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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 |
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 |
- (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.
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.