insulin regular

Pronunciation

Generic Name: insulin regular (IN soo lin REG yoo lar)
Brand Name: HumuLIN R, NovoLIN R, ReliOn/HumuLIN R

What is regular insulin?

Insulin is a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. Regular insulin is a short-acting form of insulin.

Regular insulin is used to treat diabetes.

Regular insulin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about regular insulin?

Do not use this medicine if you are having an episode of hypoglycemia (low blood sugar).

Hypoglycemia, or low blood sugar, is the most common side effect of insulin. Symptoms include headache, hunger, dizziness, sweating, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Carry hard candy or glucose tablets with you in case you have low blood sugar.

Slideshow: Flashback: FDA Drug Approvals 2013

What should I discuss with my healthcare provider before using regular insulin?

Do not use this medicine if you are allergic to insulin, or if you are having an episode of hypoglycemia (low blood sugar).

To make sure you can safely use insulin, tell your doctor if you have liver or kidney disease.

Tell your doctor about all other medications you use, especially oral diabetes medications such as pioglitazone or rosiglitazone (which are sometimes contained in combinations with glimepiride or metformin). Taking certain oral diabetes medications while you are using insulin may increase your risk of serious heart problems.

FDA pregnancy category B. Insulin is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether insulin passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use regular insulin?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office.

Regular insulin is injected under the skin. You will be shown how to use injections at home. Choose a different place in your injection skin area each time you use this medication. Do not inject into the same place two times in a row.

Regular insulin should look as clear as water. Do not use the medication if has changed colors, looks cloudy, or has particles in it. Call your doctor for a new prescription.

Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Never share an injection pen or cartridge with another person. Sharing injection pens or cartridges can allow disease such as hepatitis or HIV to pass from one person to another.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, pale skin, irritability, dizziness, feeling shaky, or trouble concentrating. Always keep a source of sugar with you in case you have low blood sugar. Sugar sources include fruit juice, hard candy, crackers, raisins, and non-diet soda. Be sure your family and close friends know how to help you in an emergency.

If you have severe hypoglycemia and cannot eat or drink, use a glucagon injection. Your doctor can prescribe a glucagon emergency injection kit and tell you how to use it.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, and weight loss.

Check your blood sugar carefully during times of stress, travel, illness, surgery or medical emergency, vigorous exercise, or if you drink alcohol or skip meals. These things can affect your glucose levels and your dose needs may also change. Do not change your medication dose or schedule without your doctor's advice.

If your doctor changes your brand, strength, or type of insulin, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of insulin you receive at the pharmacy.

Carry an ID card or wear a medical alert bracelet stating that you have diabetes, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are diabetic.

Regular insulin is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Storing unopened vials and cartridges: Keep in the carton and store in a refrigerator, protected from light.

Storing after your first use: Keep the "in-use" vials or cartridges at cool room temperature. Throw away any insulin not used within 31 days.

Do not freeze regular insulin, and throw away the medication if it has become frozen.

Throw away any insulin not used before the expiration date on the medicine label.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

It is important to keep regular insulin on hand at all times. Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An insulin overdose can cause life-threatening hypoglycemia.

Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions).

What should I avoid while using regular insulin?

Do not change the brand of insulin or syringe you are using without first talking to your doctor or pharmacist. Some brands of regular insulin and syringes are interchangeable, while others are not. Your doctor and/or pharmacist know which brands can be substituted for one another.

Avoid drinking alcohol. Your blood sugar may become dangerously low if you drink alcohol while using regular insulin.

Regular insulin side effects

Get emergency medical help if you have any of these signs of insulin allergy: itching skin rash over the entire body, wheezing, trouble breathing, fast heart rate, sweating, or feeling like you might pass out.

Call your doctor at once if you have shortness of breath, swelling in your hands or feet, or rapid weight gain (especially if you are taking an oral diabetes medication).

Hypoglycemia, or low blood sugar, is the most common side effect of insulin. Symptoms include headache, hunger, dizziness, sweating, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Carry hard candy or glucose tablets with you in case you have low blood sugar.

Tell your doctor if you have itching, swelling, redness, or thickening of the skin where you inject insulin.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Insulin regular dosing information

Usual Adult Dose for Gestational Diabetes:

Regular insulin is a short-acting insulin and is generally injected subcutaneously 2-5 times daily within 30-60 minutes before a meal.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. Twice daily injections are preferred for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.

Total daily insulin requirements:
Initial dose: 0.5-0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2-0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5-1.2 unit/kg/day subcutaneously
Insulin resistance: 0.7-2.5 units/kg/day subcutaneously

Usual Adult Dose for Diabetes Type 1:

Regular insulin is a short-acting insulin and is generally injected subcutaneously 2-5 times daily within 30-60 minutes before a meal.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. Twice daily injections are preferred for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.

Total daily insulin requirements:
Initial dose: 0.5-0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2-0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5-1.2 unit/kg/day subcutaneously
Insulin resistance: 0.7-2.5 units/kg/day subcutaneously

Usual Adult Dose for Diabetes Type 2:

Regular insulin is a short-acting insulin and should be injected within 30-60 minutes before a meal.

Diet and lifestyle modifications are recommended as initial treatment for type II diabetes, followed by oral agents. Insulin may be considered if patients are very hyperglycemic or symptomatic and/or not controlled with oral agents. Insulin may exacerbate obesity, further increase insulin resistance, and increase the frequency of hypoglycemia.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen:
Initial dose, monotherapy: Total daily requirement: 0.1 unit/kg/day subcutaneously. When insulin is used alone, twice daily injections are recommended for better glycemic control. The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 1.5-2.5 units/kg or higher in patients with obesity and insulin resistance.

Intensive regimen:
The necessity for and efficacy of intensive insulin therapy in type II diabetes has been controversial. The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.
Initial dose, monotherapy: 0.5-1.5 unit/kg/day subcutaneously.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Usual Adult Dose for Diabetic Ketoacidosis:

Begin after intravenous fluid/electrolyte therapy has been initiated:
Initial dose: 10-20 units IV or 20 units IM or 0.1 unit/kg IM or IV.
Maintenance dose: 0.1 unit/kg/hour by continuous IV infusion in normal saline; monitor blood glucose hourly and adjust rate to gradually decrease plasma glucose. Usual range is 0.05-0.2 units/kg/hour. Switch patients to subcutaneous insulin after recovery from the acute episode.
or
5-10 units IM hourly
or
0.5-4 units/hour by continuous IV infusion to achieve a maximal blood glucose decrease of 50 mg/dL/hour.

Usual Adult Dose for Growth Hormone Reserve Test:

0.05-1.5 units/kg one time by rapid IV push. Monitor patient closely.

Usual Adult Dose for Hyperkalemia:

Begin after administration of calcium gluconate and sodium bicarbonate IV:
10-20 units IV once with 25-50 g dextrose.

Usual Adult Dose for Insulin Resistance:

Total daily insulin requirements range from 0.7 to 2.5 units/kg. Concentrated insulin (500 units/mL) may be used for patients taking more than 200 units/day to allow for reasonable subcutaneous dose volumes.

Usual Adult Dose for Nonketotic Hyperosmolar Syndrome:

Begin after intravenous fluid therapy has been initiated:
Initial dose: 5-10 units or 0.1 unit/kg IV once
Maintenance dose: 0.05-0.1 unit/kg/hour by continuous IV infusion. Monitor vital signs, cardiovascular status, I/O, and plasma glucose and potassium levels. Add potassium to the IV to correct hypokalemia. Add dextrose to the IV once glucose levels reach 250 mg/dL to avoid hypoglycemia. Switch patients to subcutaneous insulin therapy after recovery from the acute episode.

Usual Pediatric Dose for Diabetes Type 1:

Regular insulin is a short-acting insulin and is generally injected subcutaneously 2-5 times daily within 30-60 minutes before a meal.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. Twice daily injections are recommended for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.

Total daily insulin requirements:
Initial dose: 0.5-0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2-0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5-1.2 unit/kg/day subcutaneously
Adolescents during growth spurts. 0.8-1.5 units/kg/day subcutaneously

Usual Pediatric Dose for Diabetes Type 2:

Regular insulin is a short-acting insulin and should be injected within 30-60 minutes before a meal.

Diet and lifestyle modifications are recommended as initial treatment for type II diabetes, followed by oral agents (metformin). Insulin may be considered if children are very hyperglycemic or symptomatic and/or not controlled with oral agents. Insulin may exacerbate obesity, further increase insulin resistance, and increase the frequency of hypoglycemia.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen:
Initial dose, monotherapy: Total daily requirement: 0.1 unit/kg/day subcutaneously. When insulin is used alone, twice daily injections are recommended for better glycemic control. The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 1.5-2.5 units/kg or higher in patients with obesity and insulin resistance.

Intensive regimen:
The necessity for and efficacy of intensive insulin therapy in type II diabetes has been controversial. The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH,zinc, extended zinc, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.
Initial dose, monotherapy: 0.5-1.5 unit/kg/day subcutaneously.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Usual Pediatric Dose for Diabetic Ketoacidosis:

<18 years:
Begin after intravenous fluid/electrolyte therapy has been initiated:
Initial dose: 0.1-0.25 unit/kg IM or IV
Maintenance dose: 0.1 unit/kg/hour by continuous IV infusion in normal saline or 0.05-0.1 unit/kg/hour by IM or subcutaneous injection. Monitor blood glucose hourly and adjust rate to gradually decrease plasma glucose. Usual range is 0.05-0.3 units/kg/hour. Switch patients to subcutaneous insulin after recovery from the acute episode.

Usual Pediatric Dose for Growth Hormone Reserve Test:

0.05-1.5 units/kg one time by rapid IV push. Monitor patient closely.

Usual Pediatric Dose for Hyperkalemia:

Begin after administration of calcium gluconate and sodium bicarbonate IV:
<18 years:
0.25-1 g/kg dextrose with 1 unit regular insulin per 3-5 g dextrose infused IV over 2 hours.
or
0.25-1 g/kg dextrose infused IV over 15-30 minutes, then give 0.1 unit/kg regular insulin subcutaneously or IV.
or
0.05-0.1 unit/kg/hour regular insulin infused IV with dextrose. 1 unit insulin per 1.9-3.9 g dextrose ratio has been used in premature infants. Adjust rate to target blood glucose level.

Usual Pediatric Dose for Insulin Resistance:

True insulin resistance is rare in children. Daily requirements may be greater than 2 units/kg. Extreme insulin resistance with insulin requirements greater than 10 units/kg/day has been reported in children with acanthosis nigricans and polycystic ovaries.

Concentrated insulin (500 units/mL) may be used for patients taking more than 200 units/day to allow for reasonable subcutaneous dose volumes.

Usual Pediatric Dose for Nonketotic Hyperosmolar Syndrome:

<18 years:
Begin after intravenous fluid therapy has been initiated:
Initial dose: 0.05-0.1 unit/kg IV once
Maintenance dose: 0.05 unit/kg/hour by continuous IV infusion. Monitor vital signs, cardiovascular status, I/O, and plasma glucose and potassium levels. Add potassium to the IV to correct hypokalemia. Add dextrose to the IV once glucose levels reach 250 mg/dL to avoid hypoglycemia. Switch patients to subcutaneous insulin therapy after recovery from the acute episode.

What other drugs will affect regular insulin?

Using certain medicines can make it harder for you to tell when you have low blood sugar. Tell your doctor if you use any of the following:

  • albuterol;

  • clonidine;

  • reserpine; or

  • a beta-blocker such as atenolol, carvedilol, labetalol, metoprolol, nadolol, nebivolol, propranolol, sotalol, and others.

This list is not complete and there are many other medicines that can increase or decrease the effects of insulin on lowering your blood sugar. Other drugs may also interact with insulin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about regular insulin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 7.02. Revision Date: 2014-03-24, 4:23:20 PM.

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