Actrapid, Actrapid Pen fill, Humulin R, Humulin R Regular, U-500 (concentrated), Hypurin, Neutral, Lletin II Regular, Novolin R, Novolin R Pen fill, Novolin R prefilled, velosulin BR, Humalog, Humalog Mix25, Humalog Mix 50/50, Humalog Mix 75/25, Humulin L, Lente Lletin II, Humulin-U, Ultralente, Humulin N, Humulin NPH, Hypurin isophane, Novolin N, Novolin N Pen fill, Novolin N prefilled, NPH Lletin II, Protaphane, Protaphane prefill, Humulin 70/30, Novolin 70/30, Novolin 70/30 pen fill, Mixtard 30/70, Mixtard 30/70 pen fill, Humulin 50/50, Mixtard 50/50, Mixtard pen fill 50/50, Mixtard 80/20, Mixtard pen fill 80/20: Increases glucose transport across muscle and fat cell membranes to reduce glucose level. Promotes conversion of glucose to its storage form, glycogen; triggers amino acid uptake and conversion to protein in muscle cells and inhibits protein degradation, stimulates triglyceride formation and inhibits release of free fatty acids from adipose tissue, and stimulates lipoprotein lipase activity, which converts circulating lipoproteins to fatty acids

Moderate to severe diabetic ketoacidosis or hyperosmolar hyperglycemia (regular insulin: Give a loading dose of 0.15 units/kg I.V. direct injection, followed by 0.1 unit/kg /hr a continuous infusion. Decrease rate of insulin infusion to 0.05 to 0.1 unit/kg/hr when glucose level reaches 250-300 mg/dl. Start infusion of D5W in half-normal saline solution separately from the insulin infusion when glucose level is 150-200mg/dl in patients with diabetic ketoacidosis or 250-300 mg/dl in those with hyperosmolar hyperglycemia. Give dose of insulin SC 1-2 hrs before stopping insulin infusion. (Intermediate-acting insulin I recommended).

Adults and children age 20 or younger: loading dose is not recommended. Begin therapy at 0.1 unit/kg/hr I.V. infusion. Once condition improves, decrease rate of insulin infusion to 0.05 unit/kg/hr. Start infusion of D5W in half-normal saline solution separately from the insulin infusion when glucose level is 250mg/dl

Mild diabetic ketoacidosis (regular insulin): give loading dose of 0.4-0.6 unit/kg divided in two equal parts, with half the dose given by direct I.V. Injection and half given I.M. or S.C. Subsequent does can be based on 0.1 unit/kg/hr I.M. or S.C.

Newly diagnosed diabetes mellitus (regular insulin): Individualize therapy. Initially, 0.5-1.0 unit/kg/day S.C. as part of a regimen with short-acting and long acting insulin therapy. Adults and children younger than age 20: individualize therapy. Initially, 0.1-0.25 unit/kg S.C. Q6-8hrs for 24 hrs then adjust accordingly.

Control of hyperglycemia with Humalog and Longer acting insulin in patients with type 1 DM: Dosage varies among patients and must be determined by prescriber familiar with patient’ metabolic needs, eating habits, and other lifestyle variables. Inject S.C. within 15 min before or after a meal.

Control of hyperglycemia with Humalog and sulfonylureas in patient with type 2 DM: Adult and children older than age 3: Dosage varies among patients and must be determined by prescriber familiar with patient metabolic needs, eating habits, and other lifestyle variables. Inject S.C. within 15min. before or after a meal.

Hyperkalemia: Adults: 50 ml of dextrose 50% given over 5min. followed by 5-10 unit of regular insulin by I.V. push.

I.V. Administration:

  • Give only regular insulin I.V. inject directly into vein or into a port close to I.V. access site. Intermittent infusion isn’t recommended. If given by continuous infusion, infuse drug diluted in normal saline solution at prescribed rate.
  • Regular insulin is used in patients with circulatory collapse. Diabetic ketoacidosis or Hyperkalemia. Don’t use Humulin R (concentrated) U-500 I.V. Don’t use intermediate or long acting insulin’s for coma or other emergency requiring rapid drug action. Also ketoisprone type 1, severely ill, and newly diagnosed diabetic patient with very high glucose level may need hospitalization and I.V. treatment with regular fast acting insulin.

Nursing Considerations:

  • Insulin is the drug of choice to treat diabetes during pregnancy. Insulin requirements increase in pregnant diabetic women and then decline immediately postpartum. Monitor patient closely.
  • Dosage is always expressed in USP units. Use only the syringes calibrated for the particular concentration of insulin given.
  • Some patients may develop insulin resistance and need large insulin doses to control symptoms of diabetes. U-500 insulin is available as Humulin R (concentrated) U-500for such patients. Give pharmacy sufficient notice when requesting refill prescription. Never store U-500 insulin in the same area with other insulin preparations because of danger of severe overdose if given accidentally to other patients.
  • To mix insulin suspension, swirl vial gently or rotate between palms or between palm and thigh, don’t shake vigorously this causes bubbling and air in syringe.
  • Lente, semilente, and ultralente insulin’s may be mixed in any proportion. Regular insulin may be mixed with NPH or Lente insulin’s in ay proportion. When mixing regular insulin with intermediate or long acting insulin, always draw up regular insulin into syringe first.
  • Switching from separate injections to a prepared mixture may alter patient response. When NPH or Lente is mixed with regular insulin in the same syringe, give immediately to avoid loss of potency.
  • Lispro insulin may be mixed with Humulin N or Humulin U, give within 15 minutes before a meal to prevent a hypoglycemic reaction.
  • Don’t use insulin that changes color or becomes clumped or granular in appearance
  • Check expiration date on vial before using contents
  • Usually administration route is S.C. for proper S.C. administration, pinch a fold of skin with finger atleast 3 inches apart, and insert needle at a 45-90 degree angle
  • Press but don’t rub site after injection. Rotate injection sites to avoid overuse of one area. Diabetic patients may achieve better control if injection site is rotated with in the same anatomic region.
  • Monitor patient for hyperglycemia
  • Store insulin in cool area. Refrigeration is desirable but not essential, except with Humulin R (concentrated) U-500

Side Effects:

Metabolic: hypoglycemia, hyperglycemia, hypomagnesemia, Hyperkalemia

Skin: rash, urticaria, pruritus, swelling, redness, stinging, warmth at injection site

Other: lipoatrophy, lipohypertrophy, hypersensitivity reactions, anaphylaxis