Insulin Human

Insulin (human) is a prescription medication used to control hyperglycemia (high blood sugar) in patients with diabetes mellitus.

Insulin (human) is a naturally occurring hormone produced by the pancreas. Insulin helps move sugar from the blood into other tissues that use it for energy.

This medication comes in solution and suspension for injection and inhalational forms. The dose and frequency of administration will depend on many factors, including diet, lifestyle, and other conditions you have.

The most common side effect of insulin (human) is hypoglycemia (low blood sugar).                                                                               

Hypoglycemia related to insulin can also cause dizziness, drowsiness, and blurred vision. Do not drive or operate heavy machinery until you know how insulin (human) affects you.

Insulin human is part of the drug class:

• Insulins and analogues for inhalation

Tell your doctor if you are breastfeeding or plan to breastfeed.

Insulin (human) is naturally present in human breast milk. No adverse reactions have been associated with infant exposure to insulin in human breast milk. Glucose control supports lactation. 

Use this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your level of physical activity
• your meal times and eating habits

If you take too much insulin (human), call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

Specific Drugs

Drugs That May Potentiate Hypoglycemic Effects

• Alcohol

• ACE inhibitors

• Disopyramide

• Fibrate derivatives

• Fluoxetine

• Guanethidine

• MAO inhibitors

• Oral antidiabetic agents

• Propoxyphene

• Salicylates

• Somatostatin derivatives (e.g., octreotide)

• Sulfa anti-infectives

Drugs That May Antagonize Hypoglycemic Effects

• Calcium-channel blocker

• Corticosteroids

• Danazol

• Diuretics

• Estrogens and progestins (e.g., oral contraceptives)

• Isoniazid

• Niacin

• Phenothiazines

• Somatropin

• Sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline)

• Thyroid hormones

Drugs That May Have a Variable Effect on Glycemic Control

• Alcohol

• β-Adrenergic blocking agents

• Clonidine

• Lithium salts

• Pentamidine

Drugs That May Reduce or Eliminate Signs of Hypoglycemia (Sympatholytic Agents)

• β-Adrenergic blocking agents

• Clonidine

• Guanethidine

• Reserpine

Absorption

Bioavailability

Because of its protein nature, insulin is destroyed in the GI tract and usually is administered parenterally.e

Following sub-Q injection, insulin human (regular) appears to be absorbed more rapidly than purified pork insulin (regular).17 24 28 29 30 42

Following IM or IV administration, serum insulin concentrations are similar for insulin human (regular) and purified pork insulin (regular).17 18 19 31 32 43

Onset and Duration of Action of Human Insulins

In patients with diabetes mellitus, insulin human appears to have a slightly faster onset and shorter duration of action than purified pork insulin.58

Distribution

Extent

Rapidly distributed throughout extracellular fluids.e

Elimination

Metabolism

Rapidly metabolized mainly in the liver and to a lesser extent in the kidneys and muscle tissue.e

Elimination Route

Excreted in the urine principally as metabolites.e

Half-life

Insulin has a plasma half-life of a few minutes in healthy individuals.e The biologic half-life may be prolonged in diabetic patients, probably as a result of binding of the hormone to antibodies.

Special Populations

In patients with renal impairment, the biologic half-life may be prolonged as a result of altered degradation/decreased clearance.

Storage

Parenteral

With unopened vials or cartridges of insulin human injections than have not been placed in a delivery device, 2–8°C; do not freeze.5 7 53 64 67 71 82 89 93 100 101 c j Vials in use, below 30°C; protect from excessive heat or cold and light.67 c

Novolin PenFill 3-mL cartridges of insulin human (regular) injection assembled in a delivery device are stable for 28 days at room temperature.71 Discard unrefrigerated Novolin Penfill cartridges not used within this time period.67 Protect from excessive heat or cold and light.71

Discard insulin human (regular) injection exhibiting discoloration, turbidity, or unusual viscosity,5 7 71 82 88 89 since these changes indicate deterioration or contamination.5 7 101

With unopened vials, pens, prefilled syringes, or cartridges containing insulin human zinc or isophane insulin human suspensions, 2–8°C in the original container; do not freeze.6 8 53 64 65 80 84 92 93 100 101 f g h i k l m p q With vials in use, below 30°C; protect from heat and light.80 g h i k l m r Freezing will cause isophane insulin human and insulin human zinc to resuspend improperly, preventing accurate measurement of a dose.54 55 In addition, agglomeration of particles may occur, altering absorption from the injection site.54 55

Preparations of insulin isophane suspension available with a delivery device (Novolin N PenFill cartridges, Humulin N pen) are stable below 30°C for 14 days.67 f m Protect from excessive heatf m or coldf and light.f m

Preparations of insulin human and isophane insulin human suspensions available with a delivery device (Novolin 70/30 PenFill 3-mL cartridges assembled in a delivery device, Novolin 70/30 Innoletprefilled syringes, Humulin 70/30 pen) are stable below 30°C for 10 days.67 f p q Should discard unrefrigerated insulin after 10 days.p Protect from excessive heat and light.p

Should discard isophane insulin human and insulin human zinc if the suspensions are clear, if they remain clear after the vial is rotated, if the precipitate has become clumped or granular in appearance, or if solid particles have adhered to the wall of the vial.6 8 64 65 75 76 80 83 84 90 92 93 101

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

10% insulin loss in 1 hour in PVC container; 35–45% loss in 24 hours in polyolefin container.

• Importance of strict adherence to manufacturer’s instructions regarding assembly, administration, and care of specialized delivery systems, such as insulin pens or pumps.n

• Provide instructions regarding insulin storage and injection technique.d n

• Provide instructions regarding the use of intensive insulin therapy with multiple injections.d Advise patients of the risks of such therapy (e.g., hypoglycemia).

• Provide instructions regarding self-monitoring of blood glucose concentrations.c n Particular importance of frequent self-monitoring of blood glucose concentrations in patients with a history of hypoglycemic unawareness or recurrent, severe hypoglycemic episodes.

• Provide instructions regarding adherence to meal planning, regular physical exercise, periodic hemoglobin A1c (HbA1c) monitoring, and management of hypoglycemia or hyperglycemia.d n

• Importance of changing insulin dosage with caution and only under medical supervision.d Discuss potential for alterations in insulin requirements in special situations (e.g., illness, concomitant agents that alter glycemic control, travel, emotional disturbances or other stresses).c d Discuss potential for alterations in insulin requirements as a result of changes in physical activity, missed doses, or inadvertent administration of incorrect doses.c d

• Importance of not changing the order of mixing insulins or the model or brand of syringe or needle without medical supervision.c e When mixing with other insulin preparations, importance of drawing regular insulin into the syringe first.e n

• Importance of informing clinicians of the development of skin reactions (erythema, pruritus, edema, lipodystrophy) at injection site.c

• Importance of informing clinicians of the development of generalized hypersensitivity reactions (shortness of breath, hypotension, wheezing, whole body rash, tachycardia, diaphoresis).c

• Importance of patient wearing a medical identification bracelet or pendant, carrying ample insulin supply and syringes on trips, having carbohydrates (sugar or candy) on hand for emergencies, and of noting time-zone changes for dose schedule when traveling.c n

• Inform patient that use of marijuana may increase insulin requirements.n

• Importance of patient not smoking within 30 minutes after insulin injection due to potential for decreased absorption of insulin.n

• Instruct patient on the appropriate measures for safe disposal of needles.n

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.c

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.c

• Importance of informing patients of other important precautionary information.c (See Cautions.)