Insulin for Diabetes Treatment (Types, Side Effects, and Preparations) (cont.)

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Short acting insulin

  • Novolin R, Humulin R (regular insulin): Supplied in a vial

Intermediate acting insulin

  • Humulin N, Novolin N (NPH): Supplied in a vial, pen (Humulin N pen)

Long acting insulin

  • Lantus (insulin glargine): Supplied in a vial, cartridge (OptiClick), prefilled pen (Solostar)
  • Levemir (insulin detemir): Supplied in a vial, prefilled pen (FlexPen)

For what type of diabetes is insulin prescribed?

Indications for insulin

  • Diabetes mellitus type 1
  • Diabetes mellitus type 2
  • Insulin resistance
  • Diabetic ketoacidosis (DKA)
  • Gestational diabetes
  • Diabetes mellitus treatment during pregnancy

What is the dosage and how is insulin administrated?

Dosage and Administration of insulin

  • A meal should be consumed at least 30 minutes after administering regular insulin
  • Insulin usually is administered by subcutaneous injection into the abdominal wall, thigh, gluteal region (buttocks), or upper arm. Injection sites should be rotated within the same region.
  • Some insulins (for example, regular insulin) also may be administered intravenously.
  • Dosage is individualized for each patient.
  • A combination of short/rapid acting and intermediate insulin or long acting insulin typically are used
  • Some patients may develop insulin resistance.
  • Multiple daily insulin injections or continuous subcutaneous infusions via a pump closely mimic pancreatic insulin secretion.
  • Insulin sliding scales are used for managing critically ill hospitalized patients.

What are the side effects of insulin?

Common and Serious Side Effects of Regular Insulin
Common Side Effects Frequency Serious Frequency
Hypoglycemia >40% Severe hypoglycemia n/a
Headache 12% to 35% Allergic reactions n/a
Flu-like symptoms 13% Anaphylaxis n/a
Weight gain 33% Hyopkalemia n/a
Lipoatrophy n/a
Itching n/a
Rash n/a
Injection site reaction n/a
* n/a = not available

What are the contraindications, warnings, and precautions for insulin?

Contraindications

  • Hypoglycemia (low blood sugar)
  • Hypersensitivity to insulin or its excipients (inactive co-ingredients)

Warnings and Precautions

  • Hypoglycemia may occur and is the most common side effect of insulin treatment.
  • Severe, life-threatening allergic reactions, including anaphylaxis, may occur.
  • Hypokalemia (low blood potassium) may occur because insulin stimulates movement of potassium from blood into cells. Combining insulin with potassium-lowering drugs may increase the risk of hypokalemia.
  • Hepatic (liver) impairment may reduce the insulin requirement.
  • Renal (kidney) dysfunction may reduce the insulin requirement.
  • Illness, emotional disturbance, or other stress may alter the insulin requirement.
  • Intravenous administration increases the risk of hypoglycemia and hypokalemia.

Which drugs interact with insulin?

Insulin Drug Interactions

Examples of Regular Insulin Drug Interactions
Drug or Drug Class Effect Recommendation
Beta blockers (for example, propranolol [Inderal, Inderal LA, Innopran XL], atenolol [Tenormin]) Beta blockers may mask symptoms of hypoglycemia or prolong hypoglycemia and alter glucose metabolism Avoid combination if possible
Repaglinide (Prandin) Increased risk of hypoglycemia and heart attack (myocardial infarction) Avoid combination if possible
Rosiglitazone (Avandia) or rosiglitazone combination products Increased incidence of hypoglycemia, fluid retention, ischemia (manifest by angina or heart pain), congestive heart failure Avoid combination if possible
Thiazides and thiazide combination products Hyperglycemia; may reduce effect of insulin Monitor glucose levels and adjust accordingly
Corticosteroids Hyperglycemia; may reduce effect of insulin Monitor glucose levels and adjust accordingly
Estrogens Hyperglycemia; may reduce effect of insulin Monitor therapy and adjust as needed
Levefloxacin and other fluoroquinolones Increased risk of hypoglycemia or hyperglycemia Use with caution, monitor therapy
Monoamine oxidase inhibitors (MAOIs) MAIOs may increase insulin secretion. Combination increases risk of prolonged hypoglycemia. Monitor glucose levels and adjust accordingly
Sulfonylureas Increased risk of hypoglycemia and Monitor glucose levels and adjust accordingly
Thyroid hormones Thyroid hormones may increase insulin requirement Monitor glucose levels and adjust accordingly
Yohimbe Yohimbe may increase risk of hypoglycemia Caution is advised
Medically Reviewed by a Doctor on 1/9/2013


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