Insulin. (Medication Update).Mode of Action Insulin is produced by beta cells of the pancreas, and it lowers blood glucose by increasing peripheral glucose uptake (mostly into fat and skeletal muscle) and inhibiting hepatic gluconeogenesis gluconeogenesis /glu·co·neo·gen·e·sis/ (gloo?ko-ne?o-jen´e-sis) the synthesis of glucose from molecules that are not carbohydrates, such as amino and fatty acids. glu·co·ne·o·gen·e·sis n. . Contraindications Known hypersensitivity to the particular insulin, or components of the preparation. Hypoglycemia. Pregnancy Category: B. (Insulin glargine and insulin aspart are Pregnancy Category C.) Adverse Effects Hypoglycemia, hypokalemia, lipodystrophy (which can be avoided by rotating the injection sites), reactions at the injection site. Injection site pain has been more frequently reported with insulin glargine (2.7%) than with NPH insulin (0.7%). Drug-Drug Interactions The following drugs may decrease the effectiveness of insulin, resulting in hyperglycemia: acetazolamide, albuterol, asparaginase asparaginase /as·par·a·gin·ase/ (as-par´ah-jin-as?) an enzyme that catalyzes the deamination of asparagine; a preparation is used as an antineoplastic agent in acute lymphoblastic leukemia to reduce availability of asparagine to tumor , calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, ethacrynic acid, HIV antivirals, isoniazid, lithium, morphine, niacin, oral contraceptives, phenothiazines, phenytoin, somatropin, terbutaline, thiazide diuretics, and thyroid supplements. The following drugs may increase the effectiveness of insulin, resulting in hypoglycemia: ACE inhibitors, alcohol, anabolic steroids, beta blockers, calcium, chloroquine, clofibrate clofibrate /clo·fi·brate/ (-fi´brat) an antihyperlipidemic used to reduce serum lipids. clo·fi·brate n. , clonidine, disopyramide, fluoxetine, guanethidine guanethidine /guan·eth·i·dine/ (gwahn-eth´i-den) an adrenergic blocking agent, used as the monosulfate salt as an antihypertensive. gua·neth·i·dine n. , lithium, mebendazole, monoamine oxidase inhibitors, octreotide, pentamidine pentamidine /pen·tam·i·dine/ (pen-tam´i-den) an antiinfective used as the isethionate salt in the treatment of pneumonia, leishmaniasis, and early African trypanosomiasis. , phenylbutazone phenylbutazone /phen·yl·bu·ta·zone/ (-bu´tah-zon) a nonsteroidal antiinflammatory drug used in the short-term treatment of severe rheumatoid disorders unresponsive to less toxic agents. , propoxyphene propoxyphene /pro·poxy·phene/ (-pok´si-fen) an opioid analgesic structurally related to methadone, used as the hydrochloride and napsylate salts. propoxyphene an analgesic used as the hydrochloride and napsylate salts. , pyridoxine pyridoxine: see coenzyme; vitamin. , salicylates, sulfinpyrazone sulfinpyrazone /sul·fin·py·ra·zone/ (sul?fin-pi´rah-zon) a uricosuric agent used in the treatment of gout. Sulfinpyrazone A drug that corrects hyperuricemia by increasing the urinary excretion of urate. , sulfonamides Sulfonamides Definition Sulfonamides are medicines that prevent the growth of bacteria in the body. Purpose Sulfonamides are used to treat many kinds of infections caused by bacteria and certain other microorganisms. , and tetracyclines. Commonly Used Human and Human Analog Insulin Products * Regular (Humulin R, Novolin R): Onset, 0.5 - 1 hours. Peak, 2.5 - 5 hours. Duration, 8-12 hours. Give 30-60 minutes prior to meal. * Semilente (Iletin): Onset, 1-1.5 hours. Peak, 5 - 10 hours. Duration, 12 - 16 hours. * Lispro (Humalog): Onset, 0.25 hours. Peak, 0.5-1.5 hours. Duration, 6 - 8 hours. Give 15 minutes prior to or immediately after meal. * Aspart (NovoLog): Onset, 0.25 hours. Peak, 1 - 3 hours. Duration, 3-5 hours. Give 5-10 minutes prior to meal. * NPH (Humulin N, Novolin N): Onset, 1 - 1.5 hours. Peak, 4 - 12 hours. Duration, 24 hours. * Lente (Humulin L, Novolin L): Onset, 1 - 2.5 hours. Peak, 7 - 15 hours. Duration, 22 - 24 hours. * Glargine (Lantus): Onset, 1.1 hours. Peak, 5 hours. Duration, 24 hours. Give dose once a day at bedtime. Should not be mixed with any other insulin or given IV. Average starting dose is 10 units/day. * PZI (Protamine Zinc Iletin I): Onset, 4-8 hours. Peak, 14-24 hours. Duration, 36 hours. * Ultralente (Humulin U, Ultralente): Onset, 4-8 hours. Peak, 10-30 hours. Duration, >36 hours. Human and Human Analog Combination Insulin Products * 70% NPH and 30% regular: Humulin 70/30, Novolin 70/30. * 50% NPH and 50% regular: Humulin 50/50. * 75% NPH and 25% lispro: Humalog Mix 75/25. * 50% NPH and 50% lispro: Humalog Mix 50/50. Recommended Doses Most patients require 0.5-1 unit/kg/day of insulin. Dosing is highly individualized based upon patient response. Other Points of Interest When mixing insulins, such as regular and NPH, the regular insulin should be drawn into the syringe first. References (1.) Hutchison TA, Shahan DR, Anderson ML (eds): DRUG-DEX System. MICROMEDEX, Inc, Englewood, Colo. (Edition expires 12/2000) (2.) Hebel SK, Katstrup EK (eds): Drug Facts and Comparisons. St. Louis, Mo. 2001 |
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