Insulin (Regular, Rapid-acting,
Brand Names: Humulin
BR, Humulin R, Novolin R, Novolin R Pen-Fill Cartridges, Regular
Iletin I (beef and pork), Regular Iletin II (purified beef),
Regular Iletin II (purified pork), Semilente Iletin I (beef
and pork), Semilente Insulin (beef), Velosulin Human, Velosulin
Drug Class: Antidiabetic
Available in: Injection
Available OTC? Yes
As Generic? No
of hypoglycemia can be caused by the release of adrenaline
or by an inadequate supply of glucose to the brain. With severe
of sufficient glucose to the brain may cause slurred speech, impaired
concentration, confusion, seizures, coma, irreversible brain
damage, and death. Mild hypoglycemia
may cause restless sleep, nightmares, or a cold sweat that awakens patients
resulting from release of adrenaline are common manifestations
to moderate hypoglycemia. They include cold sweats, anxiety,
hunger, rapid heartbeat, headache, and nervousness. Weight gain is common
when taking insulin.
Less Common: Allergic
reactions, lipoatrophy (depressions in the skin due to loss
of fat tissue), and lipohypertrophy (excessive accumulation
of fat tissue).
For long-term treatment of diabetes mellitus. All
patients with type 1 diabetes require lifelong insulin treatment.
Patients with type 2 diabetes may require insulin if they are
unable to control their blood glucose (sugar) levels with diet
and oral medications.
How the Drug Works
Insulin, a hormone secreted by the beta cells of
the pancreas, plays an essential role in controlling the metabolism
and storage of carbohydrates, fat, and protein. Insulin is secreted
in response to a rise in blood sugar (glucose). Insulin lowers
blood glucose by increasing its uptake by body cells, especially
muscle, and by reducing the release of glucose from the liver
It may be taken 1 to 4 times daily, before meals
and possibly at bedtime. Doses and frequency are determined by
your doctor. Regular (or rapid-acting or semilente) insulin should
be administered 30 to 45 minutes before a meal. It can be mixed
in the same syringe with intermediate-acting insulins. Draw up
the regular insulin first.
Onset of Effect
Within 45 minutes; peak effect occurs within 2
to 4 hours.
Duration of Action
From 4 to 6 hours.
All patients with diabetes should follow the general
dietary recommendations of the American Diabetes Association.
Though intake of simple sugars is not forbidden, consuming a
large amount of sugary foods at one time may trigger a rapid
rise in blood glucose that can increase urination and thirst.
In addition, patients who take insulin must remain consistent
from day to day in the timing and caloric content of their meals.
Depending on the timing, dose, and types of insulin prescribed,
snacks may be recommended in the late afternoon, before bedtime,
or prior to unusual physical activity. Diabetic patients must
always have available juice, food, or tablets that can raise
blood glucose levels rapidly to counter an episode of hypoglycemia.
Refrigerate insulin but do not allow it to freeze.
Insulin does not have to be kept refrigerated when you are traveling
for short periods, but exposure to high temperatures must be
If You Miss a Dose
Timing of insulin doses is extremely important.
The best approach is to measure blood glucose and add a dose
of regular insulin if glucose levels are too high. Otherwise,
wait for the next scheduled dose.
Stopping the Drug
Do not stop taking insulin injections unless ordered
by your doctor. Patients with diabetes are often given general
instructions for modifying their insulin doses based on home
blood glucose measurements.
After many years with diabetes, some patients become
insensitive to the symptoms of hypoglycemia and are at risk for
serious brain complications of prolonged, unrecognized hypoglycemia.
Over 60: No special
warnings. Some older people may, however, have vision problems
that may make it difficult to draw up the correct dose of insulin.
Driving and Hazardous Work: Patients
taking insulin must be very careful to avoid hypoglycemia when
driving or engaging in hazardous work.
alcohol intake, especially when taken with large meals, does
not adversely affect control of diabetes or alter the dose of
insulin. However, large amounts of alcohol increase the risk
metabolic control, using insulin injections in most women, must
be maintained during pregnancy to reduce the risk of birth defects,
fetal complications, or death at the time of delivery. In women
who had diabetes before the onset of pregnancy, the dose of insulin
is often smaller during the first third (trimester) of pregnancy
and then higher during the final two trimesters. When women first
develop diabetes during pregnancy (gestational diabetes), insulin
requirements drop rapidly after delivery and most do not need
to continue with insulin treatment.
Breast Feeding: Insulin
requirements tend to be lower during breast feeding. Home glucose
monitoring is important to avoid hypoglycemia. Insulin is not
present in breast milk.
Infants and Children: Treatment
with insulin in young patients is the same as that in older people
Special Concerns: Inadequate
amounts of insulin in type 1 diabetes may lead to the serious
complication of diabetic ketoacidosis, characterized by loss
of appetite, excessive thirst and urination, nausea, vomiting,
deep breathing, fruity breath odor, drowsiness, confusion, and
loss of consciousness.
overdose results in hypoglycemia (see Side
Effects for symptoms).
What to Do: For mild
to moderate hypoglycemia, ingest drinks or food containing sugar.
For more severe hypoglycemia, administer injections of glucagon
or call emergency medical services (EMS) immediately.
A large number of drugs can promote either elevated
blood glucose levels or hypoglycemia. Be sure that your doctor
knows about all of the medications you take and is informed before
you start taking any new drugs, either by prescription or over
the counter. Corticosteroids in particular are likely to raise
blood glucose levels and insulin requirements. Beta-blockers
(commonly prescribed for hypertension) may cause either high
blood glucose levels or hypoglycemia; in addition, because these
medications may dampen the symptoms of hypoglycemia that are
caused by adrenaline release, mild degrees of hypoglycemia may
progress unnoticed to more serious hypoglycemia affecting the
Insulin requirements are increased when larger
amounts of calories are ingested, especially simple sugars and
Insulin requirements are increased by infections,
psychological stress, or an uncontrolled overactive thyroid,
and often at the time of surgery. Requirements may diminish with
kidney disease or an underactive adrenal or pituitary gland.
From The Johns
Hopkins Consumer Guide to Drugs. You can order
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