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
The primary activity of Insulin Aspart is the regulation of glucose metabolism. Insulin Aspart bind to the insulin receptors on muscle and fat cells and lower blood glucose by facilitating the cellular uptake of glucose and simultaneously inhibiting the output of glucose from the liver.
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 as well as Insulin Aspart requirements: Oral anti-diabetic products, angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, propoxyphene, pentoxifylline, salicylates and sulfonamide antibiotics. The following substances may increase the Insulin as well as Insulin Aspart requirements: Thiazides, glucocorticoids, thyroid hormones, beta-sympathomimetics, growth hormone and danazol. Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood glucose lowering effect of insulin.
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.
A specific overdose for insulin cannot be defined, however, hypoglycaemia may develop over sequential stages if too high doses relative to the patient’s requirement are administered. Mild hypoglycaemic episodes can be treated by oral administration of glucose or sugary products. Severe hypoglycaemic episodes, where the patient has become unconscious, can be treated by glucagon (0.5 to 1 mg) given intramuscularly or subcutaneously. Glucose must also be given intravenously if the patient does not respond to glucagon within 10 to 15 minutes. Upon regaining consciousness administration of oral carbohydrate is recommended for the patient in order to prevent relapse.
Store at 2°C to 8°C in a refrigerator. Do not freeze. Protect from light.
Each ml suspension contains 100 IU (equivalent to 3.50 mg) Insulin Aspart (rDNA) BP as 30% soluble Insulin Aspart and 70% protamine-crystallised Insulin Aspart.
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