insulin injection (regular insulin, crystalline zinc insulin)
insulin (lispro)
insulin zinc suspension, prompt (semilente)
isophane insulin suspension (neutral protamine Hagedorn insulin, NPH)
isophane insulin suspension with insulin injection
insulin zinc suspension (lente)
protamine zinc suspension (PZI)
insulin zinc suspension, extended (ultralente)
Pregnancy Risk Category NR
How supplied
insulin injection
Injection (human): 100 U/ml (Humulin-ROTC, Novolin ROTC, Velosulin Human BR‡); 100 U/ml in 1.5-ml cartridge systemOTC (Novolin R PenFillOTC)
Injection (from pork): 100 U/mlOTC
Injection (purified beef): 100 U/ml (Hypurin Neutral‡, Insulin 2 Neutral‡)
Injection (purified pork): 100 U/ml (Actrapid‡, Pork Regular Iletin IIOTC, Regular Purified Pork InsulinOTC); 100 U/ml in 1.5-ml cartridge system‡ (Actrapid PenFill‡); 100 U/ml in 2-ml cartridge system‡; 500 U/ml (Regular [Concentrated] Iletin II)
insulin lispro injection
Injection (human): 100 U/ml (Humalog)
insulin zinc suspension, prompt
Injection (purified pork): 100 U/mlOTC
isophane insulin suspension
Injection (from beef): 100 U/mlOTC (NPH InsulinOTC)
Injection (human, recombinant): 100 U/ml (Humulin NOTC, Humulin NPH‡, Novolin NOTC); 100 U/ml in 1.5-ml cartridge system (Novolin N PenFillOTC, Protaphane PenFill‡)
Injection (purified beef): 100 U/ml (Hypurin Isophane‡, Isotard MC‡)
Injection (purified pork): 100 U/ml (NPH Purified PorkOTC, Purified Pork NPH Iletin II, Protaphane‡)
isophane insulin suspension 50% with insulin injection 50%
Injection (human): 100 U/ml (Humulin 50/50OTC)
isophane insulin suspension 70% with insulin injection 30%
Injection (human): 100 U/ml (Humulin 70/30OTC, Novolin 70/30OTC; 100 U/ml in 1.5-ml cartridge system (Novolin 70/30 PenFillOTC)
insulin zinc suspension
Injection (from beef): 100 U/ml (Lente InsulinOTC, Lente MC‡)
Injection (purified beef): 100 U/ml (Lente MC‡)
Injection (purified pork): 100 U/ml (Lente Iletin II, Lente Purified Pork InsulinOTC)
Injection (human): 100 U/mlOTC (Humulin LOTC, Novolin LOTC)
protamine zinc suspension
Injection (purified beef): 100 U/ml (Hypurin Bovine Protamine Zinc §)
insulin zinc suspension, extended
Injection (from beef): 100 U/mlOTC(Ultralente InsulinOTC)
Injection (human): 100 U/ml (Humulin-UOTC)
Action
Increases glucose transport across muscle and fat cell membranes to reduce blood 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.
Indications & dosage
Diabetic ketoacidosis (use regular insulin only)--
Adults: 0.33 U/kg as I.V. bolus; then 0.1 U/kg/hour by continuous infusion. Continue infusion until blood glucose level drops to 250 mg/dl; then S.C. insulin is begun with dosage, and dosage interval is adjusted according to patient's blood glucose level.
Or, 50 to 100 U I.V. and 50 to 100 U S.C. immediately; then additional doses q 2 to 6 hours based on blood glucose levels.
To prepare infusion, add 100 U of regular insulin and 1 g of albumin to 100 ml of normal saline solution. Insulin concentration will be 1 U/ml. (The albumin will adhere to plastic, preventing insulin from adhering to plastic.)
Children: 0.1 U/kg as I.V. bolus; then 0.1 U/kg hourly by continuous infusion until blood glucose level drops to 250 mg/dl; then S.C. insulin started. Or, 1 to 2 U/kg in two divided doses, one I.V. and the other S.C., followed by 0.5 to 1 U/kg I.V. q 1 to 2 hours based on blood glucose levels.
Type 1 insulin-dependent diabetes, adjunct to type 2 non-insulin-dependent diabetes inadequately controlled by diet and oral antidiabetics--
Adults and children: therapeutic regimen is prescribed by doctor and adjusted based on patient's blood glucose levels.
Control of hyperglycemia with longer-acting insulin (Humalog) in patients with type 1 diabetes mellitus and with sulfonylureas in patients with type 2 diabetes mellitus--
Adults and children over age 3: Dosage varies among patients and must be determined by a prescriber familiar with patient's metabolic needs, eating habits, and other lifestyle variables. Inject S.C. within 15 minutes before or immediately after a meal.
Adverse reactions
Metabolic: hypoglycemia, hyperglycemia (rebound, or Somogyi effect), decreased serum magnesium, potassium, or inorganic phosphate levels.
Skin: rash, urticaria, pruritus, swelling, redness, stinging, warmth at injection site.
Other: lipoatrophy, lipohypertrophy, hypersensitivity reactions, anaphylaxis.
Interactions
Drug-drug. Anabolic steroids, beta blockers, clofibrate, fenfluramine, guanethidine, MAO inhibitors, salicylates, tetracycline: prolonged hypoglycemic effect. Monitor blood glucose level carefully.
Corticosteroids, dextrothyroxine, epinephrine, thiazide diuretics, thyroid hormone: diminished insulin response. Monitor for hyperglycemia.
Diazoxide, phenytoin (high doses): may inhibit endogenous insulin secretion and cause hypoglycemia in diabetic patients. Carefully adjust insulin dosage when using with these drugs.
Oral contraceptives: may decrease glucose tolerance in diabetic patients. Monitor blood glucose levels and adjust insulin dosage carefully.
Drug-herb. Basil, bay, bee pollen, burdock, sage: may affect glycemic control. Monitor blood glucose level closely.
Garlic dust, ginseng: may decrease blood glucose levels. Monitor for effects.
Drug-lifestyle. Alcohol use: hypoglycemic effect. Discourage concomitant use.
Marijuana use: may increase serum glucose levels. Tell patient to avoid use of marijuana.
Smoking: may increase blood glucose levels and decrease response to insulin administration. Monitor blood glucose
levels.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with history of systemic allergic reaction to pork.
Nursing considerations
I.V. administration
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING