Insulin


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Diabetic ketoacidosis As soluble insulin at a concentration of 1 u/mL via an infusion pump: Initial: Infuse at a rate of 6 u/hr, double or quadruple the rate if blood glucose concentration do not decrease by about 5 mmol/L/hr. If blood glucose concentrations have decreased to 10 mmol/L, reduce infusion rate to 3 u/hr and continue w/ 5% glucose until the patient can eat orally. IM Diabetic ketoacidosis As soluble insulin: Loading dose: 20 u, then 6 u/hr until blood glucose drops to 10 mmol/L, when the dose is given 2 hrly. SC DM Dosage should be individualised and adjusted based on patient's glycaemic response.
Dosage Details
Intramuscular
Diabetic ketoacidosis
Adult: As soluble insulin, initial loading dose of 20 units, followed by 6 units/hr until blood glucose drops to 10 mmol/l, when the dose is given 2 hrly.

Intravenous
Diabetic ketoacidosis
Adult: As soluble insulin, given in concentration of 1 unit/ml using an infusion pump: Initially infuse at a rate of 6 units/hr, double or quadruple the rate if blood glucose concentration do not decrease by about 5 mmol/l/hr. If blood glucose concentrations have decreased to 10 mmol/l, reduce the infusion rate to 3 units/hr and continue with 5% glucose to prevent hypoglycaemia, until the patient can eat orally. Do not stop the insulin infusion before SC insulin is started. Ensure adequate fluid replacement and include potassium chloride in the infusion to prevent insulin-induced hypokalaemia.
Child: As soluble insulin, given in concentration of 1 unit/ml using an infusion pump: Initially infuse at a rate of 0.1 units/kg/hr, double or quadruple the rate if blood glucose concentration do not decrease by about 5 mmol/l/hr. If blood glucose concentrations have decreased to 10 mmol/l, reduce the infusion rate to 0.05 units/kg/hr and continue with 5% glucose to prevent hypoglycaemia, until the patient can eat orally. Do not stop the insulin infusion before SC insulin is started. Ensure adequate fluid replacement and include potassium chloride in the infusion to prevent insulin-induced hypokalaemia.

Subcutaneous
Diabetes mellitus
Adult: Admin according to requirements; inject into thighs, upper arms, buttocks, or abdomen.
Renal Impairment
Intramuscular:
Dose reduction may be needed.
Intravenous:
Dose reduction may be needed.
Subcutaneous:
Dose adjustments may be needed.
Hepatic Impairment
Intramuscular:
Dose reduction may be needed.
Intravenous:
Dose reduction may be needed.
Subcutaneous:
Dose adjustments may be needed.
Contraindications
Hypoglycaemia.
Special Precautions
Pregnancy (insulin requirements tend to fall during the 1st trimester, increase during the 2nd and 3rd) and lactation. Regular monitoring of HbA1c and blood glucose concentrations.
Adverse Reactions
Hypoglycaemia, insulin resistance, lipoatrophy, hypokalaemia, blurred vision.
Inhalation/Respiratory: C; Parenteral: B
Overdosage
Symptoms: Hypoglycaemia. Management: In mild hypoglycaemic episodes, treat with oral glucose. In severe hypoglycaemic episodes, where the patient has become unconscious, treat with IM/SC glucagon (0.5-1 mg) or IV glucose. If the patient does not respond to glucagon within 10-15 minutes, IV glucose must be given. Once consciousness is regained, admin oral carbohydrates to prevent a relapse.
Drug Interactions
Possible absence of hypoglycaemic warning symptoms with β-blockers. Decreased hypoglycaemic effect with corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, phenothiazine derivatives, somatropin, sympathomimetic agents, thyroid hormones, oestrogens, progestins (e.g. in oral contraceptives), protease inhibitors and atypical antipsychotic (e.g. olanzapine and clozapine). Increased hypoglycaemic effect with oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, pentoxifylline, propoxyphene, salicylates and sulfonamide antibiotics. Decreased insulin resistance with octreotide and lanreotide. Increased risk of wt gain and peripheral oedema with pioglitazone, rosiglitazone. Decreased effect of sermorelin.
Action
Description: Insulin lowers blood glucose levels. It regulates carbohydrate, protein and fat metabolism by inhibiting hepatic glucose production and lipolysis, and enhancing peripheral glucose disposal. The various insulin formulations are classified according to their durations of action after SC Inj. They are divided into short-, intermediate-, or long-acting insulin. Soluble insulin (also known as 'neutral insulin' or 'regular insulin') is a short-acting preparation. To extend the duration of action of insulin, preparations are formulated as suspensions in 2 methods. The 1st method involves complexing insulin with a protein so that it is slowly released, e.g. protamine zinc insulin (contains an excess of protamine) and isophane insulin (or NPH insulin which contains equal amounts of protamine and insulin). An alternative method is particle size modification e.g. insulin zinc suspensions. While all the formulations can be admin by SC inj, most by IM inj, only soluble insulin can be admin by IV. Compared to SC inj, IM admin usually has a faster onset of action, with a shorter duration of action.
Onset: 0.5-1 hr (short-acting e.g. soluble insulin); 2 hr (intermediate-acting e.g. biphasic insulin, isophane insulin, amorphous insulin zinc suspensions); 2-3 hr (mixed-insulin Zn suspension); 4 hr (long-acting e.g. insulin zinc suspensions, protamine zinc insulins).
Duration: 6-8 hr (short-acting e.g. soluble insulin); 24 hr (intermediate-acting e.g. biphasic insulin, isophane insulin, amorphous insulin zinc suspensions); 30 hr (mixed-insulin Zn suspension); 36 hr (long-acting e.g. insulin zinc suspensions, protamine zinc insulins).
Pharmacokinetics:
Absorption: Inactivated (oral); fairly rapid (SC); rapid (IM); increased by exercise.
Metabolism: Mainly in liver, also in kidneys and muscle tissue.
Excretion: Small amount excreted as unchanged drug in urine.
Disclaimer: This information is independently developed by MIMS based on Insulin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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