Insulin Injection (Humulin R) Drug study

Insulin Injection, Regular (Humulin R, Novolin R) Overview

Insulin Injection, Regular, known by brand names such as Humulin R and Novolin R, is a short-acting insulin used to control blood sugar levels in patients with diabetes. It is available as a clear, colorless solution derived from pork pancreas or synthesized via recombinant DNA technology.

Generic Name:

Insulin Injection, Regular

Brand Name:

Humulin R, Novolin R, Regular Insulin, Pork Regular Iletin II, Regular Purified Pork Insulin, Velosulin, Velosulin BR, Velosulin Human

Classifications:

• Hormone and synthetic substitute
• Antidiabetic agent
• Insulin

Pregnancy Category:

B

Availability:

100 units/mL

Actions:

• Short-acting insulin that enhances the movement of glucose across cell membranes.
• Promotes the conversion of glucose to glycogen.

Therapeutic Effects:

• Lowers blood glucose levels by increasing peripheral glucose uptake, especially by skeletal muscle and fat tissue, and by inhibiting hepatic glucose production.

Uses:

• Emergency treatment of diabetic ketoacidosis or coma.
• Initiation of therapy in patients with insulin-dependent diabetes mellitus.
• Combined with intermediate or long-acting insulin to provide better control of blood glucose concentrations.
• IV use to stimulate growth hormone secretion (glucose counter-regulatory hormone) to evaluate pituitary growth hormone reserve.
• Promotion of intracellular shift of potassium in the treatment of hyperkalemia (IV).
• Induction of hypoglycemic shock as therapy in psychiatry.

Contraindications:

• Hypersensitivity to insulin or animal proteins.

Cautious Use:

• Pregnancy (Category B)
• Lactation
• Renal impairment
• Hepatic impairment
• Older adults
• Safety and efficacy in children under 2 years are not established

Route & Dosage:

Diabetes Mellitus:

• Adults: SC 5–10 U 15–30 min before meals and at bedtime (dose adjustments based on blood glucose determinations)
• Children: SC 2–4 U 15–30 min before meals and at bedtime (dose adjustments based on blood glucose determinations)

Ketoacidosis:

• Adults: IV 2.4–7.2 U loading dose, followed by 2.4–7.2 U/h continuous infusion
• Children: IV 0.1 U/kg loading dose, followed by 0.1 U/h continuous infusion

Administration:

Subcutaneous:

• Use an insulin syringe.
• Give regular insulin 30 minutes before a meal.
• Avoid injecting cold insulin; it can lead to lipodystrophy, reduced rate of absorption, and local reactions.
• Common injection sites: Upper arms, thighs, abdomen (avoid the area over the urinary bladder and 2 in. [5 cm] around the navel), buttocks, and upper back (if fat is loose enough to pick up). Rotate sites.

Intravenous:

• Prepare: Direct – Give undiluted. Continuous – Typically diluted in NS or 0.45% NaCl. 100 U added to 1000 mL yields 0.1 U/mL.
• Administer: Direct – Give 50 U or a fraction thereof over 1 min. Continuous – Rate must be ordered by physician.

Incompatibilities:

• Solution/Additive: Aminophylline, amobarbital, chlorothiazide, cytarabine, dobutamine, pentobarbital, phenobarbital, phenytoin, secobarbital, sodium bicarbonate, thiopental.
• Y-site: Dobutamine.

Note: Regular insulin may be adsorbed into the container or tubing when added to an IV infusion solution. The amount lost is variable and depends on the concentration of insulin, infusion system, contact duration, and flow rate. Monitor patient response closely.

Stability:

• Stable at room temperature for up to 1 month.
• Avoid exposure to direct sunlight and temperature extremes (safe range is wide: 5°–38° C [40°–100° F]). Refrigerate but do not freeze stock supply. Insulin tolerates temperatures above 38° C with less harm than freezing.

Adverse

• Hypoglycemia
• Anaphylaxis (rare)
• Hyperinsulinemia
• Rebound hyperglycemia (Somogyi effect)
• Injection site reactions
• Lipoatrophy and lipohypertrophy

 Effects:

Diagnostic Test Interference:

• Large doses of insulin may increase urinary excretion of VMA.
• Insulin can cause alterations in thyroid function tests and liver function tests and may decrease serum potassium and serum calcium.

Nursing Implications:

Assessment & Drug Effects:

• Frequency of blood glucose monitoring is determined by the type of insulin regimen and health status of the patient.
• Lab tests: Periodic postprandial blood glucose, HbA1C, and urine ketones.
• Notify physician promptly for presence of acetone with sugar in the urine; may indicate the onset of ketoacidosis. Acetone without sugar in the urine usually signifies insufficient carbohydrate intake.
• Monitor for hypoglycemia at the time of peak action of insulin. Onset of hypoglycemia (blood sugar: 50–40 mg/dL) may be rapid and sudden.
• Check BP, I&O ratio, and blood glucose and ketones every hour during treatment for ketoacidosis with IV insulin.
• Give patients with severe hypoglycemia glucagon, epinephrine, or IV glucose 10%–50%. As soon as the patient is fully conscious, give oral carbohydrates (e.g., dilute corn syrup or orange juice with sugar, Gatorade, or Pedialyte) to prevent secondary hypoglycemia.

Patient & Family Education:

• Learn correct injection technique.
• Inject insulin into the abdomen rather than a near muscle that will be heavily taxed if engaged in active sports.
• Notify the physician of local reactions at the injection site; may develop 1–3 weeks after therapy starts and last several hours to days, usually disappearing with continued use.
• Do not change prescription lenses during the early period of dosage regulation; vision stabilizes, usually 3–6 weeks.
• Hypoglycemia can result from excess insulin, insufficient food intake, vomiting, diarrhea, unaccustomed exercise, infection, illness, nervous or emotional tension, or overindulgence in alcohol.
• Respond promptly to beginning symptoms of hypoglycemia. Severe hypoglycemia is an emergency situation. Take 4 oz (120 mL) of any fruit juice or regular carbonated beverage (1.5–3 oz [45–90 mL] for a child) followed by a meal of longer-acting carbohydrate or protein food. Failure to show signs of recovery within 30 min indicates the need for emergency treatment.
• Carry some form of fast-acting carbohydrate (e.g., lump sugar, Life-Savers, or other candy) at all times to treat hypoglycemia.
• Check blood glucose regularly during the menstrual period; loss of diabetes control (hyperglycemia or hypoglycemia) is common; adjust insulin dosage accordingly, as prescribed by the physician.
• Notify the physician of S&S of diabetic ketoacidosis.
• Continue taking insulin during an illness, go to bed, and drink non-caloric liquids liberally (every hour if possible). Consult the physician for insulin regulation if unable to eat the prescribed diet.
• Avoid OTC medications unless approved by a physician.
• Do not breastfeed while taking this drug without consulting the physician.

References

1. American Diabetes Association. (2020). Insulin therapy and management of diabetes. Retrieved from https://www.diabetes.org/insulin-therapy
2. National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Insulin basics. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-basics
3. U.S. Food and Drug Administration. (2020). Insulin types and action times. Retrieved from https://www.fda.gov/insulin-types-action-times
4. Harvard Health Publishing. (2020). Understanding insulin for diabetes management. Retrieved from https://www.health.harvard.edu/insulin-diabetes-management
5. Johns Hopkins Medicine. (2020). Insulin and diabetes. Retrieved from https://www.hopkinsmedicine.org/insulin-diabetes