Regular Insulin Warnings/Precautions

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Regular Insulin Warnings/Precautions
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Medication Safety Issues

Sound-alike/look-alike issues:

Humulin® may be confused with Humalog®, Humira®

Novolin® may be confused with NovoLog®

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error. Due to the number of insulin preparations, it is essential to identify/clarify the type of insulin to be used.

Concentrated solutions (eg, U-500) should not be available in patient care areas.

Cross-contamination may occur if insulin pens are shared among multiple patients. Steps should be taken to prohibit sharing of insulin pens.

Pronunciation

(IN soo lin REG yoo ler)

U.S. Brand Names

* Humulin® R
* Humulin® R U-500
* Novolin® R

Index Terms

* Regular Insulin

Generic Available

No

Canadian Brand Names

* Humulin® R
* Novolin® ge Toronto

Pharmacologic Category

* Antidote
* Insulin, Short-Acting

Pharmacologic Category Synonyms

* Antidiabetic Agent, Insulin, Short-Acting

...
Warnings & Precautions:

Concerns related to adverse effects:

• Hypoglycemia: The most common adverse effects of insulin is hypoglycemia. The timing of hypoglycemia differs among various insulin formulations. Hypoglycemia may result from increased work or exercise without eating; use of long-acting insulin preparations (insulin detemir, insulin glargine) may delay recovery from hypoglycemia. Profound and prolonged episodes of hypoglycemia may result in convulsions, unconsciousness, temporary or permanent brain damage, or even death. Insulin requirements may be altered during illness, emotional disturbances, or other stresses.

• Hypokalemia: Insulin (especially I.V. insulin) causes a shift of potassium from the extracellular space to the intracellular space, possibly producing hypokalemia which, if left untreated, may result in respiratory paralysis, ventricular arrhythmia and even death. Use with caution in patients at risk for hypokalemia (eg, loop diuretic use). Monitor serum potassium frequently with I.V. use and supplement potassium when necessary.

Disease-related concerns:

• Hepatic impairment: Use with caution in patients with hepatic impairment. Dosage requirements may be reduced.

• Renal impairment: Use with caution in patients with renal impairment. Dosage requirements may be reduced.

Dosage form specific issues:

• Product variation: Human insulin differs from animal-source insulin. Any change of insulin should be made cautiously; changing manufacturers, type, and/or method of manufacture may result in the need for a change of dosage.

Other warnings/precautions:

• Appropriate use: The general objective of exogenous insulin therapy is to approximate the physiologic pattern of insulin secretion which is characterized by two distinct phases. Phase 1 insulin secretion suppresses hepatic glucose production and phase 2 insulin secretion occurs in response to carbohydrate ingestion; therefore, exogenous insulin therapy may consist of basal insulin (eg, intermediate- or long-acting insulin or continuous insulin infusion administered via an external SubQ insulin infusion pump) and/or preprandial insulin (eg, short- or rapid-acting insulin) (see Related Information: Insulin Products). Patients with type 1 diabetes do not produce endogenous insulin; therefore, these patients require both basal and preprandial insulin administration. Patients with type 2 diabetes retain some beta-cell function in the early stages of their disease; however, as the disease progresses, phase 1 insulin secretion may become completely impaired and phase 2 insulin secretion becomes delayed and/or inadequate in response to meals. Therefore, patients with type 2 diabetes may be treated with oral antidiabetic agents, basal insulin, and/or preprandial insulin depending on the stage of disease and current glycemic control. Since treatment regimens often consist of multiple agents, dosage adjustments must address the specific phase of insulin release that is primarily contributing to the patient's impaired glycemic control. Treatment and monitoring regimens must be individualized.

• I.V. administration: Regular insulin may be administered I.V. in selected clinical situations to control hyperglycemia; close medical supervision is required.

• Patient education: Diabetic education and nutritional counseling are essential to maximize the effectiveness of therapy.

Last full review/revision February 2009
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