Insulin (Emergency)

Registered South African indications:

• Diabetes Mellitus

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Hypoglycaemia

Cautions

• Renal impairment _5,U2D
• Hepatic impairment
• Elderly
• Hypoglycaemia
• Concomitant illness
• Insulin antibodies
• Changes in strength, brand, type species and/or method of manufacture may result in the need for a change in dosage

Forms avail. in SA and covered in this monograph: inj

Hyperglycemia
Glucose control in critically ill patients 
Insulin-dependant diabetes mellitus  

Dosing is individual and determined in accordance with the needs of the patient 

• SC infusion, IV, IM:Dose as per individual requirements
• SC: Initial: 0.2-0.6 units/kg, dly, in divided doses; Maintenance dose: 0.5-1.0 unit/kg, dly, in divided doses

SC admin. should be in the upper arms, thighs, buttocks, or abdomen. Injection sites should be rotated so that the same site is not used more than approximately once a month

Care must be taken to ensure that a blood vessel has not been entered for SC and IM admin.

Injection site should not be massaged

Continuous SC infusion admin. via insulin infusion pump 

Beta blocker and calcium channel blocker toxicity

• IV: Initial: 1unit/kg, followed by 1-10units/kg/hr infusion

High dose insulin therapy should only be carried out in a high care facility with the ability to monitor blood glucose and serum potassium

Paed. forms avail. in SA and covered in this monograph: inj

Older than 1 year

Hyperglycemia
Glucose control in critically ill patients 
Insulin dependant diabetes mellitus

• SC, Continuous SC infusion, IM, IV: Dosage based on individual patient needs

Pregnancy

• Safe
• Insulin aspart can be used in pregnancy. Data from two randomised controlled clinical trials (322 and 27 exposed pregnancies) do not indicate any adverse effect of insulin aspart on pregnancy or on the health of the foetus/newborn when compared to human insulin. Intensified blood glucose control and monitoring of pregnant women with diabetes (type 1 diabetes, type 2 diabetes or gestational diabetes) are recommended throughout pregnancy and when contemplating pregnancy. Insulin requirements usually fall in the first trimester and increase subsequently during the second and third trimester. After delivery, insulin requirements normally return rapidly to pre-pregnancy values

Breastfeeding

• Compatible
• There are no restrictions on treatment with insulin aspart during breastfeeding. Insulin treatment of the nursing mother presents no risk to the baby. However, the insulin aspart dose may need to be adjusted

Renal Impairment

• Caution; dose adjustment recommended
  Monitor blood glucose; Insulin dose adjusted on individual basis

Hepatic Impairment

• Caution; dose adjustment recommended
  Monitor blood glucose; Insulin dose adjusted on individual basis

Elderly

• Caution, dose adjustment recommended
  Monitor blood glucose; Insulin dose adjusted on individual basis

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Prohibited - At all times

Central Nervous System Disorders

• Peripheral neuropathy

Endocrine and Metabolic Disorders

• Hypoglycaemia

Skin and Subcutaneous Tissue Disorders

• Lipodystrophy

Immune System Disorders

• Urticaria
• Rash
• Eruptions
• Anaphylactic reactions

Sensory Disorders

• Refraction disorders
• Diabetic retinopathy

Others

• Injection site reactions
• Oedema

• Oral contraceptives
• Corticosteroids
• Thyroid replacement therapy
• Danazol
• Beta blockers
• Oral hypoglycaemic
• Salicylates
• Antidepressants
• Angiotensin converting enzyme inhibitors
• Angiotensin II receptor blockers
• Octreotide
• Alcohol
• Sulphonamides 
• Thiazides
• Sympathomimetics
• Growth hormone

• Blood glucose levels

Insulin is a peptide hormone , secreted by pancreatic beta cells.  It is central to regulating carbohydrate and fat metabolism in the body. Insulin binds to a glycoprotein receptor on muscle and fat cells. This receptor consists of an alpha-subunit , which binds the hormone and a beta-subunit , which is an insulin stimulated , tyrosine-specify protein kinase. This generates a signal which results in insulin's action on glucose, lipid and protein metabolism.

Insulin (per ml) 100u
- Insulin glulisine

• Apidra (Sanofi) originator

- Insulin lispro

• Humalog (Eli lilly) originator

- Insulin aspart

• NovoRapid (Novo Nordisk)

- Soluble biosynthetic human insulin

• Actrapid (Novo Nordisk)
• Biosulin R (Dezzo Trading)
• Humulin R (Eli-lily)