Insulin, Regular

Category:

  • Miscellaneous

Description:

  • Antidiabetic agent

Indications:

  • Diabetes mellitus

  • Diabetic ketoacidosis

  • Hyperkalemia

  • Nutritional supplementation

Contraindications:

  • Hypoglycemia, porcine hypersensitivity (if from pork)

Precautions:

  • Pregnancy category B

  • Hypoglycemia related to dose

  • Renal impairment/failure, hepatic disease

Adverse Reactions (Side Effects):

  • anaphylactoid reactions, hyperinulinism, hypoglycemia, hypokalemia

  • reaction at injection site, insulin resistance, lipodystrophy, nausea, vomiting

  • pruritus, sinus tachycardia, urticaria

 

Dosage:

Administered subcutaneously, intramuscularly, and intravenously

  • Diabetes mellitus type I or diabetes type II inadequately managed by diet and oral hypoglycemics: 

    • Adult and child: 

      • SC range 0.1-2.5 units/kg/day; 

      • most patients require 0.5-1.2 units/kg/day.

  • Diabetic ketoacidosis: 

    • Adult: Initially, 0.1 unit/kg/hr continuous IV INF in addition to adequate fluid therapy (usually 0.9% NaCl at 1 L/hour for 2-3 hours, then 0.45% NaCl).  

    • When blood glucose reaches 250 mg/dl, fluid therapy should be changed to 5% dextrose in 0.45% NaCl, while IV INF of insulin is continued at roughly half the initial rate until acidosis is also corrected.

  • Child: 

    • Initially, 0.1 unit/kg IV BOLUS, followed by 0.1 unit/kg/hour (range 0.05-0.2 units/kg/hour) continuous IV INF until blood glucose reaches 250 mg/dl, at which time IV dextrose may be added while IV INF of insulin is continued until acidosis is also corrected.

  • Nutiritional supplement in neonates to optimize caloric intake while on parenteral nutrition:  

    • 0.01-0.1 units/kg/hour via continuous IV INF. (start at lower end of dosage range)

  • Hyperkalemia: 

    • Adult: 5-10 units IV in 50ml D50W over 5 minutes

Subcutaneous Dosing:

  • Individualize dosage based on careful monitoring of blood glucose and other clinical parameters.

  • Administer 30 minutes prior to a meal

  • Inject into upper thighs, upper arms, buttocks, or abdomen.  Inject over 2-4 seconds.

 
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