Insulin regular (human)PA study guide

Why they happen and how to manage them

Hypoglycemia

Insulin action exceeds glucose intake, highest at peak effect about 3 hours after a subcutaneous dose. Management: Treat with glucose or glucagon; review dose, meals, activity, and interacting drugs.

Hypokalemia

Insulin shifts potassium from blood into cells. Management: Monitor potassium, especially with IV insulin or potassium-lowering drugs, and replace.

Lipodystrophy and erratic absorption

Repeated injections at the same site. Management: Rotate sites; moving to fresh tissue can raise absorption, so watch for lows.

Weight gain and edema

Anabolic effects and sodium retention. Management: Adjust the regimen; watch for heart failure with thiazolidinediones.

Sources: [1][2][3][4]

Common and serious

Sources: [1][2][3][4][5]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Blood glucose

Why

Hypoglycemia and dose adjustment

When

More often with regimen changes, renal or hepatic impairment, hypoglycemia unawareness, and IV use

Act on

Do not give during hypoglycemia; treat lows with glucose or glucagon

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2][3][4][5]

Hemoglobin A1c

Why

Long-term glycemic control

When

Periodically per diabetes care standards

Normal

Below 5.7% is normal and 6.5% or higher indicates diabetes. Many people with diabetes aim for below 7%.

Sources: [1]

Potassium

Why

Insulin-induced hypokalemia

When

Closely during IV use and in patients at risk

Act on

Treat hypokalemia

Normal

3.7 to 5.2 mEq/L.

Sources: [1][2][3]

Adult dose

Diabetes mellitus

No fixed label dose. Individualize to route, metabolic needs, glucose readings, and glycemic goal. Subcutaneous doses usually pair with an intermediate- or long-acting insulin.

IV infusion

Concentration 0.1 to 1 unit/mL in 0.9% sodium chloride, titrated under medical supervision.

Sources: [1][2]

Renal adjustment

No fixed adjustment; not studied. Hypoglycemia risk is higher, so expect more frequent dose changes and glucose checks.

Sources: [1]

Hepatic adjustment

No fixed adjustment; not studied. Hypoglycemia risk is higher, so expect more frequent dose changes and glucose checks.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Contraindications

• During episodes of hypoglycemia
• Hypersensitivity to the insulin or its excipients

Sources: [1]

Key interactions

Other diabetes drugs, ACE inhibitors, ARBs, fibrates, fluoxetine, MAO inhibitors, salicylates, sulfonamide antibiotics, octreotide, pramlintide

Raise hypoglycemia risk.

Corticosteroids, diuretics, atypical antipsychotics, estrogens and oral contraceptives, thyroid hormones, sympathomimetics such as albuterol, protease inhibitors

Blunt the glucose-lowering effect.

Beta blockers, clonidine, guanethidine, reserpine

Can hide the warning signs of hypoglycemia.

Alcohol, beta blockers, clonidine, lithium

May push glucose either up or down.

Thiazolidinediones (pioglitazone)

Fluid retention that can cause or worsen heart failure.

Sources: [1][2]

Antidote or reversal

Hypoglycemia: oral glucose for mild episodes; a glucagon product or IV glucose for coma, seizures, or neurologic impairment. Continue carbohydrates and observation because lows can recur. Correct any hypokalemia.

Sources: [1]

Pregnancy

Decades of data have not linked human insulin to birth defects, miscarriage, or poor outcomes. Poorly controlled diabetes in pregnancy raises the risk of birth defects, stillbirth, and DKA.

Sources: [1]

Lactation

Human insulin passes into milk, with no adverse infant reactions reported.

Sources: [1]

Pediatric

Indicated in children. Dose to metabolic needs with frequent glucose monitoring to limit hypoglycemia.

Sources: [1]

Geriatric

Effect of age not studied. Older adults may face more hypoglycemia because of coexisting disease.

Sources: [1]