• Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus.

Contraindicated in:

• Hypoglycemia
• Allergy or hypersensitivity to a particular type of insulin, preservatives, or other additives.

Use Cautiously in:

• Stress and infection (may temporarily ↑ insulin requirements)
• Renal/hepatic impairment (may ↓ insulin requirements)
• Concomitant use with pioglitazone (↑ risk of fluid retention and worsening HF)
• OB: Pregnancy may temporarily ↑ insulin requirements
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Safety of Humalog not established.

Endo: HYPOGLYCEMIA.

F and E: hypokalemia.

Local: cutaneous amyloidosis, erythema, lipodystrophy, pruritus, swelling.
Misc: (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Beta blockers and clonidine may mask some of the signs and symptoms of hypoglycemia.
• Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, and rifampin may ↑ insulin requirements.
• Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates may ↓ insulin requirements.
• Concurrent use with pioglitazone may ↑ risk of fluid retention and worsening HF.

Drug-Natural Products:

• Glucosamine may worsen blood glucose control.
• Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

• Insulin aspart protamine suspension/insulin aspart injection mixture: 70% insulin aspart protamine suspension and 30% insulin aspart inection — NovoLog Mix 70/30 100 units/mL (vials and prefilled pens);
• Insulin lispro protamine suspension/insulin lispro injection mixture: 75% insulin lispro protamine suspension and 25% insulin lispro injection — Humalog Mix 75/25 100 units/mL (vials and prefilled pens); 50% insulin lispro protamine suspension and 50% insulin lispro injection — Humalog Mix 50/50 100 units/mL (vials and prefilled pens);
• NPH insulin/regular insulin suspension mixture: 70 units NPH/30 units regular insulin/mL — Novolin 70/30, Humulin 70/30 (100 units/mL total) (vials and prefilled pens);

• SC (Adults and Children): 0.5–1 unit/kg/day. Adolescents during rapid growth: 0.8–1.2 units/kg/day.

insulin aspart protamine suspension/insulin aspart injection mixtures, rDNA origin: NovoLOG Mix 70/30, NovoLOG Mix 70/30 FlexPen

insulin lispro protamine suspension/insulin lispro injection mixtures, rDNA origin: HumaLOG Mix 75/25, HumaLOG Mix 50/50

NPH/regular insulin mixtures: HumuLIN 70/30, NovoLIN 70/30

• Lower blood glucose by:
  • stimulating glucose uptake in skeletal muscle and fat,
  • inhibiting hepatic glucose production.
• Other actions:
  • inhibition of lipolysis and proteolysis,
  • enhanced protein synthesis.

• Control of hyperglycemia in diabetic patients.

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

Absorption: Well absorbed from SUBQ administration sites.

Distribution: Widely distributed.

Metabolism/Excretion: Metabolized by liver, spleen, kidney, and muscle.

Half-life: 5–6 min (prolonged in patients with diabetes; biologic half-life is 1–1.5 hr).

(hypoglycemic effect)

• Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Caution patient that insulin pens should not be shared with others, even if clean needles are used.
• Caution patient not to share pen device with another person, even if needle is changed; may risk transmission of bloodborne pathogens.
• Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
• Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
• Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, herbal products, or alcohol.
• Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
• Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled.
• Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
• Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
• Advise patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.
• Emphasize the importance of regular follow-up, especially during first few wk of therapy.

IN-su-lin