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.

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300