Insulin Regular Human

Insulin Regular Human is used with a proper diet and exercise program to control high blood sugar in people with diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke.

This man-made insulin product is the same as human insulin. It replaces the insulin that your body would normally make. It is a short-acting insulin. It works by helping blood sugar (glucose) get into cells so your body can use it for energy. This medication is usually used in combination with a medium- or long-acting insulin product. This medication may also be used alone or with other oral diabetes drugs (such as metformin).

Insulin Regular Human is available under the following different brand names: Humulin R, Novolin R, and Humulin R U-500.

Dosage Forms and Strengths

Injectable solution

• Over-the-counter (OTC)
  • 100units/mL (3mL vial)
  • 100units/mL (10mL vial)
• Prescription (Rx)
  • 500units/mL (20mL vial); prescribe with U-500 syringes to avoid conversion for U-100 tuberculin syringes
  • 500units/mL (3mL pen)

Dosage Considerations – Should be Given as Follows:

Type 1 Diabetes Mellitus

Adult

• Initial: 0.2-0.4 units/kg/day subcutaneously (SC) divided every 8 hours or more frequently
• Maintenance: 0.5-1 unit/kg/day subcutaneously (SC) divided every 8 hours or more frequently; in insulin-resistant patients (e.g., due to obesity), substantially higher daily insulin may be required
• Approximately 50-75% of the total daily insulin requirements are given as intermediate- or long-acting insulin administered in 1-2 injections; rapid- or short-acting insulin should be used before or at mealtimes to satisfy the
• remainder balance of the total daily insulin requirements
• Premixed combinations are available that deliver rapid- or short-acting components at the same time as the intermediate- or long-acting component

Pediatric:

• Initial: 0.2-0.4 unit/kg/day subcutaneously (SC) divided every 8 hours or more frequently
• Maintenance: 0.5-1 unit/kg/day subcutaneously (SC) divided every 8 hours or more frequently; in insulin-resistant patients (e.g., due to obesity), substantially higher daily insulin may be required
• Adolescents: May require up to 1.5 mg/kg/day during puberty
• The average total daily insulin requirement for pre-pubertal children varies from 0.7-1 unit/kg/day but may be much lower

• Dosing considerations

• Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and/or urine glucose tests and must be carefully individualized to optimal effect
• Approximately 50-75% of the total daily insulin requirements are given as intermediate- or long-acting insulin administered in 1-2 injections
• Rapid- or short-acting insulin should be used before or at mealtimes to satisfy the remainder balance of the total daily insulin requirements
• Premixed combinations are available that deliver a rapid- or short-acting component at the same time as the intermediate- or long-acting component

Type 2 Diabetes Mellitus

Type 2 diabetes inadequately controlled by diet, exercise, or oral medication: Suggested beginning dose of 10 units/day subcutaneously (SC) (or 0.1-0.2 unit/kg/day) in evening or divided every 12 hours

Morning

• Give two thirds of daily insulin requirement
• Ratio of regular insulin to NPH insulin 1:2

Evening

• Give two thirds of daily insulin requirement
• Ratio of regular insulin to NPH insulin 1:1

Severe Hyperglycemia (Diabetic Ketoacidosis)

• 0.1 unit/kg intravenous (IV) bolus (some argue against bolus), THEN
• 0.1 unit/kg/hour IV continuous infusion; if serum glucose does not fall by 50 mg/dL in the first hour, check hydration status; if possible, double the insulin hourly until glucose levels fall at the rate of 50-75 mg/dL/hour; decrease infusion to 0.05-0.1 unit/kg/hour when blood sugar reaches 250 mg/dL

Hyperkalemia

• 5-10 units intravenous (IV) insulin in 50 mL D50W (25 g) infused over 15-30 minutes

Administration

Administer within 15 minutes before a meal or immediately after a meal

Dosing Considerations

Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect

Dose adjustments should be based on regular blood glucose testing

Adjust to achieve appropriate glucose control

Planning dose adjustments

• Look for consistent pattern in blood sugars for more than 3 days
• Same time each day: Compare blood glucose levels with previous levels found at that time of day
• For each time of day: Calculate blood glucose range
• Calculate median blood glucose
• Consider eating and activity patterns during day

Making dose adjustments

• Adjust only 1 insulin dose at a time
• Correct hypoglycemia first
• Correct highest blood sugars next
• If all blood sugars are high (within 2.75 mmol/L [50 mg/dL]): Correct morning fasting blood glucose first
• Change insulin doses in small increments: Type 1 diabetes (1-2 unit change); type 2 diabetes (2-3 unit change)

Sliding scales

• Many sliding scales exist to determine exact insulin dose based on frequent blood glucose monitoring
• Commonly written for every 4 hours blood glucose test
• Sliding scale coverage usually begins after blood glucose greater than 11 mmol/L (200 mg/dL)
• If coverage is needed every 4 hours for 24 hours, then base insulin dose is adjusted first; sliding scale doses may be adjusted upwards as well

Side effects associated with use of Insulin, include the following:

• Injection site reactions (pain, redness, irritation)
• Headache
• Influenza-like symptoms
• Indigestion
• Diarrhea
• Back pain
• Sore throat
• Low blood sugar symptoms (hypoglycemia) including headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizures
• Insulin resistance
• Body fat redistribution
• Abnormal accumulation of fat underneath the surface of the skin
• Local allergic reaction

Serious side effects of insulin regular human include:

• Low blood potassium symptoms (hypokalemia) including muscle cramps, weakness, irregular heartbeat

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of insulin include:

• pramlintide

Serious Interactions of insulin include:

• ethanol

Insulin Regular Human has moderate interactions with at least 100 different drugs.

Insulin Regular Human has mild interactions with at least 83 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

• This medication contains insulin regular human. Do not take Humulin R, Novolin R, or Humulin R U-500 if you are allergic to insulin regular human or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Hypersensitivity
• Low blood sugar (hypoglycemia)

Effects of Drug Abuse

• No information provided

Short-Term Effects

• See "What Are Side Effects Associated with Using Insulin?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Insulin?"

Cautions

• Never share an insulin pen between patients even if needle is changed
• Use with caution in patients with decreased insulin requirements: Diarrhea, nausea/vomiting, malabsorption, hypothyroidism, renal impairment, and hepatic impairment
• Use with caution in patients with increased insulin requirements: Fever, hyperthyroidism, trauma, infection, and surgery
• Rapid changes in serum glucose may induce symptoms of hypoglycemia; increase monitoring with changes to insulin dosage, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with renal impairment or hepatic impairment or hypoglycemia unawareness
• Hypoglycemia is the most common cause of adverse reactions (headache, tachycardia, etc.)
• May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when co-administered with potassium-lowering drugs or when administered to patients with a condition that may decrease potassium
• Thiazolidinediones are peroxisome proliferator-activated receptor (PPAR)-gamma agonists and can cause dose-related fluid retention, particularly when used in combination with insulin; fluid retention may lead to or exacerbate heart failure; monitor for signs and symptoms of heart failure, treat the patient accordingly, and consider discontinuing thiazolidinediones
• Change in insulin regimen should be carried out under close medical supervision and frequency of blood glucose monitoring should be increased
• Severe, life-threatening, generalized allergy, including anaphylaxis, can occur; discontinue therapy if indicated
• Not for mixing with any insulin for intravenous use or with insulins other than NPH insulin for subcutaneous use
• Pregnancy

Medication errors associated with U-500:

• Prescribed dose should always be expressed in actual units of insulin and NOT volume
• Reports of errors resulting in hyperglycemia, hypoglycemia, or death
• Majority of errors occurred due to errors in dispensing, prescribing, or administration; confusion with corresponding markings on the syringe the patient is using (i.e., a U-100 insulin syringe or tuberculin syringe)

Pregnancy and Lactation

• Insulin regular human may be acceptable for use during pregnancy
• Either animal studies show no risk but human studies are not available or animal studies showed minor risks and human studies were done and showed no risk
• Insulin regular human is considered safe for use while breastfeeding