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What Type Of Insulin Can Be Given Intravenously?

Types Of Insulin For Diabetes Treatment

Types Of Insulin For Diabetes Treatment

Many forms of insulin treat diabetes. They're grouped by how fast they start to work and how long their effects last. The types of insulin include: Rapid-acting Short-acting Intermediate-acting Long-acting Pre-mixed What Type of Insulin Is Best for My Diabetes? Your doctor will work with you to prescribe the type of insulin that's best for you and your diabetes. Making that choice will depend on many things, including: How you respond to insulin. (How long it takes the body to absorb it and how long it remains active varies from person to person.) Lifestyle choices. The type of food you eat, how much alcohol you drink, or how much exercise you get will all affect how your body uses insulin. Your willingness to give yourself multiple injections per day Your age Your goals for managing your blood sugar Afrezza, a rapid-acting inhaled insulin, is FDA-approved for use before meals for both type 1 and type 2 diabetes. The drug peaks in your blood in about 15-20 minutes and it clears your body in 2-3 hours. It must be used along with long-acting insulin in people with type 1 diabetes. The chart below lists the types of injectable insulin with details about onset (the length of time before insulin reaches the bloodstream and begins to lower blood sugar), peak (the time period when it best lowers blood sugar) and duration (how long insulin continues to work). These three things may vary. The final column offers some insight into the "coverage" provided by the different insulin types in relation to mealtime. Type of Insulin & Brand Names Onset Peak Duration Role in Blood Sugar Management Rapid-Acting Lispro (Humalog) 15-30 min. 30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with Continue reading >>

Humulin R

Humulin R

HUMULIN®R (regular insulin human) Injection, USP (rDNA Origin) 100 Units per ML (U-100) DESCRIPTION Humulin® R U-100 is a polypeptide hormone structurally identical to human insulin synthesized through rDNA technology in a special non-disease-producing laboratory strain of Escherichia coli bacteria. Humulin R (insulin human recombinant) U-100 has the empirical formula C257H383N65O77S6 and a molecular weight of 5808. Humulin R (insulin human recombinant) U-100 is a sterile, clear, aqueous, and colorless solution that contains human insulin (rDNA origin) 100 units/mL, glycerin 16 mg/mL and metacresol 2.5 mg/mL, endogenous zinc (approximately 0.015 mg/100 units) and water for injection. The pH is 7.0 to 7.8. Sodiumhydroxide and/or hydrochloric acid may be added during manufacture to adjust the pH. Adequate insulin dosage permits patients with diabetes to effectively utilize carbohydrates, proteins and fats. Regardless of dose strength, insulin enables carbohydrate metabolism to occur and thus to prevent the production of ketone bodies by the liver. Some patients develop severe insulin resistance such that daily doses of several hundred units of insulin or more are required. Continue reading >>

A Nurse's Guide To Administering Iv Insulin

A Nurse's Guide To Administering Iv Insulin

You have a patient that comes up to your unit with a blood sugar of 952. The labs are sent off and the patient is found to be in severe diabetic ketoacidosis (DKA). The doctor puts in the orders for serial lab work, fluid boluses, electrolyte replacements, and an insulin drip. As a newer nurse, you are familiar with labs, boluses, your replacement protocols, but have never administered insulin through an IV. What nursing interventions do you need to perform to safely care for this patient? How Does Insulin Work? Insulin is a hormone created by the pancreas. It allows your body to use glucose to provide the body's cells with the necessary energy they need. Insulin production from the pancreas is based off of your blood sugar levels. If you are getting hyperglycemic, the pancreas is signaled and insulin is released into the bloodstream. Insulin then signals different cells to absorb the glucose and use it as energy or store it for later use. When insulin facilitates glucose being pulled into a cell, a potassium cation is also pulled from extracellular fluid (meaning the bloodstream) into the intracellular fluid. How does this affect our patients? Initially, patients in DKA have an increased extracellular potassium level due to the hyperglycemia and acidosis they are experiencing. This potassium level is quickly decreased as blood glucose is pulled into the cells. Administration As with all critical care medications, be sure to check your hospital's policy for administration. I have seen two main situations in which IV insulin (meaning regular insulin, not Lantus, Aspart, etc.) is given. Treatment of DKA: It seems like each hospital has a different protocol they use to manage DKA patients with. Commonly patients are treated with a bolus of regular insulin IV and then place Continue reading >>

Should I Inject Insulin Into A Vein?

Should I Inject Insulin Into A Vein?

I am 20 years old and have type 1 diabetes. When I am off the insulin pump, my blood sugar gets unstable and can take more than 48 hours to go down. Two friends told me that to handle this, they just inject a very small amount of insulin directly into the bloodstream. I know it sounds crazy, but this would save me time and money. Is it safe? Continue reading >>

Rapid-acting Insulin Approved For Iv Use

Rapid-acting Insulin Approved For Iv Use

Adult patients with Type 1 or 2 diabetes will now have the option of receiving insulin glulisine (rDNA origin) injection (Apidra, Sanofi-Aventis) by intravenous infusion while under medical supervision in a clinical setting. The FDA approved the sNDA for the product following review of an open-label, crossover study of 16 healthy male patients who received an infusion of the insulin in saline diluent for two hours at a rate of 0.8 IU/kg/min. According to the manufacturer, infusion of the same dose of Apidra or regular insulin produced equivalent glucose disposal at steady state. Apidra was originally approved in 2004 for the treatment of adult patients with diabetes mellitus for the control of hyperglycemia. To see more Hot off the Press news articles, click here. To go to the Drug Topics homepage, click here. Continue reading >>

Short-acting Insulins

Short-acting Insulins

Rapid-Acting Analogues Short-Acting Insulins Intermediate-Acting Insulins Long-Acting Insulins Combination Insulins Onset: 30 minutes Peak: 2.5 - 5 hours Duration: 4 - 12 hours Solution: Clear Comments: Best if administered 30 minutes before a meal. Mixing NPH: If Regular insulin is mixed with NPH human insulin, the Regular insulin should be drawn into the syringe first. Aspart - Novolog ®: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin. Lispro - Humalog ®: Compatible - but NO support clinically for such a mixture. Draw up Humalog first before drawing up Regular Insulin. Mixtures should not be administered intravenously. When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Novolog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin. CLINICAL PHARMACOLOGY Insulin is a polypeptide hormone that controls the storage and metabolism of carbohydrates, proteins, and fats. This activity occurs primarily in the liver, in muscle, and in adipose tissues after binding of the insulin molecules to receptor sites on cellular plasma membranes. Insulin promotes uptake of carbohydrates, proteins, and fats in most tissues. Also, insulin influences carbohydrate, protein, and fat metabolism by stimulating protein and free fatty acid synthesis, and by inhibiting release of free fatty acid from adipose cells. Insulin increases active glucose transport through muscle and adipose cellular membranes, and promotes conversion of intracellular glucose and free fatty acid to the appropriate storage forms (glycogen and triglyceride, respectively). Although the liver does not require active glucose transport, insulin increases hepatic gl Continue reading >>

Types Of Insulin

Types Of Insulin

Insulin analogs are now replacing human insulin in the US. Insulins are categorized by differences in onset, peak, duration, concentration, and route of delivery. Human Insulin and Insulin Analogs are available for insulin replacement therapy. Insulins also are classified by the timing of their action in your body – specifically, how quickly they start to act, when they have a maximal effect and how long they act.Insulin analogs have been developed because human insulins have limitations when injected under the skin. In high concentrations, such as in a vial or cartridge, human (and also animal insulin) clumps together. This clumping causes slow and unpredictable absorption from the subcutaneous tissue and a dose-dependent duration of action (i.e. the larger dose, the longer the effect or duration). In contrast, insulin analogs have a more predictable duration of action. The rapid acting insulin analogs work more quickly, and the long acting insulin analogs last longer and have a more even, “peakless” effect. Background Insulin has been available since 1925. It was initially extracted from beef and pork pancreases. In the early 1980’s, technology became available to produce human insulin synthetically. Synthetic human insulin has replaced beef and pork insulin in the US. And now, insulin analogs are replacing human insulin. Characteristics of Insulin Insulins are categorized by differences in: Onset (how quickly they act) Peak (how long it takes to achieve maximum impact) Duration (how long they last before they wear off) Concentration (Insulins sold in the U.S. have a concentration of 100 units per ml or U100. In other countries, additional concentrations are available. Note: If you purchase insulin abroad, be sure it is U100.) Route of delivery (whether they a Continue reading >>

Nclex Study Pharmacology Insulin

Nclex Study Pharmacology Insulin

Sort Can intermediate acting insulin be mixed with regular or rapid acting insulin? Isophane suspension: NPH Humulin N Novolin N YES What is the technique for mixing intermediate insulin with rapid or regular insulin? Isophane suspension: NPH Humulin N Novolin N CLEAR TO CLOUDY Draw up clear (regular or rapid acting) then draw up cloudy (NPH) Continue reading >>

Insulin

Insulin

Sort Mixing Compatibilities •NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30) •NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30) •insulin aspart protamine suspension 75% and insulin aspart 25% (NovoLog Mix 75/25) •insulin lispro protamine suspension 75% and insulin lispro 25% (Humalog Mix 75/25) •Premixed; do not mix with other insulins Rapid-acting o Insulin lispro (Humalog) o Insulin aspart (NovoLog) o Insulin glulisine (Apidra) •Given SC or continuous SC pump (not IV) •Most rapid onset (5-15 min) •Shorter duration •Pt must eat meal after injection oMust eat within 15min of dosage Intermediate-acting oIsophane insulin suspension oAKA NPH - Novolin •Cloudy or opaque in appearance •NPH insulin is often combined with regular insulin to reduce the number of insulin injections per day. •Slower in onset than endogenous insulin •More prolonged in duration than endogenous insulin obut not as long as those of the long-acting insulins Put the following insulins in order from shortest to longest time of onset oInsulin glargine (Lantus) oInsulin isophane suspension (NPH) oInsulin Lispro (Humalog) oRegular insulin (Humulin or Novolin R) oRegular insulin (Humulin or Novolin R) 1 oInsulin Lispro (Humalog) 2 oInsulin glargine (Lantus) 3 oInsulin isophane suspension (NPH) 4 Continue reading >>

Insulin (medication)

Insulin (medication)

"Insulin therapy" redirects here. For the psychiatric treatment, see Insulin shock therapy. Insulin is used as a medication to treat high blood sugar.[3] This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Insulin can be made from the pancreas of pigs or cows.[5] Human versions can be made either by modifying pig versions or recombinant technology.[5] It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).[5] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.[8][9] In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS 7.48 pounds, while this amount of insulin glargine costs 30.68 pounds.[5] Medical uses[edit] Giving insulin with an insulin pen. Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacid Continue reading >>

Insulin Administration

Insulin Administration

Insulin is a protein formed by two cross-linked peptide chains. Insulin is secreted in pulses by the pancreas and reaches the liver via the portal circulation. Some 80% of the insulin reaching the liver is cleared from the circulation, which means that insulin attains much higher concentrations in the liver than in the peripheral circulation. Insulin has a short plasma half-life (3-4 minutes), and choice of the route and timing of insulin administration is a major determinant of metabolic control. Conventional insulin injections are given into the thigh, abdomen or outer side of the buttock. Standard needles range from 0.8 - 1.6 cm in length, are used with a syringe or pen device and deliver insulin into the subcutaneous fat. Too long a needle or poor injection technique can result in injection into a muscle, which is painful and results in more rapid absorption of insulin. Many alternative routes of administration have been tested, but none can match direct injection or infusion. Subcutaneous insulin injection or infusion share the disadvantages of delivery into the systemic rather than portal circulation, and rates of appearance in the blood stream which are delayed and rendered somewhat erratic by the process of absorption from subcutaneous tissues. Characteristics of an ideal insulin administration system Nature has placed the pancreatic beta cell inside a digestive gland and astride an arterial supply that continuously samples the rate of nutrient absorption from the gut. It responds instantaneously to these blood-borne signals by releasing insulin in synchronised pulses, a pattern of secretion that maximises its effect on liver cells. Furthermore, it matches this insulin secretion with reciprocal suppression or release of its partner hormone pancreatic glucagon, t Continue reading >>

Regular Insulin - An Overview | Sciencedirect Topics

Regular Insulin - An Overview | Sciencedirect Topics

Regular insulin is a crystalline zinc insulin preparation, the effect of which appears within 30 minutes of subcutaneous injection. Mark A. Atkinson*, in Williams Textbook of Endocrinology (Thirteenth Edition) , 2016 Regular insulin consists of zinc-insulin crystals dissolved in a clear fluid. After subcutaneous injection, regular insulin tends to dissociate from its normal hexameric form, first into dimers and then into monomers; only the monomeric and dimeric forms can pass through the endothelium into the circulation to any appreciable degree.309 This feature determines the pharmacokinetic profile of regular insulin. The resulting relative delay in onset and duration of action of regular insulin limits its effectiveness in controlling postprandial glucose and results in dose-dependent pharmacokinetics, with a prolonged onset, peak, and duration of action with higher doses. Mark A. Sperling MD, ... Moshe Phillip MD, in Pediatric Endocrinology (Fourth Edition) , 2014 Human regular insulin was a mainstay of insulin management of youth with T1D until the early 2000s when the advent of rapid-acting insulin analogs virtually eliminated its use in children and adolescents, except for intravenous administration. The delayed absorption and prolonged duration of action of the large premeal bolus doses of regular insulin that are required by adolescents with T1D to overcome the insulin resistance of puberty contributed to problems with hyper- and hypoglycemia in this age group.142 Regular insulin remains the insulin of choice for intravenous infusion in the treatment of diabetic ketoacidosis. A special U-500 (500 units/mL) formulation of regular insulin as is available for use in patients with severe insulin resistance who require very large daily doses of insulin. Syed Khalid Continue reading >>

Insulin

Insulin

Sources There’s pork insulin which is almost nonexistent at this point. Pork insulin differs from human insulin by only two amino acids. Most of the insulin is now bio-genetic insulin (“human insulin”) which comes from E. coli bacteria. Human insulin is now cheap enough to drive pork insulin out of the market although it’s still available. Reactions: Lipodystrophy can develop, which is a fat bump under the skin that occurs from constantly injecting from the same place. To prevent this you must rotate the injection sites. Varieties U-100: When we administer insulin, we administer it in units. Insulins can come in a variety of unit concentrations but most of them are U-100 insulin. That means 100 units per milliliter. If you look at an insulin syringe, it has number markings on it. Those numbers indicate the units. 1 unit is a tenth of a cc. (1 unit = 0.01cc) U-500: There’s another type of insulin you may see a couple times a year in your patients which is a U-500 insulin. That’s 500 units per ml. These patients have a severe form of diabetes that requires more than 100 units of injection. If the patient needs 150 units of insulin, you don’t want to use two injections, so you would use U-500 insulin, which is five times more concentrated and can fit into one syringe. When a pharmacy sends a U500 vial to the nursing floor and it goes in the refrigerator, they put fluorescent stickers all over this vial to warn you that this is U500 insulin. If you draw up 30 units for a patient and it’s accidentally U500 instead of U100, that’s 150 units of insulin and they can become hypoglycemic and die. Ultra-short acting insulin: Lispro (Humalog) works in a matter of minutes and just for an hour or two. Rapid/Short acting insulin: Regular insulin works in a matter of Continue reading >>

Continuous Intravenous Insulin: Ready For Prime Time

Continuous Intravenous Insulin: Ready For Prime Time

Abstract In Brief Hyperglycemia in the inpatient setting has been linked to poor outcomes. There is evidence that careful management of hyperglycemia in the acute care setting can decrease lengths of stay, morbidity, and mortality. In unstable, critically ill patients, blood glucose excursions are most effectively controlled through the use of continuous intravenous insulin infusion protocols. However, barriers remain to the acceptance and successful implementation of protocol-driven initiatives to achieve normoglycemia. A multidisciplinary team approach can help overcome staff misconceptions and fears regarding tight glycemic management in hospitalized patients. Rationale for Continuous Insulin Infusion Stress-induced hyperglycemia is a commonly encountered problem in the acute-care setting. Elevated blood glucose levels in critically ill patients may result from the presence of excessive counterregulatory hormones and high levels of tissue and circulating cytokines. These metabolic changes can result in increased insulin resistance and a failure to suppress hepatic gluconeogenesis. Thus, hyperglycemia may be present even in inpatients without a diagnosis of diabetes. Studies have shown an association between hyperglycemia and an increased risk of infection, sepsis, renal failure, congestive heart failure, stroke, and neuropathy.1–6 The recognition of hyperglycemia as a contributor to poor outcomes has provided the rationale to pursue tight glycemic control. The key to effectively controlling hyperglycemia is to identify early patients who have or are at risk of developing elevated blood glucose levels and to initiate appropriate therapy in a timely manner to maintain near-normoglycemia. Insulin is the therapy of choice for management of hyperglycemia in hospitalized Continue reading >>

Intravenous Insulin Therapy

Intravenous Insulin Therapy

Overview Patients with hyperglycemia in the ICU have increased morbidity and mortality. Hyperglycemia is associated with immune dysfunction, increased systemic inflammation, and vascular insufficiency. Elevated blood glucose levels have been shown to worsen outcomes in medical patients who are in the ICU for more than 3 days. Hyperglycemia may result from stress, infection, steroid therapy, decreased physical activity, discontinuation of outpatient regimens, and nutrition. [1] Improved control of hyperglycemia improves patient outcomes, but clinical confirmation of this thesis has proven elusive. Significant interest was generated by initial single-center results that have not been replicated in multisite studies. In 2001, a randomized controlled study in a surgical ICU demonstrated a decrease in mortality from 8% to 4.6% in patients with intensive continuous intravenous insulin therapy. [2] The author repeated the protocol in a study of 1200 patients in a medical ICU. [3] The conventional treatment group was treated to maintain a blood glucose level between 180-200 mg/dL, whereas the intensive treatment group was treated to maintain a blood glucose level between 80-110 mg/dL. Mortality was not significantly reduced by intensive insulin therapy and was actually higher in patients in the intensive treatment group who were in the ICU for less than 3 days. In patients who were in the ICU for longer than 3 days, the intensive treatment group did demonstrate reduced morbidityfrom decreased kidney injury, earlier weaning from mechanical ventilation, and earlier discharge from the medical ICU and hospital. Hypoglycemia occurred more often in the intensive treatment group than the conventional treatment group. In addition, an experienced physician was actively involved in admin Continue reading >>

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