INSULIN

General Information

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Therapeutic Action

Pancreatic hormone, antidiabetic

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Types Of Insulin

Intermediate- Biphasic insulin Short-acting SC acting human (a) human insulin administration insulin (Actrapid®) human analogue (Insulatard®) 30 minutes Onset 1 to 2 hours 30 minutes 10 to 20 minutes to 1 hour Peak time 2 to 4 hours 4 to 12 hours 2 to 8 hours 2 to 8 hours Duration 7 to 8 hours around 24 hours around 24 hours around 24 hours Dosage form solution suspension suspension suspension Aspect clear cloudy cloudy cloudy a Short-acting insulin is also known as regular insulin. For each preparation, onset and duration of activity are indicated by the manufacturer. Nevertheless, for the same preparation, onset and duration vary from one patient to another. In one same patient, duration of activity varies depending on the dose, site of injection, blood flow, body temperature and exercise. The type of insulin used depends of several factors: type of diabetes, patient's age, patient's response (blood glucose levels). Analogue insulins have a different chemical structure to human insulin that modifies their onset and duration of activity after SC injection.

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Indications

Type 1 and type 2 diabetes Diabetes during pregnancy Transient therapy of type 2 diabetes during periods of severe infection, trauma, surgery

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Contraindications Adverse Effects Precautions

Do not administer in patients with allergy to insulin (rare). May cause : hypoglycaemia due to overdosage or inadequate diet; local reactions: pain, erythema at the injection site, lipodystrophy. Rotate injection sites systematically and use all available sites (abdomen, thigh, buttock or arm); weight gain. Monitor combination with: drugs enhancing hypoglycaemic effect of insulin: acetylsalicylic acid, angiotensin-converting enzyme inhibitors, beta-blockers (which in addition, may mask symptoms of hypoglycaemia); drugs increasing blood glucose levels: corticosteroids, hydrochlorothiazide, salbutamol, chlorpromazine. Avoid alcohol (enhances and prolongs hypoglycaemic effect of insulin). In the event of renal or hepatic impairment and during the first trimester of pregnancy, reduce insulin doses. In the event of infection, emotional stress, accident or surgical intervention and during the last 2 trimesters of pregnancy, increase insulin doses. Use sterile technique. Pregnancy and breast-feeding: no contra-indication

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Dosage

Dosage must be individualised. Frequency of administration depends on the type of insulin and the patient's response.

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Duration

Type 1 diabetes: life-time treatment Other indications: according to clinical response and laboratory tests

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Remarks

Insulin cannot be administered by mouth since it is inactivated in the gastrointestinal tract. After SC injection, insulin absorption is rapid in the abdomen, slower in thighs, buttocks and arms. When using an insulin pen, hold the needle in the skin at least six seconds to ensure the entire dose is injected.

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