insulin isophane human/insulin regular human (Humulin 70/30, Novolin 70/30)

Dosing and uses of Humulin70/30, Novolin 70/30 (insulin isophane human/insulin regular human)

• Adult
• Pediatric

 

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%