INSULIN injectable

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 
(Actrapid®)


Intermediate-acting human insulin
(Insulatard®)

Biphasic insulin
humananalogue
Onset30 minutes to 1 hour1 to 2 hours30 minutes10 to 20 minutes
Peak time2 to 4 hours4 to 12 hours2 to 8 hours2 to 8 hours
Duration
7 to 8 hoursaround 24 hoursaround 24 hoursaround 24 hours
Dosage formsolutionsuspensionsuspensionsuspension
Aspectclearcloudycloudycloudy

* 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;
• weight gain;

• local reactions: pain, erythema at the injection site, lipodystrophy. Rotate injection sites systematically and use all available sites (abdomen, thigh, buttock or arm).
– 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