Name of the Rapid Acting Drugs (Insulin analogues)
- Insulin lispro
- Insulin aspart
- Insulin glulisine
1.Insulin lispro
| Insulin lispro |
| Availability 100 units/ml in 10-ml vials and 1.5-ml cartridges |
| Indications and dosages ➣ Type 1 (insulin-dependent) diabetes mellitus; type 2 (non-insulin dependent) diabetes mellitus unresponsive to diet and oral hypoglycemics Adults and children: In newly diagnosed diabetes, total of 0.5 to 1 unit/ kg/day subcutaneously as part of multidose regimen of short- and longacting insulin. Dosage individualized based on patient’s glucose level, adjusted to premeal and bedtime glucose levels. Reserve concentrated insulin (500 units/ml) for patients requiring more than 200 units/day. ➣ Diabetic ketoacidosis Adults and children: Loading dose of 0.15 units/kg (nonconcentrated regular insulin) I.V. bolus, followed by continuous infusion of 0.1 unit/kg/hour until glucose level drops. Then administer subcutaneously, adjusting dosage according to glucose level. |
Mechanism of Action
Protein hormone; stimulates glucose uptake by peripheral cells
Regulates glucose metabolism; insulins lower blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat and by inhibiting hepatic glucose production. Insulins inhibit lipolysis and proteolysis and enhance protein synthesis; targets include skeletal muscle, liver, and adipose tissue
Pharmacokinetics
- Bioavailability: 55-77% following SC; well absorbed
- Onset: 0.5-5 hr (initial); 0.5-2.5 hr Duration of action: ≤5 hr
- Peak plasma time: 0.1 to 0.4 unit/kg dose: 0.5-1.5 hr
- Human metabolism studies have not been conducted Animal studies indicate that the metabolism of insulin lispro is identical to regular human insulin
- Half-life, SC use: 1 hr
- Mean clearance, IV use: 21.0 mL/min/kg (0.1 unit/kg dose); 9.6 mL/min/kg (0.2 unit/kg dose)
- Mean half-life: 0.85 hr (0.1 unit/kg); 0.92 hr (0.2 unit/kg)
Administration
- Be aware that insulin is a highalert drug whether given subcutaneously or I.V.
- Don’t give insulin I.V. (except nonconcentrated regular insulin), because anaphylactic reaction may occur.
- When mixing two types of insulin, draw up regular insulin into syringe first.
- For I.V. infusion, mix regular insulin only with normal or half-normal saline solution, as prescribed, to yield a concentration of 1 unit/ml. Give every 50 units I.V. over at least 1 minute.
- Rotate subcutaneous injection sites to prevent lipodystrophy.
- Administer mixtures of regular and NPH or regular and lente insulins within 5 to 15 minutes of mixing.
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)
- Skin: urticaria, rash, pruritus
- Other: edema; lipodystrophy; lipohypertrophy; erythema, stinging, or warmth at injection site; allergic reactions including anaphylaxis
Patient monitoring
- Monitor glucose level frequently to assess 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)
- Monitor for signs and symptoms of hypoglycemia. Keep glucose source at hand in case hypoglycemia occurs.
- Assess for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by blood and urinary ketones, metabolic acidosis, extremely elevated blood glucose level).
- Monitor for glycosuria.
- Closely evaluate kidney and liver function test results in patients with renal or hepatic impairment
Patient teaching
- Teach patient how to administer insulin subcutaneously as appropriate.
- Advise patient to draw up regular insulin into syringe first when mixing two types of insulin. Caution him not to change order of mixing insulins.
- Instruct patient to rotate subcutaneous injection sites and keep a record of sites used, to prevent fatty tissue breakdown.
- Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to carry a glucose source at all times.
- Instruct patient to store insulin in refrigerator (not freezer).
- Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
- Tell patient that dietary changes, activity, and stress can alter blood glucose level and insulin requirements.
- Instruct patient to wear medical identification stating that he is diabetic and takes insulin.
- Advise patient to have regular medical, vision, and dental exams.
- 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.
2.Insulin aspart
| Insulin aspart |
| Availability Injection (NovoLog): 100 units/ml in 10-ml vials and 3-ml PenFill cartridges Injection (NovoLog Mix 70/30): 100 units/ml in 10-ml vials, 3-ml PenFill cartridges, and 3-ml FlexPen prefilled syringes |
| 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 as part provides 50% to 70% of dose; intermediate or long-acting 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: SC, well absorbed (2-3 times faster than regular insulin)
- Onset: 0.2-0.3 hr; 1-3 hr (peak effect)
- Duration of action: 3-5 hr
- Peak plasma time: 40-50 minutes
- Peak plasma concentration: 82 microunits/L
- Peak plasma time: 91 minutes (0.1 unit/kg); 122 minutes (0.2 unit/kg); 133 minutes (0.4 unit/kg)
- Protein bound: <10%, similar to regular insulin (not bound to serum binding-protein, but present as a monomer in plasma)
- Liver (>50%); kidney (30%); adipose tissue/muscle (20%)
- Half-life: 81 min (Novolog SC); 1.1 hr (Fiasp)
- 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.
- Give 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.
3.Insulin glulisine
Administration
- Be aware that insulin is a highalert drug.
- Know that drug is bioavailable as regular human insulin but has a faster onset and shorter duration.
- Give 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: hypokalaemia, sodium retention, hypoglycaemia, rebound hyperglycaemia (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 glucose level frequently to assess 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)
- Monitor for signs and symptoms of hypoglycemia. Keep glucose source at hand in case hypoglycemia occurs.
- Assess for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by blood and urinary ketones, metabolic acidosis, extremely elevated blood glucose level).
- Monitor for glycosuria.
- Closely evaluate kidney and liver function test results in patients with renal or hepatic impairment
Patient teaching
- Teach patient how to administer insulin subcutaneously as appropriate.
- Advise patient to draw up regular insulin into syringe first when mixing two types of insulin. Caution him not to change order of mixing insulins.
- Instruct patient to rotate subcutaneous injection sites and keep a record of sites used, to prevent fatty tissue breakdown.
- Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to carry a glucose source at all times.
- Instruct patient to store insulin in refrigerator (not freezer).
- Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
- Tell patient that dietary changes, activity, and stress can alter blood glucose level and insulin requirements.
- Instruct patient to wear medical identification stating that he is diabetic and takes insulin.
- Advise patient to have regular medical, vision, and dental exams.
- 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.
- Advise patient to have regular medical, vision, and dental exams.
- 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
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