insulin isophane human/insulin regular human (Humulin 70/30, Novolin 70/30)
Classes: Antidiabetics, Insulins
- Dosing and uses of Humulin70/30, Novolin 70/30 (insulin isophane human/insulin regular human)
- Humulin70/30, Novolin 70/30 (insulin isophane human/insulin regular human) adverse (side) effects
- Warnings
- Pregnancy
- Pharmacology of Humulin70/30, Novolin 70/30 (insulin isophane human/insulin regular human)
Dosing and uses of Humulin70/30, Novolin 70/30 (insulin isophane human/insulin regular human)
Adult dosage forms and strengths
insulin isophane human/insulin regular human
injectable suspension
- (70 units/30 units)/mL
Type 1 Diabetes Mellitus
Suggested guidelines for beginning dose
Ketones moderate or less: 0.5 U/kg/day SC
Ketones large: 0.7 U/kg/day SC
Typically, 50-75% of total daily dose is given as intermediate- or long-acting insulin
May use this combination product if the dosage ratio of NPH (isophane) to regular is 2:1
Type 2 Diabetes Mellitus
Suggested guidelines for beginning dose; adjust according to blood glucose levels
Initial dose: 0.5-1 units/kg/day in divided doses
Typically, 50-75% of total daily dose is given as intermediate- or long-acting insulin
May use this combination product if the dosage ratio of NPH (isophane) to regular is 2:1
Morning
- Give 2/3rds of daily insulin SC
- Ratio of regular insulin to NPH (isophane) insulin 1:2
Evening
- Give 1/3 of daily insulin SC
Administration
Administer within 15 min before a meal or immediately after a meaL
Store unopened vials/pens refrigerated; do not freeze
Opened (in-use) product may be stored at ambient room temperature (below 86°F [30°C]) and away from heat and light
Dosage Adjustment Strategies
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 (See Dosage Adjustment Strategies)
Adjust to achieve appropriate glucose controL
Look for consistent pattern in blood sugars for >3 days
- Compare blood glucose for same time each day
- For each time of day: calculate blood glucose range
- Calculate median blood glucose
- Consider eating and activity patterns during day
Adjust only one 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 1st
- Many sliding scales exist to determine exact insulin dose based on frequent blood glucose monitoring
- - Commonly written for q4hr blood glucose test
- - Sliding scale coverage usually begins after blood glucose >11 mmol/L (200 mg/dL)
- - If coverage is needed q4hr x 24 hr, then base insulin dose is adjusted first; sliding scale doses may be adjusted upwards as well
- Change insulin doses in small increments
- - Type I diabetes: 1-2 U change
- - Type II diabetes: 2-3 U change
Pediatric dosage forms and strengths
insulin isophane human/insulin regular human
injectable suspension
- (70 units/30 units)/mL
Type 1 Diabetes Mellitus
Suggested guidelines for beginning dose
Ketones moderate or less: 0.5 U/kg/day SC
Ketones large: 0.7 U/kg/day SC
Increased dose may be required during growth spurts
Typically, 50-75% of total daily dose is given as intermediate- or long-acting insulin
May use this combination product if the dosage ratio of NPH (isophane) to regular is 2:1
Administration
Administer within 15 min before a meal or immediately after a meaL
Store unopened vials/pens refrigerated; do not freeze
Opened (in-use) product may be stored at ambient room temperature (below 86°F [30°C]) and away from heat and light
Dosage Adjustment Strategies
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 (See Dosage Adjustment Strategies)
Adjust to achieve appropriate glucose controL
Look for consistent pattern in blood sugars for >3 days
- Compare blood glucose for same time each day
- For each time of day: calculate blood glucose range
- Calculate median blood glucose
- Consider eating and activity patterns during day
Adjust only one 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 1st
- Many sliding scales exist to determine exact insulin dose based on frequent blood glucose monitoring
- - Commonly written for q4hr blood glucose test
- - Sliding scale coverage usually begins after blood glucose >11 mmol/L (200 mg/dL)
- - If coverage is needed q4hr x 24 hr, then base insulin dose is adjusted first; sliding scale doses may be adjusted upwards as well
- Change insulin doses in small increments; for type I diabetes - 1-2 U change
Humulin70/30, Novolin 70/30 (insulin isophane human/insulin regular human) adverse (side) effects
Frequency not defined
Hypoglycemia
Insulin resistance
Lipodystrophy
Lipohypertrophy
Local allergic reaction
Hypokalemia
Warnings
Contraindications
Hypoglycemia
Systemic allergic reactions
Cautions
Never share pen between patients even if needle is changed
Intermediate-acting insulin, do not use for circumstances that require rapid-acting insulin
Caution with decreased insulin requirements (eg, diarrhea, nausea/vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment)
Caution with increased insulin requirements (eg, fever, hyperthyroidism, trauma, infection, surgery)
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 and treat accordingly and consider discontinuing thiazolidinediones
Pregnancy, lactation
Pregnancy and lactation
Pregnancy category: B
Lactation: Safe to use while breast feeding
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Humulin70/30, Novolin 70/30 (insulin isophane human/insulin regular human)
Mechanism of action
Regulates glucose metabolism
Insulin and its analogs lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production; insulin inhibits lipolysis and proteolysis, and enhances protein synthesis
Insulin NPH and insulin regular is a combination insulin product with intermediate duration that has more rapid onset than that of insulin NPH alone
Pharmacokinetics
Onset: 1-1.5 hr (NPH); 0.5 hr (regular)
Peak: 4-12 hr (NPH); 2.5-5 hr (regular)
Duration: Up to 24 hr (NPH); 8 hr (regular)
Bioavailability: IM, SC, IP: well absorbed
Protein Bound: 5% (not bound to serum binding-protein, but present as a monomer in plasma)
Vd: 0.15 L/kg
Metabolism: Liver >50%; kidney 30%; adipose tissue/muscle 20%