IntravenousDiabetic ketoacidosisAdult: Correct hypokalaemia (if present) before insulin regular administration. Initially, 0.1 units/kg via IV bolus inj, followed by 0.1 units/kg/hour via continuous IV infusion. Alternatively, an initial dose of 0.14 units/kg/hour via continuous IV infusion (without preceding bolus dose) may be given. If blood glucose levels do not decrease by approx 50-75 mg/dL within the 1st hour, the IV infusion rate may be doubled every hour. Once blood glucose reaches 200-250 mg/dL, may reduce the IV infusion rate to 0.02-0.05 units/kg/hour and start giving dextrose-containing IV fluids. Adjust the rate of insulin regular administration and concentration of dextrose until the patient's condition is resolved. Dosage must be individualised and adjusted according to the patient's electrolyte and fluid levels, blood glucose, serum osmolality and cardiac, renal and mental status. Dosing regimen recommendations may vary among countries or local guidelines (refer to institution-specific treatment protocols).
Child: Initially, 0.1 units/kg/hour via continuous IV infusion (begin insulin infusion at least 1 hour after starting the fluid replacement therapy); continued until ketoacidosis is resolved (blood pH >7.3, serum bicarbonate >15 mEq/L). Upon resolution, decrease the infusion rate to 0.05 units/kg/hour. Add dextrose 5% or 10% solution to the infusion fluid when blood glucose reaches 250 mg/dL. Continue infusion until the patient can eat orally and then transition to SC insulin regimen. Dosage must be individualised and adjusted according to the patient's electrolyte and fluid levels, blood glucose, serum osmolality and cardiac, renal and mental status. Dosing regimen recommendations may vary among countries or local guidelines (refer to institution-specific treatment protocols).
Intravenous, SubcutaneousDiabetes mellitusAdult: Dosage must be individualised and adjusted according to the patient's metabolic needs, blood glucose monitoring results, and goal in glycaemic control. Generally used in combination with intermediate- or long-acting insulin. Via SC inj: Inject approx 30 minutes before a meal into the thigh, upper arm, abdomen or buttock. Via IV infusion: Give only under medical supervision with close monitoring of blood glucose and K levels. Dose adjustments may be necessary when switching from another insulin or with changes in physical activity, meal patterns, renal or hepatic function, or during acute illness. Dosage recommendations may vary among individual products and countries (refer to detailed product or local guidelines).
Child: Dosage must be individualised and adjusted according to the patient's metabolic needs, blood glucose monitoring results, and goal in glycaemic control. Dosage recommendations may vary among individual products and countries (refer to detailed product or local guidelines).
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Diabetes mellitus; Diabetic ketoacidosis:
Dosage adjustment may be required.
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Diabetes mellitus; Diabetic ketoacidosis:
Dosage adjustment may be required.
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IV infusion: Adults: Dilute with NaCl 0.9% solution or other compatible IV fluids to a standard concentration of 1 unit/mL. Children: Dilute with NaCl 0.9% solution or other compatible IV solutions to a concentration of 0.2 unit/mL or 1 unit/mL. Neonates: Dilute with NaCl 0.9% solution or other compatible fluids to a standard concentration of 0.1 unit/mL or 0.5 unit/mL. Recommendations for dilution and concentration may vary among individual products and countries (refer to detailed product guidelines).
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SC inj: Not to be mixed with other insulin preparations other than isophane insulin (neutral protamine Hagedorn [NPH] insulin). Incompatible with products containing thiols or sulfites.
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Hypersensitivity. Episodes of hypoglycaemia.
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Patient with risk factors for hypoglycaemia, including changes in meal pattern, level of physical activity, concurrent illness (particularly infection, conditions with fever, or accidental/surgical trauma), emotional stress, and concomitant drugs; cardiac disease; adrenal, pituitary or thyroid disease. Symptoms of hypoglycaemia may be less pronounced in patients with long history of diabetes, intensified insulin treatment, recurrent hypoglycaemia, diabetic neuropathy, diabetic nerve disease, and those who switched from animal insulin to human insulin or receiving β-blockers. Some available brands cannot be used in insulin pumps for continuous SC insulin infusion (refer to specific product information). Concomitant use with peroxisome proliferator-activated receptor (PPAR)-γ agonists. Renal and hepatic impairment. Neonates, children and elderly. Pregnancy and lactation.
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Significant: Hypoglycaemia, hypokalaemia; lipodystrophy, lipoatrophy, lipohypertophy, and localised cutaneous amyloidosis at the inj site; development of insulin antibodies.
General disorders and administration site conditions: Inj site reactions (e.g. erythema, pruritus, inflammation).
Investigations: Weight gain.
Metabolism and nutrition disorders: Peripheral oedema.
Skin and subcutaneous tissue disorders: Rash, urticaria.
Potentially Fatal: Severe allergic reactions, including anaphylaxis; severe and prolonged hypoglycaemia resulting in unconsciousness, convulsion, or brain damage (temporary or permanent); untreated hypokalaemia which may lead to respiratory paralysis and ventricular arrhythmia.
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Inhalation/Respiratory: C; Parenteral: B; Inhalation/Respiratory: C; IM/IV/SC: B
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This drug may impair your ability to concentrate and react due to hypoglycaemia; if affected, do not drive or operate machinery. SC: Continuously rotate inj sites within the same body region to prevent inj site reactions.
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Monitor serum glucose levels (frequency is individualised based on therapy regimen and hypoglycaemia risk), electrolytes (particularly serum K levels), renal and hepatic function, and weight; HbA1c (at least twice yearly in patients with stable glycaemic control; quarterly in patients not meeting treatment goals or with treatment change). For diabetic ketoacidosis: Closely monitor serum electrolytes (e.g. Na, K, bicarbonate, phosphate), serum glucose levels, venous pH, anion gap, serum osmolality, serum BUN and creatinine, fluid status and mental status.
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Symptoms: Hypoglycaemia and hypokalaemia. Management: Give oral glucose or sugary products to treat mild hypoglycaemic episodes. Administer IM or SC glucagon in case of severe hypoglycaemia (e.g. with neurologic impairment, seizure or coma). IV glucose must be given if the patient fails to respond to glucagon within 10-15 minutes. Once consciousness is regained, sustained carbohydrate intake and observation may be needed to prevent relapse. Correct hypokalaemia as appropriately.
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May cause dose-related fluid retention and heart failure with PPAR-γ agonists, including thiazolidinediones (e.g. pioglitazone). May increase the risk of hypoglycaemia with other antidiabetic agents (e.g. oral hypoglycaemic agents), sulfonamide antibiotics, anabolic steroids, salicylates, fibrates, ACE inhibitors, angiotensin II receptor blockers, MAOIs, and disopyramide. May mask signs and symptoms of hypoglycaemia with β-blockers, clonidine and guanethidine. May decrease the hypoglycaemic effects with corticosteroids, thyroid hormones, thiazide or loop diuretics, atypical antipsychotics (e.g. clozapine, olanzapine), sympathomimetic agents (e.g. epinephrine, salbutamol, terbutaline), oral contraceptives, glucagon, danazol, and isoniazid. May either increase or decrease the blood glucose-lowering effect with β-blockers, clonidine, octreotide, lithium salts and pentamidine.
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May either increase or decrease the blood glucose-lowering effect with alcohol.
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Description:
Mechanism of Action: Insulin regular is a short-acting insulin analogue. It may be available as an insulin human produced by recombinant DNA technology usually using Escherichia coli or Saccharomyces cerevisiae, or as a sterile solution of insulin porcine in some countries. Insulin regular stimulates peripheral glucose uptake (particularly by skeletal muscle and fat) and inhibits hepatic glucose production, thereby decreasing blood glucose levels. It also prevents lipolysis and proteolysis and increases protein synthesis.
Synonym(s): Neutral insulin; soluble insulin; unmodified insulin.
Onset: SC: Within 30-60 minutes. IV: 10-15 minutes.
Duration: SC: 6-8 hours.
Pharmacokinetics:
Absorption: Fairly rapidly absorbed after SC inj. Bioavailability: 48-89% (SC). Time to peak plasma concentration: 1.5-2.5 hours (SC).
Distribution: Volume of distribution: 0.32-0.67 L/kg.
Metabolism: Metabolised mainly in the liver, kidneys, and muscle tissue.
Excretion: Via urine as unchanged drug (small amounts).
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Unopened vial/pen/cartridge: Store between 2-8°C. Do not freeze. Protect from excessive heat and light. Opened (in-use) vial/pen/cartridge: May be stored between 2-8°C or below 30°C for up to 6 weeks. Do not freeze. Protect from excessive heat and light. Storage recommendations may vary among individual products or countries. Refer to specific product guidelines.
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American Diabetes Association. Hyperglycemic Crises in Patients With Diabetes Mellitus. Diabetes Care. 2001 Jan;24(1):154-161. https://doi.org/10.2337/diacare.24.1.154. Accessed 15/05/2023 Actrapid FlexPen 100 International Units/mL Solution for Injection in Pre-filled Pen (Novo Nordisk A/S). MHRA. https://products.mhra.gov.uk. Accessed 18/07/2023. Anon. Insulin Human. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 10/05/2023. Anon. Insulin Regular (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 10/05/2023. Anon. Insulin Regular. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 10/05/2023. Buckingham R (ed). Insulin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/07/2023. Humulin R Injection, Solution (Eli Lilly and Company). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/05/2023. Humulin S (Soluble) 100 IU/mL Solution for Injection in Vial (Eli Lilly Nederland B.V.). MHRA. https://products.mhra.gov.uk. Accessed 18/07/2023. Hypurin Porcine Neutral (Wockhardt UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/05/2023. Insugen-R 100 IU/mL (Biocon Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/05/2023. Joint Formulary Committee. Insulin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/07/2023. Novo Nordisk Pharmaceuticals Ltd Actrapid 100 IU/mL data sheet 14 July 2020. Medsafe. http://www.medsafe.govt.nz. Accessed 18/07/2023. Paediatric Formulary Committee. Insulin. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 10/05/2023. Regular Insulin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 18/07/2023.
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