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ISMP: Similar Names But Different Actions: Potential Premix Insulin Prescription Errors

From the Institute for Safe Medication Practices (ISMP: Recently there have been reports of a mix up of mixed insulins.   The insulins involved were:

  • NovoLog® Mix (analog) 70/30 (70% insulin aspart protamine suspension and 30% insulin aspart injection, [rDNA origin])
  • Novolin® 70/30 human insulin.

Be prepared to address these potential premix insulin prescription errors .When prescribing NovoLog® Mix 70/30 analog insulin, health care professionals may write an unclear prescription, or if using an EMR system, inadvertently select Novolin® 70/30 human insulin instead. Be on the lookout for these errors when patients come to you with their questions on why the insulin is not working like you described.  Read on for a breakdown of the key differences between these 2 types of insulin….

Two Major differences are:
ü Novolin® 70/30 is not available in a pen.

ü NovoLog® Mix 70/30 has a flexible dosing approach that allows patients with type 2 diabetes to dose within 15 minutes before or after meal initiation vs 30 minutes before

Novo Nordisk Inc. and FDA announced  in 2006 that package labeling changes were implemented to help prevent product selection mix-ups between NOVOLOGMIX 70/30 (70% insulin aspart protamine suspension and 30% insulin aspart injection, [rDNA origin]) and NOVOLOG(insulin aspart [rDNA origin] injection). Previous packaging for both product lines was very similar, using a white background with a blue band. The new packaging for NovoLog Mix 70/30 products retains a similar design using a white background with a blue band, but the new packaging for NovoLog products utilizes a white background with an orange band (see photo).

 
 

Although color differentiation can help with product recognition, it should not be relied on as the sole means of identification. Practitioners should also use the product name and NDC number to distinguish insulin formulations. Keep in mind that this packaging change will not help to prevent name confusion errors involving these two products or other Novo insulin products (i.e., NovoLog Mix 70/30 and NOVOLIN 70/30 or NovoLog and NOVOLIN ) that may occur during prescribing, prescription interpretation, and order entry. To view the FDA alert, go to http://www.ismp.org/MSAarticles/fdasafetyalerts.htm

Selected Important Safety Information

NovoLog® Mix 70/30 should not be mixed with any other insulin product, administered intravenously, or used in insulin infusion pumps. NovoLog® Mix 70/30 has a faster onset of action than human insulin premix 70/30 and should be dosed within 15 minutes before meal initiation for patients with type 1 diabetes. For patients with type 2 diabetes, dosing should occur within 15 minutes before or after meal initiation.

The difference in time of action from 15 to 30 minutes can increase the risk of hypoglycemia or hyperglycemia.

References:

  1. Shah S, Benroubi M, Borzi V, et al; IMPROVE™ Study Group Expert Panel. Safety and effectiveness of biphasic insulin aspart 30⁄70 (NovoMix® 30) when switching from human premix insulin in patients with type 2 diabetes: subgroup analysis from the 6-month IMPROVE™ observational study. Int J Clin Pract. 2009;63(4):574-582.
  2. Fingertip Formulary: February 2014.