insulin injection


Also found in: Dictionary, Thesaurus, Encyclopedia.

insulin, regular (insulin injection)

Humulin R, Humulin-R Regular U-500 (concentrate), Insulin-Toronto (CA)

insulin (lispro)

Humalog, Humalog Pen

insulin glulisine, recombinant

Apidra, Apidra SoloSTAR

insulin lispro protamine, human

Humalog Mix 50/50, Humalog Mix 75/25

isophane insulin suspension (NPH insulin)

Humulin N, Novolin N

isophane insulin suspension (NPH) and insulin injection (regular)

Humulin 70/30 (70% isophane insulin and 30% insulin injection), Humulin 70/30 PenFill, Novolin 70/30, Novolin 70/30 PenFill

Pharmacologic class: Pancreatic hormone

Therapeutic class: Hypoglycemic

Pregnancy risk category B

Action

Promotes glucose transport, which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where it is converted to glycogen. Directly affects fat and protein metabolism, stimulates protein synthesis, inhibits release of free fatty acids, and indirectly decreases phosphate and potassium.

Availability

Glulisine, recombinant: 100 units/ml in 10-ml vials, 100 units/ml in 3-ml cartridge system, 100 units/ml in 3-ml prefilled pen

Isophane suspension, injection (regular): 70 units NPH and 30 units regular insulin/ml (100 units/ml total), 50 units NPH and 50 units regular insulin/ml (100 units/ml total)

Isophane suspension (NPH insulin): 100 units/ml

Lispro: 100 units/ml in 10-ml vials and 1.5-ml cartridges

Regular insulin injection: 100 units/ml

Regular U-500 (concentrated), insulin human injection: 500 units/ml

Zinc suspension, extended (ultralente): 100 units/ml

Zinc suspension (lente insulin): 100 units/ml

Indications and dosages

Type 1 (insulin-dependent) diabetes mellitus; type 2 (non-insulin-dependent) diabetes mellitus unresponsive to diet and oral hypoglycemics

Adults and children: In newly diagnosed diabetes, total of 0.5 to 1 unit/kg/day subcutaneously as part of multidose regimen of short- and long-acting insulin. Dosage individualized based on patient's glucose level, adjusted to premeal and bedtime glucose levels. Reserve concentrated insulin (500 units/ml) for patients requiring more than 200 units/day.

Diabetic ketoacidosis

Adults and children: Loading dose of 0.15 units/kg (nonconcentrated regular insulin) I.V. bolus, followed by continuous infusion of 0.1 unit/kg/hour until glucose level drops. Then administer subcutaneously, adjusting dosage according to glucose level.

Contraindications

• Hypersensitivity to drug or its components

• Hypoglycemia

Precautions

Use cautiously in:

• hepatic or renal impairment, hypothyroidism, hyperthyroidism

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

Be aware that insulin is a high-alert drug whether given subcutaneously or I.V.

Don't give insulin I.V. (except nonconcentrated regular insulin), because anaphylactic reaction may occur.

• When mixing two types of insulin, draw up regular insulin into syringe first.

• For I.V. infusion, mix regular insulin only with normal or half-normal saline solution, as prescribed, to yield a concentration of 1 unit/ml. Give every 50 units I.V. over at least 1 minute.

• Rotate subcutaneous injection sites to prevent lipodystrophy.

• Administer mixtures of regular and NPH or regular and lente insulins within 5 to 15 minutes of mixing.

Adverse reactions

Metabolic: hypokalemia, sodium retention, hypoglycemia, rebound hyperglycemia (Somogyi effect)

Skin: urticaria, rash, pruritus

Other: edema; lipodystrophy; lipohypertrophy; erythema, stinging, or warmth at injection site; allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetazolamide, albuterol, antiretrovirals, asparaginase, calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, hormonal contraceptives, isoniazid, morphine, niacin, phenothiazines, phenytoin, somatropin, terbutaline, thyroid hormones: decreased hypoglycemic effect

Anabolic steroids, angiotensin-converting enzyme inhibitors, calcium, chloroquine, clofibrate, clonidine, disopyramide, fluoxetine, guanethidine, mebendazole, MAO inhibitors, octreotide, oral hypoglycemics, phenylbutazone, propoxyphene, pyridoxine, salicylates, sulfinpyrazone, sulfonamides, tetracyclines: increased hypoglycemic effect

Beta-adrenergic blockers (nonselective): masking of some hypoglycemia symptoms, delayed recovery from hypoglycemia

Lithium carbonate: decreased or increased hypoglycemic effect

Pentamidine: increased hypoglycemic effect, possibly followed by hyperglycemia

Drug-diagnostic tests. Glucose, inorganic phosphate, magnesium, potassium: decreased levels

Liver and thyroid function tests: interference with test results

Urine vanillylmandelic acid: increased level

Drug-herbs. Basil, burdock, glucosamine, sage: altered glycemic control Chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek, marshmallow: increased hypoglycemic effect

Garlic, ginseng: decreased blood glucose level

Drug-behaviors. Alcohol use: increased hypoglycemic effect

Marijuana use: increased blood glucose level

Smoking: increased blood glucose level, decreased response to insulin

Patient monitoring

• Monitor glucose level frequently to assess drug efficacy and appropriateness of dosage.

• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).

Monitor for signs and symptoms of hypoglycemia. Keep glucose source at hand in case hypoglycemia occurs.

Assess for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by blood and urinary ketones, metabolic acidosis, extremely elevated blood glucose level).

• Monitor for glycosuria.

• Closely evaluate kidney and liver function test results in patients with renal or hepatic impairment.

Patient teaching

• Teach patient how to administer insulin subcutaneously as appropriate.

• Advise patient to draw up regular insulin into syringe first when mixing two types of insulin. Caution him not to change order of mixing insulins.

• Instruct patient to rotate subcutaneous injection sites and keep a record of sites used, to prevent fatty tissue breakdown.

Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to carry a glucose source at all times.

• Instruct patient to store insulin in refrigerator (not freezer).

• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.

• Tell patient that dietary changes, activity, and stress can alter blood glucose level and insulin requirements.

• Instruct patient to wear medical identification stating that he is diabetic and takes insulin.

• Advise patient to have regular medical, vision, and dental exams.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

in·su·lin in·jec·tion

a preparation that usually contains 100 USP insulin units per mL; it is administered subcutaneously, occasionally intravenously, and has a rapid onset of action, has a brief duration (5-7 hours), and is compatible for mixing with long-acting insulin preparations; used to treat diabetic acidosis and insulin coma.

in·su·lin in·jec·tion

(insŭ-lin in-jekshŭn)
Preparation that usually contains 100 USP insulin units per mL; it is administered subcutaneously; occasionally intravenously; has rapid onset of action; and brief duration (5-7 hours). Used to treat diabetic acidosis and insulin coma.
References in periodicals archive ?
The participants said that insulin therapy was more beneficial in regulating blood glucose levels by comparison with oral anti-diabetic drugs; however, insulin injection was considered to be painful and failure in the maintenance of previous treatments was associated with starting insulin therapy in 39.
With our new Guardian Connect system, we've continued to innovate so we can deliver these insights for people with diabetes on insulin injection therapy," said Annette Brls, president, Diabetes Service and Solutions at Medtronic.
THE mum of a brave fouryear-old who was diagnosed with Type 1 diabetes 12 months ago fears her son may not be able to continue studying at his chosen primary school because stacannot administer his insulin injections.
Educational materials supplied by BD will be used to teach pharmacy interns and pharmacy preceptors subcutaneous insulin injection technique.
Disclosures: Patton Medical Devices, which makes an insulin injection device, funded the study.
A surprising 91% of the subjects aged 7-21 years who participated in an observational study of the pain of diabetes management reported that their typical response to both insulin injections and fingerpricks was characterized by the statements, "I can nearly feel it" or, "I can feel it a little," rather than the statement, "It hurts me.
The current research is looking at short-acting insulin and those using long-acting insulin injections would have to continue taking these.
This is done by regular examination of insulin injection sites, by the health care provider, and supplemented by self- examination.
PHILADELPHIA -- Temple University School of Pharmacy is engaged in a new program to measure the impact of pharmacists and pharmacy students on diabetes patients' understanding of insulin injection technique.
Among patients with Type 1 diabetes, four years of inhaled insulin treatment, combined with a daily long-lasting insulin injection, was shown to be effective, with no serious side effects.
Indeed, a national survey of 929 patients with type 2 diabetes showed that on average they considered a single daily insulin injection with suboptimal glucose control eightfold more valuable than two injections per day with optimal glucose control, according to Mr.