study:
“Although the mechanism for improved infusion site duration with insulin aspart is not known, the response is consistent over the lifetime of the infusion site, and has not been accompanied by an increased frequency of hypoglycemia. The improved predictability of insulin aspart has encouraged P.L. and his family to more confidently adjust the insulin pump settings to maintain tighter glycemic control without increasing the risk of hypoglycemia.”

https://care.diabetesjournals.org/content/25/9/1663

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Would be great if you posted, at the end or something, a “conclusion” - if there was one or more conclusions derived from the studies above. If there isn’t consensus then disregard.

Thanks for all the links!!

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All these studies point to the same thing - that for many people, NovoLog is better in a pump and more consistent than Humalog.

Piecing together all the snippets (with my edits to condense it), it would say this:

NovoLog has demonstrated the greatest chemical and physical stability in the insulin pump, with the lowest rates of overall occlusion in comparison with Humalog.

Resistance towards isoelectric precipitation is highest for NovoLog.

The overall adverse-effect score was significantly lower with NovoLog than with Humalog.

Postprandial glucose was more stable when NovoLog was infused as a pre-meal bolus compared with Humalog.

Daily insulin dose was significantly lower for subjects treated with NovoLog compared with those treated with Humalog.



That is the study stuff. Now here is my personal experience…

(And note - for anyone whom Humalog works well, that’s great. I know a lot of people have no problems with Humalog. And I would not want to “create” a problem for anyone if it doesn’t exist. If it ain’t broke, don’t fix it.)

But personal background… Humalog is the Lilly version of insulin made from recombinant DNA. It is made by Eli Lilly Pharmaceuticals.

I used Humalog when it first came out. Before that, I used the older version of Lilly insulin, which was recovered from the pancreases of cows or pigs.

So I used Lilly insulins for 44 years with injection. It worked great. I don’t know where I rank overall, but with 44 years of injecting Lilly insulin, I am probably up there in the Lilly usage rankings.

When I started using a pump, I noticed problems on different days. After about 4 or 5 months on the pump, I was so irritated with the inconsistency, I switched from Humalog to NovoLog. Those problems went away for me.

The reason I am mentioning this is that I have seriously used more Humalog than most people on the planet. With the number of injections I did, I have a pretty good handle on what’s-what with insulin. So for me, in a pump, NovoLog is far superior.

And I don’t say that as a Novo fan-boy, or a Lilly-hater. Just my experience.

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My experience was similar, although I think I originally used Regular in pump first (1986ish), then Humalog. So that initial change was significantly better. Then insurance switched to Novolog, and that worked even better (quicker onset, more consistent).

My insurance has switched several times, currently covering Humalog, not Novolog. But using the $99 novo card, I’m sticking with Novolog and stocking up.

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I wonder how this would compare to their two faster acting insulins.
I used Novolog before moving on to Fiasp. I have not used Humalog.
But, I have now used Fiasp and Lyumjev. And I have found that the LoomJev is definitely more ‘stable and reliable’.
Obviously these are insulins that have been modified from those in these reports, but still based on the base insulin, you would think that it would carry over to some degree.

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In my experience… which doesn’t compare to Eric’s or extend to pumping but does involve a fair number of years and a fair bit of paying attention I consider novolog to be a significantly superior insulin to humalog—-

That said, my brief trials of lyumjeev (humalog based) vs fiasp (novolog based) actually left me more impressed and curious with lyumjeev… I think they have possibly vastly improved humalog with it while I’m not completely convinced novolog was improved much at all with fiasp

That said… I don’t have enough experience with both lyumjeev and fiasp to declare a victor… but imo the improvement of lyumjeev vs humalog surpasses the inprovement of fiasp over novolog

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I used Humalog and switched to NovoLog prior to using a pump. They were really interchangeable, but hadn’t considered the pump angle. Good info to remember.

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I periodically have issues with Humalog with insulin resistance, in the OmniPod. I have not been able to determine if it is the Humalog or the Pod, or something else though.

I did try Novolog in the Pod as a trial. I was only given 3 vials so it wasn’t an extensive test. I found it to be essentially identical to Humalog for me. I’d like to do a longer test of it. I think it requires a prescription though so I’d have to ask my Dr, and I think that would require an insurance authorization. It is such a hassle to do any change. I might ask if I can just buy it out of pocket at a local pharmacy just to go around the insurance rigamarole. But that would be terribly expensive. I looked online for Novolog discounts and this is what I found:

The NovoLog Novo Nordisk Instant Savings Card is available to only commercially insured patients, so that means it is still going through one’s insurance plan.

NovoLog My$99Insulin Card seems to be available to uninsured or commercially insured. Can I just say I’m uninsured so that I can purchase 3 vials/month at $99?

I think there was a discussion on this at FUD a while back which probably already answers this!

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YES, I did this last year and still doing so. For 2021 I did need to get new “card” to update at pharmacy. My insurance prefers Humalog, at outrageous cost.

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Wow, thank you, @MM2! I just signed up for the My$99Insulin Card. It looks like MyChart prescriptions still has a Novolog prescription listed at my local pharmacy which I did not even know! So I will try to have it filled there with the new card. I’m not sure if that prescription is connected to my insurance though. If it is, maybe I can just say I prefer to use the Novolog card. Hopefully they will let me.

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To avoid issues with my previous script (humalog), I stopped filling it. Then took new Novolog script to different pharmacy and used $99 card to eliminate possible hassle or misunderstanding by pharmacy staff.

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I have used my NovoLog My$99Insulin Card a few times for Fiasp, no issues. Took them a few minutes to get it entered, then no issues at all after that.
I don’t even think they asked if I had insurance, or if they did, I glossed over it pretty quick.

I just recently used Lilly’s Lyumjev savings card. My prescription was written wrong in many ways, and I ended up paying $95 for two vials. I hope the next prescript will be written correctly so I get better coverage on it.

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I tried to use my brand, new card tonight to pick up my script. The pharmacy said it expired! I told them I just signed up for it but they said the $99insulin plan expired as eoy 2020 and that I should call Novolog to see if they are planning to renew it. I will call them tomorrow but in the mean time, it looks like my insurance paid for the 3 vials except for a copay of $50. I hope my Humalog prescription is still valid.

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Yeah, I had the card that expired last year, and I had to get another one for 2021. They just enter the new info and I was good to go.

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Really? I only just got the new card for 2021 yesterday though. Have you used your 2021 card yet? I signed up for the card yesterday on the internet, printed it out and gave it to the pharmacist but they still said it had expired! The pharmacist told me to call Novolog to see if they are planning to have the $99Insulin plan again in 2021!

I wonder if the pharmacist just does’t want to fill it because they get more money if the insurance reimburses them?

Oh, you just got it IN 2021. Odd.
I did use my newer one end of January I think. It shows it is good until 12/31/2021

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I used in 2020, and then got new card for 2021 and have used in 2021 without problem.
I filled at Costco, even though in past I got insulin from CVS. I wanted to avoid chance of pharmacy trying to process towards my insurance.
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For medicare info on novo website implies you can get 2021 if you already had it in 2020, but not clear if that applies to non-medicare.

The cust support line (on card printout) is
1-888-910-0632, you could give them a call.

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Thanks, @MM2! This is exactly what I’m thinking! I filled at Value Drug last night and I know they have my insurance info. I may try Costco instead since I’ve never used them and they wouldn’t have my insurance info. Do you have to be a member of Costco to use their pharmacy? I’m not a member.

Yes, I’ll give them a call. At least I’d like to know the reasoning behind the “expiration”!

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Yes, non-members can use pharmacy.

Starting this year I started getting dexcom from Costco, which does bill my insurance. Costco is able to bill both correctly.

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