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Patients with diabetes react differently in the rate at which they absorb and utilize exogenous insulin; therefore, the duration of action varies from person to person. Moreover, the site of injection, volume of injection, and the condition of the tissues into which the insulin is injected can alter its rate of absorption and peak action times, and exercising the limb which has been injected immediately after injection can increase the speed of absorption. Insulin is measured in units.
Lipodystrophies are localized manifestations of disordered fat metabolism at the sites of insulin injection. Tissue hypertrophy can be seen as a mass of fibrous scar tissue and is sometimes called “insulin tumor.” atrophy of the tissues at the injection site appears as dimpling and pitting of the skin and underlying tissues. These problems are more common in adult females and in children. Atrophy of the tissues is relatively harmless, but hypertrophy can cause malabsorption of the insulin and a possible misdiagnosis of insulin resistance. Measures that can help prevent lipodystrophies include (1) systematic rotation of injection sites, (2) warming insulin to room temperature before injection, (3) pinching the skin when injecting the insulin so that it is deposited between fat and muscle tissue, and (4) use of human insulin.
insulin, regular (insulin injection)
insulin glulisine, recombinant
insulin lispro protamine, human
isophane insulin suspension (NPH insulin)
isophane insulin suspension (NPH) and insulin injection (regular)
Pharmacologic class: Pancreatic hormone
Therapeutic class: Hypoglycemic
Pregnancy risk category B
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.
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.
• Hypersensitivity to drug or its components
Use cautiously in:
• hepatic or renal impairment, hypothyroidism, hyperthyroidism
• elderly patients
• pregnant or breastfeeding patients
☞ 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.
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
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
• 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.
• 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.
insulinPhysiology A disulfide-linked polypeptide hormone produced by the beta cells of the pancreatic islets, which controls serum glucose and anabolism of carbohydrates, fat, protein. See Biphasic insulin, PEPCK, Proinsulin, rDNA insulin.
insulin(in'su-lin) [L. insula, island + -in]
Insulin preparations differ with respect to the speed with which they act and their duration and potency following subcutaneous injection. See: table
In the past, insulin for injection was obtained from beef or swine pancreas. These peptides differed from human insulin by a few amino acids, causing some immune reactions and drug resistance. Most insulin now in use is made by recombinant DNA technology and from an immunological perspective is equivalent to human insulin.
In health, the pancreas secretes insulin in response to elevations of blood glucose, such as occur after meals. It stimulates cells, esp. in muscular tissue, to take up sugar from the bloodstream. It also facilitates the storage of excess glucose as glycogen in the liver and prevents the breakdown of stored fats. In type 1 diabetes mellitus, failure of the beta cells to produce insulin results in hyperglycemia and ketoacidosis.
The insulin dosage should always be expressed in units. There is no average dose of insulin for diabetics; each patient must be assessed and treated individually Doses are titrated gradually to achieve near normal glucose levels, about 90–125 mg/dl.
The FDA requires that all preparations of insulin contain instructions to keep in a cold place and to avoid freezing.
CAUTION!Those who use insulin should wear an easily seen bracelet or necklace stating that they have diabetes and use the drug. This helps to ensure that patients with hypoglycemic reactions will be diagnosed and treated promptly.
insulin analogSee: analog
insulin injection siteSee: site
insulin isophane suspension
insulin lipodystrophySee: lipodystrophy
monocomponent insulinSingle-component insulin.
insulin protamine zinc suspension
insulin pumpSee: pump
insulin shockHypoglycemic shock.
insulin zinc extended suspension
insulin zinc prompt suspension
|Type of Insulin||Generic (Trade Names)||Onset (hr)||Maximum (hr)||Duration (hr)|
|Very rapid||Aspart (NovoLog)||0.2–0.5||1–3||3–5|
|Very rapid||Lispro (Humalog)||0.2–0.5||0.5–2.5||3–5|
|Very rapid||Glulisine (Apidra)||0.2–0.5||1.6–2.8||3–4|
|Intermediate-acting||NPH (Humulin N, Novolin N)||2–4||4–12||10–18|
|Fixed-dose combination insulins **||70/30, 50/50, etc.||Variable, depending on mixture used|
|Very long- acting||Lantus (Glargine)||2–4||none||11–32|
|Very long- acting||determir (Levemir)||3–4||3–9||6–23 Dose dependent|
|U 500 regular very concentrated (5 X U100)||0.5–1.0||2.5–5||up to 24 hr|
insulinA peptide hormone produced in the beta cells of the Islets of Langerhans in the PANCREAS. Insulin facilitates and accelerates the movement of glucose and amino acids across cell membranes. It also controls the activity of certain enzymes within the cells concerned with carbohydrate, fat and protein metabolism. Insulin production is regulated by constant monitoring of the blood glucose levels by the beta cells. Deficiency of insulin causes DIABETES. Insulin preparations may be in the ‘soluble’ form for immediate action or in a ‘retard’ form for prolonged action or as mixtures of these. Most insulins for medical use are now produced by recombinant DNA methods (genetic engineering) and are identical to human insulin. Bovine and porcine insulins are still used. Brand names include: Neutral Insulin injections: Humalog, Actrapid, Velosulin, Humulin S, Hypurin Bovine Neutral, Hypurin Porcine Neutral, Insuman Rapid, NovoRapid and Pork Actrapid. Biphasic Insulin injections: Humalog Mix25 and Mix50, Mixtard, Humulin, Hypurin Porcine, Insuman Comb, NovoMix 30 and Pork Mixtard 30. Isophane Insulin injections: Insulatard, Humulin, Hypurin Bovine Isophane, Isuman Basal and Pork Insulatard. Insulin Zinc Suspension (Mixed): Monotard, Humulin Lente and Hypurin Bovine Lente. Insulin Zinc Suspension (Crystalline): Ultratard and Humulin Zn. Protamine Zinc Insulin injection: Hypurin Bovine PZI. Long-acting Insulin Analogue: Lantus. The prefix ‘Human’ was deleted from insulin products in mid-2003.
insulinthe hormone controlling the amount of blood sugar, which is secreted by the beta cells of the ISLETS OF LANGERHANS in the pancreas. Insulin has three targets: the liver, the muscles, and adipose tissue, where its action helps to reduce the blood sugar level in the following ways:
- it stimulates the absorption of more glucose from the blood into respiring cells, by altering cell-membrane permeability;
- it stimulates the conversion of glucose into GLYCOGEN in the liver and muscles, reducing the supply of free glucose;
- it promotes the conversion of glucose into fats in the liver and adipose cells (LIPOGENESIS);
- it inhibits GLUCONEOGENESIS;
- it promotes GLYCOLYSIS of glucose in all cells.
Underproduction of insulin causes diabetes mellitus , resulting in an increase in blood sugar (hyperglycaemia) and sugar appearing in the urine (see GLYCOSURIA). The condition can be fatal if untreated, treatment being by injection of insulin into the blood stream. The hormone cannot be taken orally as, being a protein, it would be digested. Insulin was discovered by BANTING and BEST in 1921. The control of blood sugar, where a change in its level automatically brings about the opposite effect, is a good example of a negative FEEDBACK MECHANISM.
Patient discussion about insulin
Q. what does an insulin shot do? and what is it good for?
You may read more here: http://en.wikipedia.org/wiki/Insulin
Q. Why is insulin injected and not taken as a pill?
Q. is there an alternative for the Insulin shots? something less painful but yet effective as the old way?