Insulin (Human) R

Insulin (Human) R is a short-acting insulin (soluble insulin or regular insulin) used for the treatment of diabetes mellitus and diabetic ketoacidosis. It lowers blood glucose levels and regulates carbohydrate, protein and fat metabolism. It inhibits hepatic glucose production and lipolysis, and enhances peripheral glucose disposal. Soluble insulin is a short-acting preparation that can be administered SC, IM or IV.

• Diabetes mellitus (Type 1 and Type 2)
• Diabetic ketoacidosis

Adult Dose (Subcutaneous):

• Type 1 Diabetes: Initial: 0.2-0.4 units/kg/day divided q8hr; Maintenance: 0.5-1 unit/kg/day divided q8hr
• Type 2 Diabetes: Initial: 0.2-0.4 units/kg/day divided q8hr-q12hr
• 50-75% of total daily insulin given as intermediate- or long-acting insulin in 1-2 injections; rapid- or short-acting insulin used before or at mealtimes

Diabetic Ketoacidosis (IV):

• Loading dose: 20 units, then 6 units/hr until blood glucose drops to 10 mmol/l, then 3 units/hr

Child Dose (Type 1): Initial: 0.2-0.4 units/kg/day q8hr; Maintenance: 0.5-1 unit/kg/day; adolescents up to 1.5 units/kg/day

Side Effects:

• Hypoglycemia
• Injection site reactions (redness, swelling, pain)
• Lipodystrophy
• Pruritus
• Rash
• Lipoatrophy
• Hypokalemia
• Blurred vision
• Insulin resistance
• Headache
• Influenza-like symptoms
• Dyspepsia
• Diarrhea
• Back pain
• Pharyngitis

Precautions:

• Pregnancy (insulin requirements fall in 1st trimester, increase in 2nd and 3rd) and lactation
• Caution with decreased insulin requirements: Diarrhea, nausea/vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment
• Hypokalemia may occur
• Caution in renal and hepatic impairment (dosage requirements may be reduced)
• Caution with increased insulin requirements: Fever, hyperthyroidism, trauma, infection, surgery
• Only soluble insulin can be administered IV

Contraindications:

• Hypoglycemia
• Hypersensitivity to any of the components

Drug Interactions:

• Possible absence of hypoglycemic warning symptoms with beta-blockers
• Decreased hypoglycemic effect with corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, phenothiazine derivatives, somatropin, sympathomimetic agents, thyroid hormones, estrogens, progestins
• Increased hypoglycemic effect with oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, pentoxifylline, propoxyphene, salicylates, sulfonamide antibiotics
• Octreotide and lanreotide decrease insulin resistance
• Pioglitazone, rosiglitazone increase risk of weight gain and peripheral edema

Use in Pregnancy: Insulin is safe during pregnancy; insulin does not cross placental barrier; insulin requirements fall in 1st trimester, increase in 2nd and 3rd; return to pre-pregnancy values after delivery.

Use in Lactation: Safe during breastfeeding; safe to use while breastfeeding.

Renal Impairment: Dose adjustments may be needed (dosage may be reduced).

Hepatic Impairment: Dose adjustments may be needed (dosage may be reduced).

Overdose: No specific overdose definition for insulin; hypoglycemia may develop; mild episodes treated with oral glucose or sugary products; severe episodes with glucagon (0.5-1 mg) IM/SC or IV glucose; oral carbohydrate recommended after regaining consciousness.