Insulin is always used for the treatment of insulin-dependent diabetes mellitus (type I diabetes) and occasionally also for the treatment of therapy refractory non-insulin-dependent diabetes mellitus (type II).
Insulin analog; Pancreatic Hormones
INTRAMUSCULAR Diabetic ketoacidosis: Adult: As soluble insulin, initial loading dose of 20 units, followed by 6 units/hr until blood glucose drops to 10 mmoI/l, when the dose is given 2 hrly. INTRAVENOUS Diabetic ketoacidosis: Adult: As soluble insulin, given in conc of 1 unit/mI using an infusion pump: Initially infuse at a rate of 6 unitsThr, double or quadruple the rate if blood glucose conc 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 & continue w/ 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 & include K Cl in the infusion to prevent insulin-induced hypokalaemia. Child: As soluble insulin, given in conc of 1 unit/mI using an infusion pump: Initially infuse at a rate of 0.1 units/ kg/hr, double or quadruple the rate if blood glucose conc 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 & continue w/ 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 & include K Cl in the infusion to prevent insulin-induced hypokalaemia. SUBCUTANEOUS Diabetes mellitus: Adult: Admin accoiding to requirements: inject into thighs, upper arms, buttocks, or abdomen.
Hypoglycaemia. Pregnancy (insulin requirements tend to fall during the 1st trimester, increase during the 2nd & 3rd) & lactation. Regular monitoring of HbA1c & blood glucose concentrations.
Hypoglycaemia, insulin resistance, lipoatrophy, hypokalaemia, blurred vision.
Insulin has been assigned to pregnancy category B. It is the drug of choice for the treatment of diabetes during pregnancy. Data from human pregnancy have revealed an increased incidence of teratogenicity associated with diabetes mellitus; the association with the use of insulin is probably coincidental. Because of the strong association between diabetes or hyperglycemia and perinatal morbidity and multiple congenital malformations, most experts recommend strict control of maternal plasma glucose with the use of insulin during pregnancy. Insulin should only be given during pregnancy when need has been clearly established. Limited data reveal that the milk of women with insulin dependent diabetes mellitus (IDDM) has significantly lower lactose and higher total nitrogen relative to nondiabetic women. The infants of women with IDDM in this study had significantly less milk intake. The data indicate delayed lactogenesis for women with IDDM. The differences in milk composition of women with IDDM do not preclude them from breast-feeding.
.png&w=384&q=75)