Category:

• Miscellaneous

Description:

• Antidiabetic agent

Indications:

• Diabetes mellitus

• Diabetic ketoacidosis

• Hyperkalemia

• Nutritional supplementation

Contraindications:

• Hypoglycemia, porcine hypersensitivity (if from pork)

Precautions:

• Pregnancy category B

• Hypoglycemia related to dose

• Renal impairment/failure, hepatic disease

Adverse Reactions (Side Effects):

• anaphylactoid reactions, hyperinulinism, hypoglycemia, hypokalemia

• reaction at injection site, insulin resistance, lipodystrophy, nausea, vomiting

• pruritus, sinus tachycardia, urticaria

Dosage:

Administered subcutaneously, intramuscularly, and intravenously

• Diabetes mellitus type I or diabetes type II inadequately managed by diet and oral hypoglycemics: 

  • Adult and child: 

    • SC range 0.1-2.5 units/kg/day; 

    • most patients require 0.5-1.2 units/kg/day.

• Diabetic ketoacidosis: 

  • Adult: Initially, 0.1 unit/kg/hr continuous IV INF in addition to adequate fluid therapy (usually 0.9% NaCl at 1 L/hour for 2-3 hours, then 0.45% NaCl).  

  • When blood glucose reaches 250 mg/dl, fluid therapy should be changed to 5% dextrose in 0.45% NaCl, while IV INF of insulin is continued at roughly half the initial rate until acidosis is also corrected.

• Child: 

  • Initially, 0.1 unit/kg IV BOLUS, followed by 0.1 unit/kg/hour (range 0.05-0.2 units/kg/hour) continuous IV INF until blood glucose reaches 250 mg/dl, at which time IV dextrose may be added while IV INF of insulin is continued until acidosis is also corrected.

• Nutiritional supplement in neonates to optimize caloric intake while on parenteral nutrition:  

  • 0.01-0.1 units/kg/hour via continuous IV INF. (start at lower end of dosage range)

• Hyperkalemia: 

  • Adult: 5-10 units IV in 50ml D50W over 5 minutes

Subcutaneous Dosing:

• Individualize dosage based on careful monitoring of blood glucose and other clinical parameters.

• Administer 30 minutes prior to a meal

• Inject into upper thighs, upper arms, buttocks, or abdomen.  Inject over 2-4 seconds.

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001