INSULIN injectable

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    Prescription under medical supervision

     

    General information on use of insulin by SC route

     

    Therapeutic action

    • Pancreatic hormone, antidiabetic

    Types of insulin

    SC administration

    Short-acting

    human insulin (a) Citation a. Short-acting insulin is also known as regular insulin.  (Actrapid®)

    Intermediate-acting human insulin
    (Insulatard®)

    Biphasic insulin
    human analogue
    Onset

    30 minutes

    to 1 hour

    1 to 2 hours 30 minutes 10 to 20 minutes
    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
    • 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.

    Indications

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

    Dosage

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

    Duration

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

    Contra-indications, 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

    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.
    • (a)Short-acting insulin is also known as regular insulin.