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Insulin Regular Dosage

Applies to the following strength(s): beef-pork 100 units/mL ; pork 100 units/mL ; human recombinant 100 units/mL ; pork 500 units/mL ; human recombinant 500 units/mL

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Diabetes Type 1

Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL (U-100) and 500 units of insulin per mL (U-500)

Individualize dose based on metabolic needs and frequent monitoring of blood glucose
-Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day
-Most individuals with type 1 diabetes should be treated with multiple-daily insulin (MDI) injections or continuous subcutaneous insulin infusion (CSII)

MDI Regimens: Utilizing a combination of prandial (i.e., bolus, rapid, or short-acting insulins) and basal (i.e., intermediate or long acting insulin) insulin, administer 3 to 4 injections per day; regular human insulin is a short-acting prandial insulin.
--Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal
--Administer U-500 insulin subcutaneously 2 to 3 times a day approximately 30 minutes prior to start of a meal

CSII (Insulin Pump) Therapy: U-100 insulin only
-Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure pump has been evaluated with the specific insulin to be used (e.g., Novolin(R) is not recommended for use in insulin pumps due to risk of precipitation).
-While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion.

Intravenous Administration: U-100 insulin only;
-Closely monitor blood glucose and serum potassium during IV administration
-Humulin(R): Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags; this insulin is stable in normal saline
-Novolin(R): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags; this insulin is stable in normal saline, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride

Comments:
-Most people with type 1 diabetes should use insulin analogs to reduce hypoglycemic risk.
-Most people with type 1 diabetes should be educated in how to match prandial insulin dose to carbohydrate intake, pre-meal blood glucose, and anticipated activity.
-Insulin resistant patients that require daily insulin doses of more than 200 units may find U-500 insulin to be useful as large doses may be administered subcutaneously in a reasonable volume.
-To avoid any mix-up with the availability of 2 different regular human insulin concentrations, insulin doses should always be ordered in units not in volume.

Use: To improve glycemic control in adult patients with diabetes mellitus.

Usual Adult Dose for Diabetes Type 2

Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL (U-100) and 500 units of insulin per mL (U-500)

Individualize dose based on metabolic needs and frequent monitoring of blood glucose
-Initial doses are often in the range of 0.2 to 0.4 units/kg/day
-Use HbA1c values to guide therapy; consult current guidelines for optimal target ranges

Multiple-daily insulin (MDI) injections U-100 or U-500 insulin:
-Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal
-Administer U-500 insulin subcutaneously 2 to 3 times a day approximately 30 minutes prior to start of a meal
-May be used in combination with oral antihyperglycemic agents or longer-acting basal insulin

Continuous Subcutaneous Insulin Infusion (Insulin Pump) U-100 insulin only:
-Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure pump has been evaluated with specific insulin to be used (e.g., Novolin(R) is not recommended for use in insulin pumps due to risk of precipitation)
-While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion.

Intravenous Administration U-100 insulin only:
-Closely monitor blood glucose and serum potassium during IV administration
-Humulin(R): Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags; this insulin is stable in normal saline
-Novolin(R): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags; this insulin is stable in normal saline, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride

Comments:
-For people with type 2 diabetes, a patient-centered approach to care should guide choice of pharmacologic agents; considerations include efficacy, cost, potential side effects, weight, comorbidities, hypoglycemic risk, and patient preference.
-Insulin resistant patients that require daily insulin doses of more than 200 units may find U-500 insulin to be useful as large doses may be administered subcutaneously in a reasonable volume.
-To avoid any mix-up with the availability of 2 different regular human insulin concentrations (U-100 and U-500), insulin doses should always be ordered in units not in volume.

Use: To improve glycemic control in adult patients with diabetes mellitus.

Usual Adult Dose for Diabetic Ketoacidosis

Successful treatment of hyperglycemic emergencies such as diabetic ketoacidosis (DKA) requires frequent monitoring of clinical and laboratory parameters while carefully correcting volume deficits, managing electrolytes, and normalizing blood glucose. Insulin therapy is used to slowly correct high glucose levels; consult current treatment protocols for specific guidance on fluid and electrolyte management.

Initiate insulin infusion 1 to 2 hours after starting fluid replacement therapy.
-Dose: 0.14 unit/kg/hour IV; alternatively, a bolus of 0.1 unit/kg followed by an infusion of 0.1 unit/kg/hr has been used
-Blood glucose should drop 50 to 75 mg/dL per hour, if this drop does not occur in the first hour; administer bolus of 0.14 unit/kg while continuing the insulin infusion.
-When blood glucose concentration reaches 200 mg/dL, decrease the insulin infusion to 0.02 to 0.05 unit/kg/hr; dextrose should be added to the IV fluids to maintain a blood glucose between 150 and 200 mg/dL until resolution of DKA (serum bicarbonate level 15 mEq/L or greater, venous pH greater than 7.3, and a calculated anion gap in the normal range)

In circumstances where continuous IV infusion is not possible and DKA is uncomplicated, rapid and short-acting insulins have been administered subcutaneously or intramuscularly. See rapid-acting (lispro, aspart, or glulisine) insulin monographs for dosing of rapid-acting insulin.

Subcutaneous regular human insulin: 0.1 unit/kg subcutaneously every 1 to 2 hours; when blood glucose is less than 250 mg/dL (14 mmol/L), give glucose-containing fluids orally and reduce insulin to 0.05 unit/kg subcutaneously as needed to keep blood glucose around 200 mg/dL (11 mmol/L) until resolution of DKA.

Comments:
-An endocrinologist or critical care specialist with training and expertise in the management of DKA should direct care; frequent monitoring of clinical and laboratory parameters is necessary as well as identification and correction of precipitating event.
-Starting insulin therapy before IV fluid replacement may precipitate shock, and increase the risk of hypokalemia and cerebral edema.
-To prevent rebound hyperglycemia, initiate subcutaneous insulin 15 to 30 minutes (rapid-acting) or 1 to 2 hours (regular insulin) before stopping the insulin infusion; alternatively, basal insulin may be administered in the evening and the insulin infusion stopped the next morning.

Use: Treatment of diabetic ketoacidosis (DKA)

Usual Adult Dose for Insulin Resistance

Patients with insulin-resistant type 1 or type 2 diabetes who require daily insulin doses of more than 200 units may find U-500 insulin to be useful; larger doses may be administered subcutaneously in a reasonable volume.

Usual Adult Dose for Nonketotic Hyperosmolar Syndrome

Successful treatment of hyperglycemic emergencies hyperglycemic hyperosmolar state (HHS) requires frequent monitoring of clinical and laboratory parameters while carefully correcting volume deficits, managing electrolytes, and normalizing blood glucose. Insulin therapy is used to slowly correct high glucose levels; consult current treatment protocols for specific guidance on fluid and electrolyte management.

Initiate insulin infusion 1 to 2 hours after starting fluid replacement therapy
-Dose: 0.14 unit/kg/hour IV; alternatively, a bolus of 0.1 unit/kg followed by an infusion of 0.1 unit/kg/hr has been used
-If blood glucose does not fallen by 10% in first hour, give bolus of 0.14 units/kg while continuing insulin infusion
-When blood glucose concentration reaches 300 mg/dL or less, decrease the insulin infusion to 0.02 to 0.05 unit/kg/hr; dextrose should be added to the IV fluids to maintain blood glucose between 250 and 300 mg/dL until resolution of HHS.

Comments:
-An endocrinologist or critical care specialist with training and expertise in the management of HHS should direct care; frequent monitoring of clinical and laboratory parameter is necessary as well as identification and correction of precipitating event.
-Starting insulin therapy before IV fluid replacement may precipitate shock, and increase the risk of hypokalemia and cerebral edema.
-To prevent rebound hyperglycemia, initiate subcutaneous insulin 15 to 30 minutes (rapid-acting) or 1 to 2 hours (regular insulin) before stopping the insulin infusion; alternatively, basal insulin may be administered in the evening and the insulin infusion stopped the next morning.

Use: Treatment of hyperglycemic hyperosmolar state (also known as hyperosmolar non-ketotic coma (HONK); hyperosmolar hyperglycemic nonketotic syndrome)

Usual Pediatric Dose for Diabetes Type 1

Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL (U-100) and 500 units of insulin per mL (U-500); U-500 insulin has not been adequately studied in pediatric patients.

Individualize dose based on metabolic needs and frequent monitoring of blood glucose
-Total daily insulin requirements are usually between 0.5 to 1 unit/kg/day
-Insulin requirements during the honeymoon phase (period of partial remission) are usually less than 0.5 units/kg/day and may be much lower
-Insulin requirements in pre-pubertal children who are outside the partial remission phase are usually from 0.7 to 1 unit/kg/day
-Insulin requirements in patients with insulin resistance (e.g., during puberty or due to obesity) may be substantially higher than 1 unit/kg/day (up to 2 units/kg/day)
-Use HbA1c values to guide therapy; consult current guidelines for optimal target ranges
-Most individuals with type 1 diabetes should be treated with multiple-daily insulin (MDI) injections or continuous subcutaneous insulin infusion (CSII)

MDI Regimens: Utilizing a combination of prandial (i.e., bolus, rapid, or short-acting insulins) and basal (i.e., intermediate or long acting insulin) insulin, administer 3 to 4 injections per day; regular human insulin is a short-acting prandial insulin.
--Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal

CSII (Insulin Pump) U-100 insulin:
-Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure pump has been evaluated with specific insulin to be used (Novolin(R) is not recommended for use in insulin pumps due to risk of precipitation)
-While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion.

Intravenous Administration: U-100 insulin:
-Closely monitor blood glucose and serum potassium during IV administration
-Humulin(R): Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags; this insulin is stable in normal saline
-Novolin(R): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags; this insulin is stable in normal saline, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride

Comments:
-Most people with type 1 diabetes should use insulin analogs to reduce hypoglycemic risk.
-Most people with type 1 diabetes should be educated in how to match prandial insulin dose to carbohydrate intake, pre-meal blood glucose, and anticipated activity.
-Insulin resistant patients that require daily insulin doses of more than 200 units may find U-500 insulin to be useful as large doses may be administered subcutaneously in a reasonable volume.
-To avoid any mix-up with the availability of 2 different regular human insulin concentrations, insulin doses should always be ordered in units not in volume.
-Insulin therapy should be initiated in children and adolescents for whom the distinction between type 1 diabetes mellitus and type 2 diabetes mellitus is unclear, specifically those with a random venous or plasma blood glucose concentration of 250 mg/dL or greater, or those who HbA1c is greater than 9%.

Use: To improve glycemic control in pediatric patients with diabetes mellitus.

Usual Pediatric Dose for Diabetes Type 2

Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL (U-100) and 500 units of insulin per mL (U-500); U-500 insulin has not been adequately studied in pediatric patients.

Individualize dose based on metabolic needs and frequent monitoring of blood glucose
-Initial doses are often in the range of 0.2 to 0.4 units/kg/day
-Use HbA1c values to guide therapy; consult current guidelines for optimal target ranges

Multiple-Daily Insulin (MDI) injections: Utilizing a combination of prandial (i.e., bolus, rapid, or short-acting insulins) and basal (i.e., intermediate or long acting insulin) insulin, may administer 3 to 4 injections per day; regular human insulin is a short-acting prandial insulin
--Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal

Continuous Subcutaneous Insulin Infusion (CSII) - Insulin Pump Therapy:
-Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure pump has been evaluated with specific insulin to be used (Novolin(R) is not recommended for use in insulin pumps due to risk of precipitation)
-While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion.

Intravenous Administration: U-100 insulin:
-Closely monitor blood glucose and serum potassium during IV administration
-Humulin(R): Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags; this insulin is stable in normal saline
-Novolin(R): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags; this insulin is stable in normal saline, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride

Comments:
-Insulin therapy should be initiated in children and adolescents for whom the distinction between type 1 diabetes mellitus and type 2 diabetes mellitus is unclear, specifically those with a random venous or plasma blood glucose concentration of 250 mg/dL or greater, or those who HbA1c is greater than 9%.
-May administer in combination with oral antidiabetic agents.

Use: To improve glycemic control in pediatric patients with diabetes mellitus.

Usual Pediatric Dose for Diabetic Ketoacidosis

Successful treatment of hyperglycemic emergencies such as diabetic ketoacidosis (DKA) requires frequent monitoring of clinical and laboratory parameters while carefully correcting volume deficits, managing electrolytes, and normalizing blood glucose. Insulin therapy is used to slowly correct high glucose levels; consult current treatment protocols for specific guidance on fluid and electrolyte management.

Initiate insulin infusion 1 to 2 hours after starting fluid replacement therapy.
-Dose: 0.1 unit/kg/hour IV until resolution of DKA (pH greater than 7.3, bicarbonate greater than 15 mmol/L and/or closure of the anion gap); resolution of DKA takes longer than normalization of blood glucose concentrations.
-For patients with marked sensitivity to insulin, decrease insulin to 0.05 units/kg/hour or less provided the metabolic acidosis continues to resolve.

In circumstances where continuous IV infusion is not possible and DKA is uncomplicated, may administer regular insulin subcutaneously at 0.1 unit/kg every 1 to 2 hours; when blood glucose is less than 250 mg/dL (14 mmol/L), give glucose-containing fluids orally and reduce insulin to 0.05 unit/kg as needed to keep blood glucose around 200 mg/dL (11 mmol/L) until resolution of DKA.

Comments:
-An endocrinologist or critical care specialist with training and expertise in the management of DKA should direct care; frequent monitoring of clinical and laboratory parameters is necessary as well as identification and correction of precipitating event.
-Starting insulin therapy before IV fluid replacement may precipitate shock, and increase the risk of hypokalemia and cerebral edema.
-During initial volume expansion the plasma glucose falls steeply, thereafter expect decreases in the range of 36 to 90 mg/dL/hr (2 to 5 mmol/L/hr); to prevent too rapid a decrease in plasma glucose and hypoglycemia, 5% glucose should be added to the IV fluid when the plasma glucose falls to 250 to 300 mg/dL (14 to 17 mmol/L) or sooner if the rate of fall is precipitous.
-To prevent rebound hyperglycemia, initiate subcutaneous insulin 15 to 30 minutes (rapid-acting) or 1 to 2 hours (regular insulin) before stopping the insulin infusion; alternatively, basal insulin may be administered in the evening and the insulin infusion stopped the next morning.

Use: Treatment of diabetic ketoacidosis

Renal Dose Adjustments

Use caution; dose reduction may be required in patients with renal impairment

Liver Dose Adjustments

Use caution; dose reduction may be required in patients with hepatic impairment

Dose Adjustments

Elderly: Use caution due to the potential for decreased renal function.

-Daily insulin requirements may be higher during illness, stress, pregnancy, in obese patients, trauma, during concurrent use with medications having hyperglycemic effects, or after surgery
-Daily insulin requirements may be lower with exercise, weight loss, calorie restricted diets, or during concurrent use of medications having hypoglycemic effects.

Supplemental doses may be prescribed during illness
Patients with type 2 diabetes receiving oral medications may be switched to insulin therapy temporarily.

Dosage adjustments may be required when the brand, type, or species of insulin is changed; oral antidiabetic treatment may need to be adjusted as well.

Precautions

Regular human insulin is available over-the-counter in the US

Safety and efficacy of U-500 insulin have not been established in patients younger than 18 years.
Safety and efficacy of Novolin(R) for use in type 2 diabetes mellitus have not been established in patients younger than 18 years.
Safety and efficacy of Novolin(R) have not been established in patients younger than 2 years.

Consult WARNINGS section for additional precautions.

Dialysis

No data available

Other Comments

Administration advice: Always double check insulin labels before administration

-U-100 regular human insulin: May administer IV or subcutaneously
-U-500 regular human insulin: Subcutaneously only; do not give IV

Due to a risk for transmission of blood-borne pathogens:
-Do not share multi-dose insulin pens between patients, even if the needle is changed
-When using vials, never share needles or syringes between patients

Multiple-daily insulin (MDI) injections:
-Ensure patients have been educated as to proper injection technique
-Administer subcutaneously into the abdomen, buttocks, thigh, or upper arm within 30 minutes before a meal; rotate injection sites within same region to reduce the risk of lipodystrophy
-U-100 regular human insulin may be mixed with NPH insulin; draw the shorter acting insulin (U-100 regular) into the syringe first to prevent contamination of the vial by the longer-acting (NPH) insulin; administer immediately after mixing.
-U-500 regular human insulin should not be mixed with other insulins as there is no data to support such use
-Patients should be aware of the differences between insulin and tuberculin syringes for measuring insulin doses, especially if prescribed U-500 regular human insulin; consult U-500 manufacturer's product labeling for a dosing table that provides dosing information for both U-100 insulin syringe and tuberculin syringe.

Continuous Subcutaneous Infusion (Insulin pump)
-Infusion sets should be inserted into the subcutaneous fat layer of the abdominal wall; rotate sites to avoid lipodystrophy.
-Do not use diluted, intermediate-acting, long-acting, or mixed insulins in an insulin pump; do not use U-500 insulin in an insulin pump.
-Check insulin pump labeling to ensure the pump has been evaluated with the insulin to be used.
-Remind patients on insulin pump therapy that they must have an alternative insulin delivery system available in case of pump system failure.

Intravenous Administration: U-100 insulin only
-Closely monitor blood glucose and serum potassium during IV administration
-Humulin(R): Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags; this insulin is stable in normal saline
-Novolin(R): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags; this insulin is stable in normal saline, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride
-U-500 regular human insulin should not be administered IV.

Storage requirements:
-Unopened: Store in refrigerator (36F to 46F (2C to 8C)), do not freeze; discard if frozen
-Novolin(R): Unrefrigerated vial (opened or unopened): Use within 42 days; keep as cool as possible (not above 77F (25C)); do not expose to excessive heat or light
-Humulin(R): Unrefrigerated vial (opened or unopened): Use within 31 days; keep as cool as possible (not above 86F (30C)); do not expose to excessive heat or light

Infusion Fluids:
-Humulin(R): Diluted to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags: Stable for 48 hours when refrigerated (36F to 46F (2C to 8C)) and then may be used at room temperature for up to an additional 48 hours
-Novolin(R): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags: Stable at room temperature for 24 hours

General:
-Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs; duration of action of insulin will vary according to dose, injection site, blood flow, temperature, and level of physical activity.
-Regular human insulin is generally the preferred insulin for IV administration
-As a meal time insulin, rapid-acting insulin analogs are generally preferred over regular human insulin as analogs have been shown to reduce hypoglycemic risk.
-Hypoglycemia is the most common adverse reaction of insulin therapy; the timing generally reflects the time-action profile of the administered insulin.

Monitoring:
-Blood glucose monitoring is essential for patients receiving insulin therapy.
-Blood glucose and potassium should be closely monitored in patients receiving IV insulin.
-Monitor urine ketones when blood glucose levels are unexpectedly high or inconsistent, and as clinically indicated.
-Glycosylated hemoglobin measurements are recommended every 3 months.

Patient advice:
-Patients should be advised to never share an insulin pen with another person, even if the needle is changed; patients should understand that sharing needles or syringes with another person carries a risk for transmission of blood-borne pathogens.
-Patients should be instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia.
-Patients should be instructed on how to handle situations which may affect their insulin requirements.
-Remind patients to check insulin labels before injection to avoid medication errors.
-Patients should check blood sugar prior to driving a car or operating machinery.
-Advise patient to speak to physician or health care professional if pregnant or if they intend to become pregnant.

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