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1 High Alert Use Cautiously in: Stress or infection— may temporarilyqinsulin requirements;
Renal/hepatic impairment— may p insulin requirements; Concomitant use with
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insulin, regular (injection, concentrated) pioglitazone or rosiglitazone (qrisk of fluid retention and worsening HF); OB: Preg-
nancy may temporarilyqinsulin requirements.
(in-su-lin)
HumuLIN R, Insulin-Toronto, NovoLIN R, HumuLIN R Regular U-500 Adverse Reactions/Side Effects
(Concentrated) Endo: HYPOGLYCEMIA. Local: lipodystrophy, pruritus, erythema, swelling. Misc:
Classification allergic reactions including ANAPHYLAXIS.
Therapeutic: antidiabetics, hormones Interactions
Pharmacologic: pancreatics Drug-Drug: Beta blockers, clonidine, and reserpine may mask some of the
Pregnancy Category B signs and symptoms of hypoglycemia. Corticosteroids, thyroid supplements, es-
trogens, isoniazid, niacin, phenothiazines, and rifampin mayqinsulin re-
Indications quirements. Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypo-
Control of hyperglycemia in patients with diabetes mellitus. Concentrated regular glycemic agents, and salicylates, maypinsulin requirements. Concurrent use with
insulin U-500: Only for use in patients with insulin requirements ⬎200 units/day. pioglitazone or rosiglitazone mayqrisk of fluid retention and worsening HF.
Unlabeled Use: Treatment of hyperkalemia. Drug-Natural Products: Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic
Action effects.
Lowers blood glucose by: stimulating glucose uptake in skeletal muscle and fat, in-
hibiting hepatic glucose production. Other actions of insulin: inhibition of lipolysis Route/Dosage
and proteolysis, enhanced protein synthesis. Therapeutic Effects: Control of hy- Dose depends on blood glucose, response, and many other factors.
perglycemia in diabetic patients. Ketoacidosis— Regular (100 units/mL) Insulin Only
Pharmacokinetics IV (Adults): 0.1 unit/kg/hr as a continuous infusion.
Absorption: Rapidly absorbed from subcutaneous administration sites. U-100 IV (Children): Loading dose-0.1 unit/kg, then maintenance continuous infusion
regular insulin is absorbed slightly more quickly than U-500. 0.05– 0.2 unit/kg/hr, titrate to optimal rate of decrease of serum glucose of 80– 100
Distribution: Identical to endogenous insulin. mg/dL/hr.
Metabolism and Excretion: Metabolized by liver, spleen, kidney, and muscle. Maintenance Therapy
Half-life: 30– 60 min. Subcut (Adults and Children): 0.5– 1 unit/kg/day in divided doses. Adolescents
TIME/ACTION PROFILE (hypoglycemic effect) during rapid growth— 0.8– 1.2 unit/kg/day in divided doses.
ROUTE ONSET PEAK DURATION Treatment of Hyperkalemia
Regular insulin IV 10–30 min 15–30 min 30–60 min Subcut, IV (Adults and Children): dextrose 0.5– 1 g/kg combined with insulin 1
Regular insulin subcu- 30–60 min 2–4 hr 5–7 hr unit for every 4– 5 g dextrose given.
taneous
NURSING IMPLICATIONS
Contraindications/Precautions Assessment
Contraindicated in: Hypoglycemia; Allergy or hypersensitivity to a particular type ● Assess patient periodically for symptoms of hypoglycemia (anxiety; rest-
of insulin, preservatives, or other additives. lessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; con-
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 ● Insulin should be stored in a cool place but does not need to be refrigerated.
● Subcut: Administer regular insulin within 15– 30 min before a meal.
fusion; cool, pale skin; difficulty in concentration; drowsiness; night- PDF Page #2
mares or trouble sleeping; excessive hunger; headache; irritability; IV Administration
nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and ● IV: Do not use if cloudy, discolored, or unusually viscous. High Alert: Do not
hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; administer regular (concentrated) insulin U-500 IV.
rapid, deep breathing, polyuria; loss of appetite; unusual thirst) during therapy. ● Direct IV: Diluent: May be administered IV undiluted directly into vein or
● Monitor body weight periodically. Changes in weight may necessitate changes in through Y-site. Rate: Administer up to 50 units over 1 min.
insulin dose. ● Continuous Infusion: Diluent: May be diluted in 0.9% NaCl using polyvinyl
● Lab Test Considerations: Monitor blood glucose every 6 hr during therapy, chloride infusion bags. Concentration: 0.1 unit/mL to 1 unit/mL in infusion sys-
more frequently in ketoacidosis and times of stress. A1C may be monitered every tems with the infusion fluids. Rate: Rate should be ordered by health care pro-
3– 6 mo to determine effectiveness. fessional, and infusion placed on an IV pump for accurate administration.
● Toxicity and Overdose: Overdose is manifested by symptoms of hypo- ● Rate of administration should be decreased when serum glucose level reaches
glycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. 250 mg/dL.
Severe hypoglycemia is a life-threatening emergency; treatment consists ● Y-Site Compatibility: acyclovir, alfentanil, aminophylline, amphotericin B lipid
of IV glucose, glucagon, or epinephrine. complex, anidulafungin , argatroban, ascorbic acid, atropine, azathoprine, az-
treonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, cal-
Potential Nursing Diagnoses cium chloride, calcium gulconate, carboplatin, carmustine, caspofungin, cefazo-
Noncompliance (Patient/Family Teaching) lin, cefepime, ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol,
Implementation clindamycin, cyanocobalamin, cyclophosphamide, cytarabine, dactinomycin,
● High Alert: Medication errors involving insulins have resulted in serious patient daptomycin, dexamethasone, dexmedetomidine, dexrazoxane, docetaxel, dori-
harm and death. Clarify all ambiguous orders and do not accept orders using the penem, doxapram, doxorubicin liposomal, doxycycline, enalapril, ephedrine,
abbreviation “u” for units, which can be misread as a zero or the numeral 4 and epirubicin, epoetin alfa, ertapenem, erythromycin, esmolol, etoposide, etoposide
has resulted in tenfold overdoses. Insulins are available in different types and phosphate, fenoldopam, fentanyl, fluconazole, fludarabine, folic acid, foscarnet,
strengths. Check type, dose, and expiration date with another licensed nurse. Do ganciclovir, gemcitabine, granisetron, hetastarch, hydrocortisone, hydromor-
not interchange insulins without consulting health care professional. Do not con- phone, ibuprofen, idarubicin, ifosfamide, imipenem-cilastatin, indomethacin, ir-
fuse regular concentrated (U-500) insulin with regular insulin.To prevent er- inotecan, ketorolac, leucovorin calcium, lidocaine, linezolid, lorazepam, magne-
rors between regular U-100 insulin and concentrated U-500 insulin, concentrated sium sulfate, mannitol, mechlorethamine, meperidine, meropenem,
U-500 insulin is marked with a band of diagonal brown strips and “U-500” is high- methotrexate, methyldopate, methylprednisolone, metoclopramide, metoprolol,
lighted in red on the label and a conversion chart should always be available. metronidazole, milrinone, mitoxantrone, moxifloraxin, mycophenolate, nalbu-
● Do not confuse Humulin with Humalog. Do not confuse Novolin with No- phine, naloxone, nitroglycerin, nitroprusside, octreotide, oxacillin, oxaliplatin,
volog. paclitaxel, palonosetron, pamidronate, pancuronium, papaverine, pemetrexed,
● Use only insulin syringes to draw up dose. The unit markings on the insulin sy- penicilin G, pentazocine, pentobarbital, phenobarbital, phytonadione, potassium
ringe must match the insulin’s units/mL. Special syringes for doses ⬍50 units are acetate, potassium chloride, procainamide, promethazine, propofol, pyridoxime,
available. Prior to withdrawing dose, rotate vial between palms to ensure uniform remifentanil, sodium bicarbonate, streptokinase, sufentanil, tacrolimus, tenipo-
solution; do not shake. side, terbutaline, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecyc-
● When mixing insulins, draw regular insulin into syringe first to avoid contamina- line, tirofiban, tolazoline, vancomycin, vecuronium, verapamil, vinblastine, vin-
tion of regular insulin vial. cristine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid.
䉷 2015 F.A. Davis Company CONTINUED
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3 ● Instruct patient on signs and symptoms of hypoglycemia and hyperglyce-

mia and what to do if they occur.
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CONTINUED ● Advise patient to notify health care professional if pregnancy is planned or sus-
pected or if breast feeding or planning to breast feed.
insulin, regular (injection, concentrated) ● Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel)
and identification describing their disease and treatment regimen at all times.
● Y-Site Incompatibility: alemtuzumab, butorphanol, cefoperazone, cefoxitin, ● Emphasize the importance of regular follow-up, especially during first few weeks
chlorpromazine, cisplatin, dantrolene, diazepam, diazoxide, diphenhydramine, of therapy.
hydroxyzine, isoproterenol, ketamine, labetalol, micafungin, nesiritide, pentami-
dine, phentolamine, phenylephrine, phenytoin, piperacillin/tazobactam, pro- Evaluation/Desired Outcomes
chlorperazine, propranolol, protamine, quinupristin/dalfopristin, rocuronium, ● Control of blood glucose levels in diabetic patients without the appearance of hy-
trimethoprim/sulfamethoxazole. poglycemic or hyperglycemic episodes.
● Additive Compatibility: May be added to total parenteral nutrition (TPN) solu-
tions. Why was this drug prescribed for your patient?
Patient/Family Teaching
● Instruct patient on proper technique for administration. Include type of insulin,
equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard
syringes. Discuss the importance of not changing brands of insulin or syringes, se-
lection and rotation of injection sites, and compliance with therapeutic regimen.
Opened, unused insulin vials should be discarded 1 mo after opening.
● Demonstrate technique for mixing insulins by drawing up regular insulin first and
rolling intermediate-acting insulin vial between palms to mix, rather than shaking
(may cause inaccurate dose).
● Explain to patient that this medication controls hyperglycemia but does not cure
diabetes. Therapy is long term.
● Instruct patient in proper testing of serum glucose and ketones. These tests should
be closely monitored during periods of stress or illness and health care profes-
sional notified of significant changes.
● Emphasize the importance of compliance with nutritional guidelines and regular
exercise as directed by health care professional.
● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken and to consult health care professional be-
fore taking other Rx, OTC, herbal products, or alcohol.
● Advise patient to notify health care professional of medication regimen prior to
treatment or surgery.
● Advise patient to notify health care professional if nausea, vomiting, or fever devel-
ops, if unable to eat regular diet, or if blood glucose levels are not controlled.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.