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
30% Insulin Aspart and 70% Insulin Aspart Protamine (rDNA) is a human insulin analog suspension containing 30 % soluble Insulin Aspart and 70% Insulin Aspart Protamine crystals. This is a blood glucose lowering agent with an earlier onset and an intermediate duration of action. Insulin Aspart is homologous with regular human insulin with the exception of a single substitution of the proline by aspartic acid in position B28, and is produced by recombinant DNA technology utilizing Saccharomyces cerevisiae (baker’s yeast).
Primary function of insulin, including Insulin Aspart, is regulation of glucose metabolism. Insulin and its analogs lower blood glucose by stimulating peripheral glucose uptake, primarily by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin inhibits lipolysis and proteolysis, and enhances protein synthesis.
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.
A number of substances affect glucose metabolism and may require dose adjustment and particularly close monitoring.
The following are examples that may increase the blood glucose lowering effect and susceptibility to hypoglycemia: oral anti-diabetic products, pramlintide and angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, propoxyphene, salicylates and sulfonamide antibiotics.
The following substances are examples that may reduce the blood glucose lowering effect: corticosteroids, niacin, danazol, diuretics, sympathomimetic agents, isoniazid, phenothiazine derivatives, somatropin, estrogens, progestogens, atypical antipsychotics and danazol. Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood-glucose-lowering effect of insulin. Pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.
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.
Insulin Aspart overdose may result in hypoglycemia. Mild episodes of hypoglycemia can usually be treated with oral carbohydrates. Severe hypoglycemia may be treated with parenteral glucose or injections of glucagon. Adjustments in drug dosage, meal patterns, or exercise may be needed.
Store at 2°C to 8°C in a refrigerator. Do not freeze. In case of insulin for recent use need not be refrigerated, try to keep it in a cool place and keep away from heat and light. The insulin in use can be kept under the room temperature for a month.
Each ml suspension contains Insulin Aspart (rDNA) 100 units (equivalent to 3.5 mg) as 30% soluble Insulin Aspart and 70% Insulin Aspart Protamine suspension
.png&w=384&q=75)