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Which Of The Following Types Of Insulin Can Be Given Intravenously

The Optimal Choice Of Medication Administration Route Regarding Intravenous, Intramuscular, And Subcutaneous Injection

The Optimal Choice Of Medication Administration Route Regarding Intravenous, Intramuscular, And Subcutaneous Injection

Go to: Intravenous (IV), intramuscular (IM), and subcutaneous (SC) are the three most frequently used injection routes in medication administration. Comparative studies of SC versus IV, IM versus IV, or IM versus SC have been sporadically conducted, and some new findings are completely different from the dosage recommendation as described in prescribing information. However, clinicians may still be ignorant of such new evidence-based findings when choosing treatment methods. A literature search was performed using PubMed, MEDLINE, and Web of Sciences™ Core Collection to analyze the advantages and disadvantages of SC, IV, and IM administration in head-to-head comparative studies. “SC better than IV” involves trastuzumab, rituximab, antitumor necrosis factor medications, bortezomib, amifostine, recombinant human granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor, recombinant interleukin-2, immunoglobulin, epoetin alfa, heparin, and opioids. “IV better than SC” involves ketamine, vitamin K1, and abatacept. With respect to insulin and ketamine, whether IV has advantages over SC is determined by specific clinical circumstances. “IM better than IV” involves epinephrine, hepatitis B immu-noglobulin, pegaspargase, and some antibiotics. “IV better than IM” involves ketamine, morphine, and antivenom. “IM better than SC” involves epinephrine. “SC better than IM” involves interferon-beta-1a, methotrexate, human chorionic gonadotropin, hepatitis B immunoglobulin, hydrocortisone, and morphine. Safety, efficacy, patient preference, and pharmacoeconomics are four principles governing the choice of injection route. Safety and efficacy must be the preferred principles to be considered (eg, epinephrine should be given intramus 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 >>

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 >>

Pharmacy Consult: We Accidentally Just Gave Insulin Aspart Iv… Is That Bad?

Pharmacy Consult: We Accidentally Just Gave Insulin Aspart Iv… Is That Bad?

Open the Pyxis or Omnicell or fridge in your ED where insulin is stored. How many different vials are stocked? If you’re like most other EDs in the USA you’ll find a rapid acting insulin (aspart, glulisine, lispro) mainly used for hospital sliding scale regimens, insulin regular (fast acting) for IV use, an insulin mix (NPH or aspart/aspart protamine), and a long acting insulin (glargine or detemir) for maintenance. With similar sounding, appearing and often stored next to each other products, it’s not surprising that insulin is the number 1 drug related to medication errors in US hospitals. Consolidating the insulin products may be a solution, reducing the risk of grabbing the wrong vial. In pharmacy school and in residency, its rammed down your throat that your IV insulin is insulin regular. But there is no conceivable reason why rapid acting insulins (aspart, glulisine or lispro) cannot be given IV. Right in the package insert of all places, IV administration is listed as a route of administration. From an evidence-based perspective, there are two studies that compared the effects of IV aspart to IV regular and IV lispro to IV regular [1,2]. The two studies were methodologically similar. Each conducted in healthy individuals, primarily measured glycemic threshold for onset of the clinically detectable autonomic reaction to hypoglycemia induced by aspart, lispro or regular human insulin and utilized the same dosing of 2 units/kg/min. The blood glucose/time profiles were near identical between the different insulin products – practically speaking, this translates into a 1:1 dose conversion. I have not yet been able to convince anyone in the hospital pharmacy to eliminate insulin regular from the formulary. I suppose there are some valid reasons to have multiple 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 >>

Insulin Regimens

Insulin Regimens

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. The appropriate insulin regimen for each patient with diabetes will depend on their type of diabetes and their individual needs and circumstances. Regimens which attempt to improve glycaemic control will require more active involvement of the patient, both with the number of injections and with the need for close self-monitoring of blood glucose. See the separate Diabetes Education and Self-management Programmes article. Insulin regimens should be tailored to the individual, taking into account the patient's type of diabetes, previous control, age, dexterity, eyesight, and personal and cultural preferences. Insulin is usually injected into the upper arms, thighs, buttocks or abdomen. The absorption may be increased if the limb is used in strenuous exercise after the injection. Lipodystrophy can be minimised by using different injection sites in rotation. Local allergic reactions may occur but are rare.[1] Effective patient education for people using insulin treatment is essential, including 'sick day' guidance. See also the separate Diabetes and Intercurrent Illness article. Insulin Passports and patient information booklets should be offered to patients receiving insulin.[2] Insulins are classified according to their duration of action.[3] Short-acting insulins Short-acting (soluble) insulin is usually injected 15 to 30 minutes before meals. Soluble insulin is also the most appropriate form of insulin for use in diabetic emergencies - eg, diabetic ketoacidosis and at the time of 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 >>

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 >>

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 >>

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 >>

Rapid-acting Analogues

Rapid-acting Analogues

Rapid-Acting Analogues Short-Acting Insulins Intermediate-Acting Insulins Long-Acting Insulins Combination Insulins Onset: 12 - 18 min Peak: 1-3 hours Duration: 3-5 hours Solution: Clear Comments: NovoLog should generally be given immediately before a meal (start of meal within 5-10 minutes after injection) because of its fast onset of action. NovoLog is homologous with regular human insulin with the exception of a single substitution of the amino acid proline by aspartic acid in position B28 (beta chain). Insulin lispro (Humalog) and insulin aspart (Novolog), when administered intravenously, show pharmacodynamic parameters similar to regular insulin. Mixing NPH: If NovoLog is mixed with NPH human insulin, NovoLog should be drawn into the syringe first. The injection should be made immediately after mixing. Regular insulin: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin. Mixtures should not be administered intravenously. When used in external subcutaneous infusion pumps for insulin, NovoLog should not be mixed with any other insulins or diluent. When rapid-acting insulin is mixed with either an intermediate- or long-acting insulin, the mixture should be injected within 15 min before a meal. INDICATIONS AND USAGE Treatment of Diabetes Mellitus NovoLog is an insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus. DOSAGE AND ADMINISTRATION Dosing NovoLog is an insulin analog with an earlier onset of action than regular human insulin. The dosage of NovoLog must be individualized. NovoLog given by subcutaneous injection should generally be used in regimens with an intermediate or long-acting insulin [see package insert for Warnings and Precautions (5), How Supplied 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 >>

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 Lispro (intravenous Route, Subcutaneous Route)

Insulin Lispro (intravenous Route, Subcutaneous Route)

Description and Brand Names Drug information provided by: Micromedex US Brand Name Humalog Lispro-PFC Descriptions Insulin lispro is a fast-acting type of insulin. Insulin is one of many hormones that help the body turn the food we eat into energy. This is done by using the glucose (sugar) in the blood as quick energy. Also, insulin helps us store energy that we can use later. When you have diabetes mellitus, your body cannot make enough or does not use insulin properly. So, you must take additional insulin to regulate your blood sugar and keep your body healthy. This is very important as too much sugar in your blood can be harmful to your health. Insulin lispro starts to work faster than some other types of insulin, and its effects do not last as long. It should act more like the insulin your body would normally produce. Because the effects of insulin lispro are short-acting, your doctor may also prescribe a longer-acting insulin for you to use. This medicine is available only with your doctor's prescription. This product is available in the following dosage forms: Suspension Copyright © 2017 Truven Health Analytics Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. 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 >>

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