07/04/2009 16:21


Pregnancy Category B

Drug classes: Antidiabetic agent, Hormone



Therapeutic actions

Insulin is a hormone that, by receptor-mediated effects, promotes the storage of the body's fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids.




· Treatment of diabetes mellitus type 1

· Treatment of diabetes mellitus type 2 that cannot be controlled by diet or oral agents

· Treatment of severe ketoacidosis or diabetic coma (regular insulin injection)

· Treatment of hyperkalemia with infusion of glucose to produce a shift of potassium into the cells

· Highly purified and human insulins promoted for short courses of therapy (surgery, intercurrent disease), newly diagnosed patients, patients with poor metabolic control, and patients with gestational diabetes

· Insulin injection concentrated indicated for treatment of diabetic patients with marked insulin resistance (requirements of > 200 units/day)




· Allergy to pork products (varies with preparations; use of human insulin removes this caution); pregnancy (keep patients under close supervision; rigid control is desired; following delivery, requirements may drop for 24–72 hr, rising to normal levels during next 6 wk); lactation (monitor mother carefully; insulin requirements may decrease during lactation).



Adverse effects

Rash, anaphylaxis or angioedema

Allergy--local reactions at injection site--redness, swelling, itching; usually resolves in a few days to a few weeks; a change in type or species source of insulin may be tried

Hypoglycemia; ketoacidosis



Drug Interactions:

· Increased hypoglycemic effects of insulin with monoamine oxidase inhibitors, beta-blockers, salicylates, alcohol

· Delayed recovery from hypoglycemic episodes and masked signs and symptoms of hypoglycemia if taken with beta-adrenergic blocking agents

Drug-alternative therapy

· Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery



Nursing considerations


Name confusion may occur between Lantus and Lente insulin; use extreme caution.

· Ensure uniform dispersion of insulin suspensions by rolling the vial gently between hands; avoid vigorous shaking.

· Give maintenance doses SC, rotating injection sites regularly to decrease incidence of lipodystrophy; give regular insulin IV or IM in severe ketoacidosis or diabetic coma.

· Monitor patients receiving insulin IV carefully; plastic IV infusion sets have been reported to remove 20%–80% of the insulin; dosage delivered to the patient will vary.

· Do not give insulin injection concentrated IV; severe anaphylactic reactions can occur.