Name of Short Acting Insulin Drugs
Regular (soluble) insulin
| Regular (soluble) insulin |
| Availability 100 units/ml Regular U-500 (concentrated), insulin human injection: 500 units/ml |
| Indications and dosages ➣ Type 1 (insulin-dependent) diabetes mellitus; type 2 (non-insulin dependent) diabetes mellitus Adults and children ages 6 and older: Insulin aspart—Dosage tailored to patient’s needs, given subcutaneously in divided doses 5 to 10 minutes before meals. Insulin aspart provides 50% to 70% of dose; intermediate or longacting insulin provides remainder. Dosage range is 0.5 to 1 unit/kg/day in divided doses based on meals. Insulin aspart and insulin aspart protamine— Give subcutaneously b.i.d., 15 minutes before morning and evening meals. For monotherapy, initial dosage is 0.4 to 0.6 unit/kg/day in two divided doses. Titrate in increments of 2 to 4 units q 3 to 4 days to achieve target fasting plasma glucose level. When given with oral hypoglycemics, initial dosage is 0.2 to 0.3 unit/kg/day. |
Mechanism of Action
Regulates glucose metabolism
Insulin and its analogues 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; targets include skeletal muscle, liver, and adipose tissue
Pharmacokinetics
- Bioavailability: 55-77% (SC)
- Peak plasma time: 0.8-2 hr (SC)
- Metabolized by liver (>50%), kidney (30%), and adipose tissue/muscle (20%)
- Excretion: Urine
Administration
- Be aware that insulin is a high alert drug.
- Know that drug is bioavailable as regular human insulin but has a faster onset and shorter duration.
- Given by subcutaneous route only, 5 to 10 minutes (15 minutes for Novolog Mix 70/30) before a meal.
- When mixing insulin aspart with intermediate or long-acting insulin, draw up insulin aspart into syringe first.
- Don’t mix insulin aspart protamine with any other insulin.
- When giving insulin aspart by pump, don’t mix with other insulins.
- Rotate injection sites to prevent lipodystrophy
Contraindications
- Hypersensitivity to drug or its components
- Hypoglycemia
Precautions:
- Hepatic or renal impairment, hypothyroidism, hyperthyroidism
- Elderly patients
- Pregnant or breastfeeding patients
- Children.
Adverse reactions
Metabolic: hypokalemia, sodium retention, hypoglycemia, rebound hyperglycemia (Somogyi effect) Musculoskeletal: myalgia
Skin: urticaria, rash, pruritus
Other: edema; lipodystrophy; lipohypertrophy; redness, warmth, or stinging at injection site; allergic reactions including anaphylaxis
Patient monitoring
- Monitor blood glucose level frequently to gauge drug efficacy and appropriateness of dosage.
- Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
- Stay alert for signs and symptoms of hypoglycemia. Keep glucose source at hand.
- Assess for evidence of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by urine and blood ketones, metabolic acidosis, extremely elevated blood glucose level, and hypovolemia).
- Monitor for glycosuria.
- Closely monitor kidney and liver function test results in patients with renal or hepatic impairment.
Patient teaching
- Teach patient how to administer insulin subcutaneously or by injection pen.
- If patient must mix insulin aspart with intermediate or long-acting insulin, instruct him to draw up insulin aspart into syringe first.
- Tell patient not to mix any other insulin with mixture of insulin aspart and insulin aspart protamine.
- Advise patient to rotate subcutaneous injection sites and keep a record of sites used, to help prevent fatty tissue breakdown.
- Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to always carry a glucose source.
- Inform patient that changes in diet, activity, and stress level affect blood glucose levels and insulin requirements.
- Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
- Tell patient to wear medical identification stating that he is diabetic and takes insulin.
- Instruct patient to have regular medical, vision, and dental exams.
- Tell female patient to contact prescriber if she is pregnant or plans to become pregnant.
- Advise patient to store insulin in refrigerator, not freezer.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
