Names and pronunciation
Humalog Kwik Pen Mix 75/25, Humalog Mix 75/25
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Drug reference
Humalog Kwik Pen Mix 75/25, Humalog Mix 75/25
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Func. class.: Antidiabetic, pancreatic hormone
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Chem. class.: Modified structures of endogenous human insulin Do not confuse Humulin N/Humalog/Novoli N/ Humulin/ Novolin/Nogolog
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ACTION: Decreases blood glucose; by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium; insulin may be human (pro- cessed by recombinant DNA technologies)
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USES: Type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabe- tes; insulin lispro may be used in combination with sulfonylureas in chil- dren >3 yr
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CONTRAINDICATIONS: Hyper- sensitivity to protamine; creosol (aspart) Precautions: Pregnancy
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SIDE EFFECTS EENT: Blurred vision, dry mouth INTEG: Flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy, swelling, redness META: Hypoglycemia, rebound hyper- glycemia (Somogyi effect 12-72 hr or longer) MISC: Peripheral edema SYST: Anaphylaxis
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INTERACTIONS Increase: hypoglycemia—salicylate, alco- hol, β-blockers, anabolic steroids, phen- ylbutazone, sulfinpyrazone, guanethidine, oral hypoglycemics, MAOIs, tetracycline Decrease: hypoglycemia—thiazides, thy- roid hormones, oral contraceptives, cor- ticosteroids, estrogens, DOBUTamine, EPINEPHrine Drug/Lab Test Increase: VMA Decrease: potassium, calcium Interference: LFTs, thyroid function studies
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DOSAGE AND ROUTES Insulin glulisine • Adult/adolescent/child ≥4 yr: SUBCUT dosage individualized, give within 15 min before or 20 min after starting a meal • Adult: IV dilute to 1 unit/mL in infusion systems with 0.9% NaCl, use PVC Viaflex infusion bags and PVC tubing, use dedi- cated line Insulin aspart • Adult/adolescent/child ≥6 yr: IN- TERMITTENT SUBCUT Total daily dose is given as 2-4 inj/day just before beginning of meal; in general, 50%- 70% of total daily insulin may be given as insulin aspart, remainder should be intermediate- or long-acting insu- lin; CONTINUOUS SUBCUT used with external insulin pump via cont SUBCUT insulin infusion (CSII), insu- lin dose should be based on insulin dose from previous regimen Insulin lispro • Adult/adolescent/child ≥3 yr: SUB- CUT 15 min before meals; CONT SUB- CUT INFUSION (external insulin pump): total daily dose should be based on insulin dose from previous regimen, 50% of total dose can be given as meal-related boluses, remainder as basal infusion; intermittent SUBCUT (Ly- umjev) • Adult: SUBCUT 0.4-1 unit/kg/day Human regular • Adult: SUBCUT ½-1 hr before meals Insulin, isophane suspension • Adult: SUBCUT dosage individualized by blood, urine glucose; usual dose 7-26 units; may increase by 2-10 units/day if needed Insulin degludec • Adult: SUBCUT dosage individualized Insulin detemir • Adult/adolescent/child ≥2 yr: SUBCUT 1-2×/day; if 1×, give with evening meal Insulin glargine • Adult and child ≥6 yr: SUBCUT 10 units/day, range 2-100 units/day, but may go much higher Regular insulin (ketoacidosis) • Adult: IV 5-10 units, then 5-10 units/ hr until desired response, then switch to SUBCUT dose; IV/INFUSION 2-12 units (50 units/500 mL of normal saline) • Child: IV 0.1 units/kg Replacement • Adult/child: SUBCUT 0.5-1 units/kg/ day qid given 30 min before meals • Adolescent: SUBCUT 0.8-1.2 units/ kg/day; this dosage is used during rapid growth
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Available forms: NPH Inj 100 units/mL; regular inj 100 units/mL, cartridges 100 units/mL; insulin analog inj 100 units/ mL; isophane insulin inj 100 units/mL, cartridges 100 units/mL; insulin lispro 100 units/mL, 1.5-mL cartridges, Huma- LOG Pen sol for inj 100 units/mL, Humalog KwikPen; insulin glulisine inj 100 units/mL; insulin glargine inj 100, 300 units/mL; 3-mL single prefilled pen; insulin degludec solution for inj 100 units/mL (u-100), 200 units/mL (u-200); insulin detemir inj 100 units/ mL in 10 vials, 3-mL cartridges; insulin aspart inj 100 units/mL
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Administer: • Store at room temperature for <1 mo (some insulins); keep away from heat and sunlight; refrigerate all other supply; NPH, premixed insulins are cloudy; regular, rapid- acting analogs, long-acting analogs are clear; do not freeze—IV route, regular only SUBCUT route • After warming to room temperature by I rotating in palms; use only insulin sy- ringes with markings or syringe matching units/mL; rotate inj sites within one area: abdomen, upper back, thighs, upper arm, buttocks; keep record of sites • Increased dosages if tolerance occurs • Premixed insulins, NPH are cloudy suspensions • Regular human insulin, rapid-acting analogs, long-acting analogs are clear; do not use if cloudy, thick, or discol- ored CONT SUBCUT route (insulin infusion CSII) • Do not mix with other insulins when using a pump • Insulin lispro 3-mL cartridges to be used in Disetronic H-TRON plus V100 pump using Disetronic rapid infusion sets; infusion set and cartridge adapter should be changed q3days; replace 3-mL cartridge q6days IV route (insulin glulisine only) • Dilute to 1 international unit/mL in in- fusion systems with 0.9% NaCl using PVC viaflex infusion bags and PVC tubing; use dedicated line; do not admix IV route (regular only) When regular insulin is administered IV, monitor glucose, potassium often to pre vent fatal hypoglycemia, hypokalemia • IV direct, undiluted via vein, Y-site, 3-way stopcock; give at ≤50 units/min • By cont infusion after diluting with IV sol and run at prescribed rate; use IV infusion pump for correct dosing; give reduced dose at serum glucose level of 250 mg/100 mL Y-site compatibilities: Amiodarone, ampi- cillin, ampicillin/sulbactam, aztreonam, ceFAZolin, cefoTEtan, DOBUTamine, esmo- lol, famotidine, gentamicin, heparin, hepa- rin/hydrocortisone, imipenem/cilastatin, indomethacin, magnesium sulfate, meperi- dine, meropenem, midazolam, morphine, nitroglycerin, oxytocin, PENTobarbital, potassium chloride, propofol, ritodrine, sodium bicarbonate, sodium nitroprusside, tacrolimus, terbutaline, ticarcillin, ticarcil- lin/clavulanate, tobramycin, vancomycin, vit B/C
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Assess: • Fasting blood glucose; A1c may be drawn to identify treatment effectiveness q3mo • Urine ketones during illness; insulin requirements may increase during stress, illness, surgery • Hypoglycemic reaction that can occur during peak time (sweating, weakness, dizziness, chills, confusion, headache, nausea, rapid weak pulse, fatigue, tachycardia, memory lapses, slurred speech, staggering gait, anxiety, trem- ors, hunger) • Hyperglycemia: acetone breath; polyuria; fatigue; polydipsia; flushed, dry skin; lethargy • Beers: avoid use of short- or rapid-act- ing insulin in older adults; sliding-scale insulin poses a higher risk of hypoglyce- mia without improvement in hyperglyce- mia management
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Evaluate: • Therapeutic response: decrease in poly- uria, polydipsia, polyphagia; clear senso- rium; absence of dizziness; stable gait, blood glucose HBA1c within normal limits
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That blurred vision occurs; not to change corrective lenses until vision is stabilized after 1-2 mo • To keep insulin, equipment available at all times; to carry a glucagon kit, candy, or oral glucose preparation to treat hypoglycemia • That product does not cure diabetes but controls symptoms • To carry emergency ID as diabetic • To recognize hypoglycemia reaction: head- ache, tremors, fatigue, weakness, tachycardia • To recognize hyperglycemia reaction: frequent urination, thirst, fatigue, hunger • About the dosage, route, mixing in- structions, diet restrictions (if any), dis- ease process • About the symptoms of ketoacidosis: nausea; thirst; polyuria; dry mouth; de creased B/P; dry, flushed skin; acetone breath; drowsiness; Kussmaul respirations • That a plan is necessary for diet, exer- cise; that all food on diet should be eaten; that exercise routine should not vary • About blood glucose testing; how to determine glucose level • To avoid OTC products unless directed by prescriber
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PHARMACOKINETICS Rapid acting Insulin glulisine: Onset 15-30 min, peak ½-1½ hr, duration 3-4 hr Insulin aspart: Onset 10-20 min, peak 1-3 hr, duration 3-5 hr Insulin lispro: Onset 15-30 min, peak ½-1½ hr, duration 3-5 hr Short acting Insulin regular: Onset 30 min, peak 2.5-5 hr, duration up to 7 hr Intermediate acting Insulin, isophane suspension (NPH): Onset 1.5-4 hr, peak 4-12 hr, duration ≤24 hr Insulin degludec: Peak 12 hr, duration 42 hr after 8 doses Long acting Insulin detemir: Onset 0.8-2 hr, peak unknown, duration ≤24 hr (concentra- tion dependent) Insulin glargine: Onset 1.5 hr, no peak identified, duration ≥24 hr Mixtures Insulin, isophane suspension and regu- lar insulin (70/30): Onset 10-20 min, peak 2.4 hr, duration ≤24 hr Insophane insulin suspension (NPH) and insulin mixtures (50/50): Onset ½-1 hr, peak dual, duration 10-16 hr
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• Adult/adolescent/child ≥4 yr: SUBCUT dosage individualized, give within 15 min before or 20 min after starting a meal
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• Adult/adolescent/child ≥6 yr: IN- TERMITTENT SUBCUT Total daily dose is given as 2-4 inj/day just before beginning of meal; in general, 50%- 70% of total daily insulin may be given as insulin aspart, remainder should be intermediate- or long-acting insu- lin; CONTINUOUS SUBCUT used with external insulin pump via cont SUBCUT insulin infusion (CSII), insu- lin dose should be based on insulin dose from previous regimen Insulin lispro
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• Adult/adolescent/child ≥3 yr: SUB- CUT 15 min before meals; CONT SUB- CUT INFUSION (external insulin pump): total daily dose should be based on insulin dose from previous regimen, 50% of total dose can be given as meal-related boluses, remainder as basal infusion; intermittent SUBCUT (Ly- umjev)
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• Adult/adolescent/child ≥2 yr: SUBCUT 1-2×/day; if 1×, give with evening meal Insulin glargine
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• Adolescent: SUBCUT 0.8-1.2 units/ kg/day; this dosage is used during rapid growth
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