insulin (Regular, NPH, Ultralente, Humulin)
Hormone
Insulin is secreted by the beta cells (islets of Langerhans) of the pancreas and is required for proper glucose utilization by the body. Insulin lowers blood glucose by recruiting glucose transporter proteins to the cell membrane allowing an increased movement of glucose into the cell. It also promotes the conversion of glucose to glycogen.
Insulin preparations are classified as rapid-acting (Regular), intermediate-acting (NPH) and long-acting (Ultralent).
Rapid-acting: 0.5 – 1 hour
Intermediate-acting: 1-1.5 hours
Long-acting: 4-6 hours
Rapid-acting: 6-8 hours
Intermediate-acting: 24 hours
Long-Acting: 36 hours
Type I Diabetes Mellitus
Type II Diabetes Mellitus if oral hypoglycemic agents do not adequately control plasma glucose
Diabetic ketoacidosis
Nonketotic hyperosmolar coma
Insulin and D50 administration are given together to lower potassium levels in hyperkalemia
Hypoglycemia
Hypoglycemia, fatigue, weakness, confusion, headache
Tachycardia, rapid and shallow breathing
Nausea, diaphoresis, allergic reaction
Corticosterioids, epinephrine and thiazide diuretics may antagonize the hypoglycemic effects of insulin.
Alcohol, beta adrenergic blockers, MAO inhibitors, and salicylates may potentiate the hypoglycemic effects of insulin.
100 units/ml in 10 ml vials
Insulin may be administered SQ, IM or IV and dosage is governed by the clinical presentation of the patient and varies greatly. A standard dose of insulin adminstration in diabetic coma follows:
10-25 units Regular IV, followed by an infusion of 0.1 units/kg/hr
0.1-0.2 units/kg/hr IM. Infusion: 50 units of Regular
Pregnancy Safety: B
Insulin is the drug of choice for control of diabetes during pregnancy.
Regular insulins are clear, while modified insulins are cloudy.
Insulin injected into the abdominal wall is absorbed most rapidly, insulin is absorbed slowest when injected into the thigh.