• Type 1 or type 2 diabetes mellitus.

Concentrated regular insulin U-500:

• Only for use in patients with insulin requirements >200 units/day.

Unlabeled Uses:

• Hyperkalemia.

Contraindicated in:

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

Use Cautiously in:

• Stress or infection — may temporarily ↑ insulin requirements
• Renal impairment (may ↓ insulin requirements)
• Hepatic impairment (may ↓ insulin requirements)
• OB: Pregnancy may temporarily ↑ insulin requirements
• Geri: Appears on Beers list. ↑ risk of hypoglycemia in older adults. Avoid use of regimens containing only short- or rapid-acting insulin without concurrent use of basal or long-acting insulin

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.

• Premixed infusion: 100 units/100 mL 0.9% NaCl;
• Solution for injection (vials and prefilled pens): 100 units/mL^OTC;
• Solution for injection (concentrated) (vials and prefilled pens): 500 units/mL;
• In combination with: NPH insulins (Humulin 70/30, Novolin 70/30).

Ketoacidosis — Regular (100 units/mL) Insulin Only

• IV (Adults): 0.1 unit/kg/hr as a continuous infusion.
• IV (Children): Loading dose — 0.1 unit/kg, then maintenance continuous infusion 0.05–0.2 unit/kg/hr, titrate to optimal rate of ↓ of serum glucose of 80–100 mg/dL/hr.

Maintenance Therapy

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

Treatment of Hyperkalemia

• SC, IV (Adults and Children): Dextrose 0.5–1 g/kg combined with insulin 1 unit for every 4–5 g dextrose given.

HumuLIN R, HumuLIN R U-500 (Concentrated), HumuLIN R U-500 KwikPen (Concentrated), Myxredlin, NovoLIN R, NovoLIN R FlexPen

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

• Control of hyperglycemia in diabetic patients.

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

Absorption: Rapidly absorbed from SUBQ administration sites. U-100 regular insulin is absorbed slightly more quickly than U-500. IV administration results in complete bioavailability.

Distribution: Identical to endogenous insulin.

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

Half-life: 30–60 min.

Entuzity Kwikpen

(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. Opened, unused insulin vials should be discarded 1 mo after opening.
• Demonstrate technique for mixing insulins by drawing up regular insulin first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).
• 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.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
• Emphasize the importance of regular follow-up, especially during first few wk of therapy.

IN-su-lin