Dangerous Drug: Insulin(in’ su lin)
Insulin injection: Humulin R, Novolin Toronto (CAN), Novolin R
Insulin injection concentrate: Humulin R Regular U-500
Insulin lispro: Humalog
Isophane insulin suspension (NPH): Humulin N, Novolinge (CAN), Novolin NPH (CAN), Novolin N
Insulin aspart: NovoLog
Insulin detemir: Levemir
Insulin glargine: Lantus
Insulin glulisine: Apidra, Apidra SoloSTAR
Combination insulins: Humalog 50/50 Humalog 75/25, Humulin 70/30, Novolin 70/30, Novolinge 10/90, 20/80, 30/70, 40/60, 50/50 (CAN), NovoLog 70/30
PREGNANCY CATEGORY B
PREGNANCY CATEGORY C
(INSULIN GLARGINE, INSULIN ASPART, INSULIN GLULISINE)
Drug Classes
Antidiabetic
Hormone
Therapeutic Actions
Insulin is a hormone secreted by beta cells of the pancreas that, by receptor-mediated effects, promotes the storage of the body’s fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids.
Indications
Treatment of type 1 diabetes mellitus
Treatment of type 2 diabetes mellitus that cannot be controlled by diet or oral drugs
Regular insulin injection: Treatment of severe ketoacidosis or diabetic coma
Treatment of hyperkalemia with infusion of glucose to produce a shift of potassium into the cells
Highly purified and human insulins promoted for short courses of therapy (surgery, intercurrent disease), newly diagnosed patients, patients with poor metabolic control, and patients with gestational diabetes
Insulin injection concentrated: Treatment of diabetic patients with marked insulin resistance (requiring more than 200 units/day)
Glargine (Lantus): Treatment of adult patients with type 2 diabetes mellitus who require basal insulin control of hyperglycemia
Treatment of adults and children 6 yr and older who require basal insulin control
Detemir (Levemir): Treatment of adults with diabetes who require basal insulin for the control of hyperglycemia
Aspart (NovoLog): To maintain glycemic control in children 4–18 yr using a continuous subcutaneous infusion pump
Contraindications and Cautions
Contraindicated with allergy to pork products (varies with preparations; human insulin not contraindicated with pork allergy); during episodes of hypoglycemia.
Use cautiously with pregnancy (keep patients under close supervision; rigid control is desired; following delivery, requirements may drop for 24–72 hr, rising to normal levels during next 6 wk); lactation (monitor mother carefully; insulin requirements may decrease during lactation).
Available Forms
Injection—100 units/mL, 500 units/mL (concentrated); prefilled cartridges and pens—100 units/mL
Dosages
Adults and pediatric patients
General guidelines, 0.5–1 unit/kg/day. The number and size of daily doses, times of administration, and type of insulin preparation are determined after close medical scrutiny of the patient’s blood and urine glucose, diet, exercise, and intercurrent infections and other stresses. Usually given subcutaneously. Regular insulin and insulin glulisine may be given IV in diabetic coma or ketoacidosis. Insulin injection concentrated may be given subcutaneously or IM but do not administer IV.
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