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 blood glucose lowering effect of insulin is due to the facilitated uptake of glucose following binding of insulin to receptors on muscle and fat cells and to the simultaneous inhibition of glucose output from the liver. Insulin has a half-life of a few minutes in the blood stream. No profound binding to plasma proteins.
An average action profile after subcutaneous injection indicates:
Onset of action- within 30 minutes
Peak plasma levels attained between 1-3 hours
Duration of action- approximately 18-24 hours
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.
Concomitant use of other drugs may influence insulin requirements.
The following substances may reduce the insulin requirements: Oral hypoglycemic agents (OHA), monoamine oxidase inhibitors (MAOI), non-selective beta-blocking agents, angiotensin converting enzyme (ACE) inhibitors, Salicylates and Alcohol.
The following substances may increase the insulin requirements: Thiazides, glucocorticoids, thyroid hormones and beta-sympathomimetics, growth hormone and Danazol.
Beta-blockers may mask the symptoms of hypoglycemia and delay recovery from hypoglycemia. Octreotide/ Lanreotide may both increase and decrease insulin requirement. Alcohol may intensify and prolong the hypoglycemic 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.
Insulins have no specific overdose definitions. However, hypoglycemia may develop over sequential stages:
Mild hypoglycemic episodes can be treated by oral administration of glucose or sugery products.
Severe hypoglycemic episodes, where the patient has become unconscious, can be treated by Glucagon (0.5 to 1 mg) given intramuscularly or subcutaneously by a trained person or glucose given intravenously by a medical professional. 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.
Insulin preparations should be stored between 2°C and 8°C (in a refrigerator). Insulin preparations which have been frozen must not be used. Insulin preparation should be kept in the outer carton in order to protect from light. Insulin preparations should be protected from excessive heat or sunlight. When in use the cartridge should not be refrigerated. Once in use the cartridge may be used for up to 6 weeks when stored below 25 o C or 4 weeks when stored below 30°C. Preparation should be mixed thoroughly before use, preferably by rolling the cartridges slowly between the hands.
30/70: Each ml suspension contains Insulin Human (rDNA) USP 100 IU (equivalent to 3.47 mg) as 30% Regular Insulin Human and 70% Isophane Insulin Human.
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