How to Switch Insulin Products
(last modified July 2024)
Switching insulins should always be done with prescriber approval and close monitoring. Advise patients to closely monitor blood glucose levels after switching insulins. Pharmacists may need to contact the prescriber before switching, depending on state/provincial regulations. Our FAQ, Facts About Biosimilars, addresses questions that may arise about interchangeability. See our chart, Comparison of Insulins (US) (Canada), for meal timing, onset, peak, duration of action, and other information.
Clinical Scenario |
Recommendation/Comments |
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NPH to long-acting |
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NPH to insulin detemir (Levemir)
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NPH to insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US])
NPH to insulin glargine U-300 (Toujeo) |
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Long-acting to NPH |
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Insulin detemir (Levemir) to NPH |
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Insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]) to NPH
Insulin glargine U-300 (Toujeo) to NPH
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Long-acting to long-acting |
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Insulin glargine U-100 (Lantus) to/from insulin glargine U-100 (Basaglar, Semglee, Rezvoglar [US])
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Insulin detemir (Levemir) to insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US])
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Insulin detemir (Levemir) to insulin glargine U-300 (Toujeo)
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Insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]) to insulin glargine U-300 (Toujeo) |
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Insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]) to insulin detemir (Levemir)
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Insulin glargine U-300 (Toujeo) to insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]) or insulin detemir (Levemir)
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NPH or long-acting to ultra-long acting |
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NPH, insulin detemir (Levemir), insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]), or insulin glargine U-300 (Toujeo) to insulin degludec (Tresiba) or insulin icodec (Aiali [Canada]) |
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Ultra-long acting to NPH or long-acting |
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Insulin degludec (Tresiba) to NPH, insulin detemir (Levemir), insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]), or insulin glargine U-300 (Toujeo) |
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Regular to rapid-acting |
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Regular human insulin (Humulin R [US], Novolin R [US], Novolin ge Toronto [Canada], Myxredlin [Canada], Hypurin Regular [Canada]) to rapid-acting insulin analog (insulin aspart [NovoLog (US), NovoRapid (Canada), Trurapi (Canada), Fiasp, Kirsty (Canada)], insulin glulisine [Apidra], insulin lispro [Humalog, Admelog, Lyumjev])
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Regular to inhaled insulin |
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Regular human insulin (Humulin R [US], Novolin R [US]) to mealtime insulin inhalation powder (Afrezza [US])
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Rapid-acting to regular |
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Insulin aspart (NovoLog [US], NovoRapid [Canada], Trurapi [Canada], Fiasp, Kirsty [Canada]), insulin glulisine (Apidra), or insulin lispro (Humalog, Admelog, Lyumjev) to regular human insulin (Humulin R [US], Novolin R [US], Novolin ge Toronto [Canada], Myxredlin [Canada], Hypurin Regular [Canada])
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Rapid-acting to rapid-acting |
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Insulin aspart (NovoLog [US], NovoRapid [Canada], Trurapi [Canada], Fiasp, Kirsty [Canada]), insulin glulisine (Apidra), or insulin lispro (Humalog, Admelog, Lyumjev) to insulin aspart (NovoLog [US], NovoRapid [Canada], Trurapi [Canada], Fiasp, Kirsty [Canada]), insulin glulisine (Apidra), or insulin lispro (Humalog, Admelog, Lyumjev)
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Rapid-acting to inhaled insulin |
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Insulin aspart (NovoLog, Fiasp), insulin glulisine (Apidra), or insulin lispro (Humalog, Admelog, Lyumjev) to mealtime insulin inhalation powder (Afrezza [US])
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Inhaled insulin to rapid-acting or regular |
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Insulin inhalation powder (Afrezza [US]) to insulin aspart (NovoLog, Fiasp), insulin glulisine (Apidra), insulin lispro (Humalog, Admelog, Lyumjev), regular human insulin (Humulin R, Novolin R)
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Regular to long-acting or ultra-long acting |
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Regular human insulin (Humulin R [US], Novolin R [US], Novolin ge Toronto [Canada], Myxredlin [Canada], Hypurin Regular [Canada]) to insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]), insulin glargine U-300 (Toujeo), insulin detemir (Levemir), insulin degludec (Tresiba), or NPH
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NPH, long-acting, or ultra-long acting to premixed |
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NPH, insulin detemir (Levemir), insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]), insulin glargine U-300 (Toujeo), insulin degludec (Tresiba), or insulin (Awigli [Canad]) to premixed NPH/regular insulin (Humulin 70/30 [US], Humulin 30/70 [Canada], Novolin 70/30 [US], Novolin ge 30/70 [Canada], Novolin ge 40/60 [Canada], Novolin ge 50/50 [Canada]), premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25 (US), Humalog Mix 25 (Canada), Humalog Mix 50/50 (US), Humalog Mix 50 Canada)], insulin aspart protamine/insulin aspart [NovoLog Mix 70/30 (US), NovoMix 30 (Canada)])
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Premixed to NPH |
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Premixed NPH/regular insulin (Humulin 70/30 [US], Humulin 30/70 [Canada],Novolin 70/30 [US], Novolin ge 30/70 [Canada]), premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25 (US), Humalog Mix 25 (Canada)], or insulin aspart protamine/insulin aspart [NovoLog Mix 70/30]) to NPH
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Premixed to long-acting |
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Premixed NPH/regular insulin (Humulin 70/30 [US], Novolin 70/30 [US], Humulin 30/70 [Canada], Novolin ge 30/70 [Canada]), premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25 (US), Humalog Mix 25 (Canada)], or insulin aspart protamine/insulin aspart [NovoLog Mix 70/30 (US), NovoMix 30 (Canada)]) to insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]), or insulin detemir (Levemir)
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Premixed NPH/regular insulin (Humulin 70/30 [US], Humulin 30/70 [Canada], Novolin 70/30 [US], Novolin ge 30/70 [Canada], Novolin ge 40/60 [Canada], Novolin ge 50/50 [Canada]), premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25 (US), Humalog Mix 25 (Canada), Humalog Mix 50/50 (US), Humalog Mix 50 (Canada)], insulin aspart protamine/insulin aspart [NovoLog Mix 70/30 (US), NovoMix 30 (Canada)]) to insulin glargine U-300 (Toujeo)
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Premixed to ultra-long acting |
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Premixed NPH/regular insulin (Humulin 70/30 [US], Humulin 30/70 [Canada], Novolin 70/30 [US], Novolin ge 30/70 [Canada], Novolin ge 40/60 [Canada], Novolin ge 50/50 [Canada]), premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25 (US), Humalog Mix 25 (Canada), Humalog Mix 50/50 (US), Humalog Mix 50 (Canada)], insulin aspart protamine/insulin aspart [NovoLog Mix 70/30 (US), NovoMix 30 (Canada)]) to insulin degludec (Tresiba) or insulin icodec (Awiqli) |
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Premixed to premixed |
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Premixed NPH/regular insulin (Humulin 70/30 [US], Humulin 30/70 [Canada], Novolin 70/30 [US], Novolin ge 30/70 [Canada], Novolin ge 40/60 [Canada], Novolin ge 50/50 [Canada]) to premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25 (US), Humalog Mix 25 (Canada), Humalog Mix 50/50 (US), Humalog Mix 50 (Canada)], insulin aspart protamine/insulin aspart [NovoLog Mix 70/30 (US), NovoMix 30 (Canada)])
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Premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25 (US), Humalog Mix 25 (Canada), Humalog Mix 50/50 (US), Humalog Mix 50 (Canada)], insulin aspart protamine/insulin aspart [NovoLog Mix 70/30 (US), NovoMix 30 (Canada)]) to premixed NPH/regular insulin (Humulin 70/30 [US], Humulin 30/70 [Canada], Novolin 70/30 [US], Novolin ge 30/70 [Canada], Novolin ge 40/60 [Canada], Novolin ge 50/50 [Canada])
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Premixed to inhaled insulin |
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Premixed NPH/regular insulin (Humulin 70/30, Novolin 70/30), premixed protamine/rapid-acting analog (insulin lispro protamine/insulin lispro [Humalog Mix 75/25, Humalog Mix 50/50], or insulin aspart protamine/insulin aspart [NovoLog Mix 70/30]) to mealtime insulin inhalation powder (Afrezza [US])
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U-100 insulin to U-500 insulin |
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All types of U-100 insulin to Humulin R U-500 (US) or Entuzity (Canada)
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Long-acting or ultra-long acting to long-acting + GLP-1 agonist |
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Insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]), insulin detemir (Levemir), insulin glargine U-300 (Toujeo), or insulin degludec (Tresiba) to insulin glargine U-100 + lixisenatide (Soliqua 100/33 [US]) |
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Insulin glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar [US]), insulin detemir (Levemir), insulin glargine U-300 (Toujeo), or insulin degludec (Tresiba) to insulin degludec + liraglutide (Xultophy [US])
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References
- Product information for Levemir. Novo Nordisk. Plainsboro, NJ 08536. December 2022.
- Product monograph for Entuzity. Eli Lilly Canada. Toronto, ON M5X 1B1. March 2021.
- FDA. Information regarding insulin storage and switching between products in an emergency. Content current as of September 19, 2017. http://www.fda.gov/Drugs/EmergencyPreparedness/ucm085213.htm. (Accessed April 19, 2023).
- Goldman JD, Patel D, Schnee D. Diabetes mellitus. In: Zeind CS, Carvalho MG, editors. Applied Therapeutics: the Clinical Use of Drugs. 11h ed. Philadelphia, PA: Wolters Kluwer Health, 2018:1071-147.
- Mehta R, Goldenberg R, Katselnik D, Kuritzky L. Practical guidance on the initiation, titration, and switching of basal insulins: a narrative review for primary care. Ann Med. 2021 Dec;53(1):998-1009.
- Wu T, Betty B, Downie M, et al. Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes. Diabetes Ther. 2015 Sep;6(3):273-87.
- Rosenstock J, Davies M, Home PD, et al. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008 Mar;51(3):408-16.
- Eli Lilly. Humulin R U-500 dosage and titration. https://www.humulin.com/hcp/dosing-titration#insulin-activity. (Accessed April 20, 2023).
- Cochran E, Musso C, Gorden P. The use of U-500 in patients with extreme insulin resistance. Diabetes Care. 2005 May;28(5):1240-4. Erratum in: Diabetes Care. 2007 Apr;30(4):1035.
- Product monograph for Levemir. Novo Nordisk Canada. Mississauga, ON L5n 6M1. August 2021.
- Munshi MN, Florez H, Huang ES, et al. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association. Diabetes Care. 2016 Feb;39(2):308-18.
- Product information for Basaglar. Eli Lilly and Company. Indianapolis, IN 46285. July 2021.
- Product monograph for Toujeo. Sanofi-Aventis Canada. Laval, QC H7V 0A3. October 2019.
- Product information for Toujeo. Sanofi-Aventis US. Bridgewater, NJ 08807. August 2022.
- Product information for Afrezza. MannKind Corporation. Danbury, CT 06810. February 2023.
- Product monograph for Trurapi. Sanofi-Aventis Canada. Lava, QC H7V 0A3. July 2022.
- European Medicines Agency. CHMP post-authorization summary of positive opinion for Toujeo. February 26, 2015. http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion/human/000309/WC500183282.pdf. (Accessed April 10, 2023).
- Product monograph for Semglee. BGP Pharma ULC. Etobicoke, ON M8Z 2S6 September 2022.
- Product information for Tresiba. Novo Nordisk. Plainsboro, NJ 08536. July 2022.
- Product information for Lyumjev. Eli Lilly and Company. Indianapolis, IN 46285. October 2022.
- Product monograph for Fiasp. Novo Nordisk Canada. Mississauga, ON L5N 6M1. July 2021.
- Product information for Fiasp. Novo Nordisk. Princeton, NJ 08540. November 2022.
- Product monograph for Basaglar. Eli Lilly Canada. Toronto, ON M5X 1B1. August 2022.
- Product information for Soliqua. Sanofi-Aventis. Bridgewater, NJ 08807. June 2022.
- Product information for Xultophy. Novo Nordisk. Plainsboro, NJ 08536. June 2022.
- Davidson MB. Insulin Therapy: A Personal Approach. Clin Diabetes. 2015 Jul;33(3):123-35.
- Information for health care professionals. Switching between insulin products in disaster response situations. Approved by the American Diabetes Association, the Endocrine Society and JDRF. August 2020. https://diabetes.org/sites/default/files/2020-09/Switching%20Between%20Insulin%20Products%20in%20Disaster%20Response%20Situations%202020%20-%20English.pdf. (Accessed April 19. 2023).
- Sanofi-Aventis US. Toujeo-Conversion from insulin glargine 100 U/mL BID to Toujeo QD. https://www.sanofiusmedicalinformation.com. (Accessed April 20, 2023).
- Product monograph for Admelog. Sanofi-Aventis Canada. Laval, QC H7V 0A3. December 2021.
- Product information for Semglee. Mylan Specialty. Morgantown, WV 26505. October 2022.
- Product information for Admelog. Sanofi-Aventis US. Bridgewater, NJ 08807. December 2020.
- Product information for Lantus. Sanofi-Aventis US. Bridgewater, NJ 08807. June 2022.
- Product monograph for Lantus. Sanofi-Aventis Canada. Laval, QC H7V 0A3. December 2021.
- Product monograph for Tresiba. Novo Nordisk Canada. Mississauga, ON L5N 6M1. October 2022.
- Product information for Rezvoglar. Eli Lilly and Company. Indianapolis, IN 46285. November 2022.
- Product monograph for Lyumjev. Eli Lilly Canada. Toronto, ON M5X 1B1. September 2021.
- Product monograph for Awiqli. Novo Nordisk Canada. Mississauga, ON L5N 6M1. March 2024.
Cite this document as follows: Clinical Resource, How to Switch Insulin Products. Pharmacist’s Letter/Pharmacy Technician’s Letter/Prescriber’s Letter. May 2023. [390524]
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