Generic
Insulin (Human) Regular + Insulin (Human) Isophane (pre mixed)
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At a glance
Insulin (Human) Regular + Insulin (Human) Isophane (pre mixed) is a dual-acting insulin combination used for the treatment of Type 1 and Type 2 diabetes mellitus.
Description
Insulin (Human) Regular + Insulin (Human) Isophane (pre mixed) is a combination injection containing 30% soluble insulin (regular) and 70% isophane insulin (NPH) (30/70 formulation) or 50% regular and 50% NPH (50/50 formulation). It is used for Type 1 diabetes, Type 2 diabetes (not adequately controlled by diet and oral agents), diabetic ketoacidosis, and gestational diabetes.
Indications
- Type 1 diabetes mellitus
- Type 2 diabetes mellitus (not adequately controlled by diet and oral hypoglycemic agents)
- Diabetic ketoacidosis
- Hyperosmolar non-ketotic syndrome
- Gestational diabetes
Therapeutic class
Antidiabetic (Insulin)
Pharmacological class
Dual-acting Insulin (Pre-mixed)
Pharmacology
Insulin lowers blood glucose levels. It regulates carbohydrate, protein and fat metabolism by inhibiting hepatic glucose production and lipolysis, and enhancing peripheral glucose disposal. This pre-mixed insulin contains 30% soluble insulin (short-acting) and 70% isophane insulin (intermediate-acting). After subcutaneous injection, onset of action is within 30 minutes, peak plasma levels attained between 1-3 hours, and duration of action approximately 18-24 hours.
Mechanism of action
Lowers blood glucose by binding to insulin receptors, facilitating glucose uptake in muscle and fat cells, and inhibiting glucose output from the liver.
Dosage
Adult Dose (Subcutaneous):
- Type 1 Diabetes: 0.5-1 unit/kg/day in divided doses; prepubertal children: 0.7-1 unit/kg/day
- Type 2 Diabetes: Starting: 0.3-0.6 units/kg/day; titrate accordingly
- 50-75% of total daily dose given as intermediate- or long-acting insulin
- Morning: 2/3 of daily insulin (Regular:NPH = 1:2); Evening: 1/3 (Regular:NPH = 1:1)
Child Dose (Type 1): Ketones moderate or less: 0.5 units/kg/day; Ketones large: 0.7 units/kg/day
Administration
Administer within 15 minutes before or immediately after meal as subcutaneous injection in upper arm, thigh or abdominal wall; abdominal wall injection results in faster absorption; mix thoroughly before use (roll cartridge 10-20 times); rotate injection sites to avoid lipodystrophy.
Missed dose
If you miss a dose, please consult your doctor.
Side effects
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
- Angioneurotic edema
Precautions & warnings
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
- Not for IV or IM administration
- Do not use if clumps or solid white particles are present after mixing
Contraindications
Contraindications:
- Hypoglycemia
- Hypersensitivity to human insulin or any of the excipients
Drug interactions
Drug Interactions:
- Oral hypoglycemic agents, MAOIs, nonselective beta-blockers, ACE inhibitors, salicylates, alcohol, anabolic steroids, sulphonamides may reduce insulin requirement
- OCs, thiazides, glucocorticoids, thyroid hormones, sympathomimetics, danazol may increase insulin requirement
- Octreotide/lanreotide may both decrease and increase insulin requirement
- Beta-blockers may mask symptoms of hypoglycemia
- Alcohol may intensify or reduce hypoglycemic effect of insulin
Food interactions
No food interaction found/established.
Use in pregnancy
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
Use in Lactation: Safe during breastfeeding; safe to use while breastfeeding; however insulin dosage and diet may need adjustment.
Pediatric use
Prepubertal children: 0.7-1 unit/kg/day; ketones moderate or less: 0.5 units/kg/day; ketones large: 0.7 units/kg/day.
Geriatric use
No specific data for elderly.
Renal / hepatic impairment
Renal Impairment: Dose adjustments may be needed (dosage may be reduced).
Hepatic Impairment: Dose adjustments may be needed (dosage may be reduced).
Overdose effects
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.
Storage conditions
Store between 2°C-8°C in refrigerator; do not freeze; protect from light; during use may be stored below 25°C for 6 weeks or below 30°C for 4 weeks; mix thoroughly before use.
Chemical structure
Insulin (Human) Regular + Insulin (Human) Isophane (pre mixed)