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
Insulin Aspart & Insulin Aspart Protamine is a human insulin analog suspension containing 30% Insulin Aspart & 70% Insulin Aspart Protamine used to lower blood glucose. Insulin Aspart is homologous with regular human insulin with the exception of a single substitution of the Amino Acid Proline by Aspartic Acid in position B28, and is produced by recombinant DNA technology utilizing Saccharomyces cerevisiae (baker's yeast). The primary activity of insulin, including Insulin Aspart is the regulation of glucose metabolism. Insulin, and its analogs lower blood glucose by stimulating peripheral glucose uptake, especially 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 drugs affect glucose metabolism and may require dose adjustment. The following substances may reduce the insulin requirements: anti-diabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, propoxyphene, salicylates, somatostatin analog and sulfonamide antibiotics. The following substances may increase the insulin requirements: atypical antipsychotics, corticosteroids, danazol, diuretics, estrogen, glucagon, isoniazid, niacin, oral contraceptives, phenothiazine, progestogens, preotease inhibitors, somatropin, sympathomimetic agents and thyroid hormones. Beta-blockers, clonidine, lithium salts, alcohol and pentamidine may either potentiate or weaken the blood glucose lowering effect of insulin. Beta-blockers, clonidine, guanethidine and reserpine may blunt the signs and symptoms of hypoglycemia.
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.
Excess insulin administration may cause hypoglycemia and, particularly when given intravenously, hypokalemia. Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments in drug dosage, meal patterns, or exercise may be needed. Hypokalemia must be corrected appropriately.
Storage when not in use: Store in a refrigerator (2°C to 8°C). Do not freeze. After removing from the refrigerator, it is recommended to allow to reach room temperature before resuspending the insulin for the first time use.
Storage during use: This is being used is not kept in the refrigerator. It can be kept at room temperature (below 30°C) for up to 4 weeks. Keep the cartridge in the outer carton in order to protect from light. This must be protected from excessive heat and light.
Each ml suspension contains-
Insulin Aspart (rDNA) BP 100 IU (equivalent to 3.5 mg) as 30% Soluble Insulin Aspart
70% Insulin Aspart Protamine
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