Regular Insulin
Novo Nordisk
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Clinical Pharmacology
Actrapid ® NM is a short-acting insulin preparation produced by recombinant DNA biotechnology using Saccharomyces cerevisiae strain.
Interacts with a specific receptor of the external cytoplasmic cell membrane and forms an insulin-receptor complex. Through the activation of cAMP biosynthesis (in fat cells and liver cells) or by directly penetrating the cell (muscles), the insulin-receptor complex stimulates intracellular processes, including synthesis of a number of key enzymes (hexokinase, pyruvate kinase, glycogen synthetase, etc.).
The decrease in blood glucose is due to an increase in its intracellular transport, increased absorption and absorption by the tissues, stimulation of lipogenesis, glycogenogenesis, protein synthesis, a decrease in glucose production by the liver, etc.
The duration of action of insulin preparations is mainly due to the rate of absorption, which depends on several factors (for example, dose, method, site of administration and type of diabetes). Therefore, the profile of insulin action is subject to significant fluctuations, both in different people and in the same person.
The action of the drug Actrapid NM begins within half an hour after administration, and the maximum effect is manifested within 1.5-3.5 hours, while the total duration of action is about 7-8 hours.
Indications
- Insulin-dependent diabetes mellitus (type 1).
- Insulin-dependent diabetes mellitus (type 2): stage of resistance to oral hypoglycemic agents, partial resistance to these drugs (when combined therapy is used), for intercurrent diseases, operations, during pregnancy.
Composition
1 ml of solution contains:
Active substance: soluble insulin (human genetically engineered) 100 IU (3.5 mg), (1 IU corresponds to 0.035 mg of anhydrous human insulin).
Excipients: zinc chloride, glycerin (glycerol), metacresol, hydrochloric acid and / or sodium hydroxide (to adjust the pH level), water for injection.
Regular Insulin is marketed under different brands and generic names, and comes in different dosage forms:
| Brand name | Manufacturer | Country | Dosage form |
|---|---|---|---|
| Actrapid HM Penfill | Novo Nordisk | Denmark | cartridge |
| Actrapid HM | Novo Nordisk | Denmark | vials |
| Biosulin R | Pharmstandard Ufavita | Russia | suspension |
| Humulin Regular | Eli lilly | USA | cartridge |
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Dosage and Administration
The dose is set by the doctor individually, depending on the level of glycemia.
The drug should be administered subcutaneously, possibly intramuscular injection. Intravenous Humulin Regular is contraindicated!
Subcutaneously, the drug is administered to the shoulder, thigh, buttocks, or abdomen. The injection site must be alternated so that the same place is used no more than about 1 time / month.
For subcutaneous administration, care must be taken to avoid getting into the blood vessel. After the injection should not massage the injection site. Patients should be trained in the proper use of insulin injection devices.
Terms of preparation and administration of the drug
Humulin cartridges and vials Regular, before use, should be rolled between the palms 10 times and rocked, turning 180 ° also 10 times to resuspend insulin to a state until it takes on the appearance of a homogeneous turbid liquid or milk. Do not shake vigorously, because this can lead to foam, which can interfere with the correct set of doses.
Cartridges and vials should be carefully checked. Insulin should not be used if it contains flakes after mixing, if solid white particles are stuck to the bottom or walls of the vial, creating the effect of a frosty pattern.
The cartridge device does not allow mixing their contents with other insulins directly in the cartridge itself. Cartridges are not intended to be refilled.
The contents of the vial should be collected in an insulin syringe, corresponding to the concentration of insulin injected, and enter the desired dose of insulin in accordance with the instructions of the doctor.
When using cartridges, follow the manufacturer's instructions for refilling the cartridge and attaching the needle. It should be administered in accordance with the instructions of the manufacturer of the syringe pen.
Using the outer needle cap, immediately after insertion, unscrew the needle and safely destroy it. Removing the needle immediately after the injection ensures sterility, prevents leakage, air ingress and possible clogging of the needle. Then put the cap on the handle.
Needles should not be reused. Needles and pens should not be used by others. Cartridges and vials are used until they become empty, after which they should be discarded.
Humulin Regular can be administered in combination with Humulin NPH. To do this, short-acting insulin should be typed into the syringe first to prevent longer-acting insulin from entering the vial. It is desirable to introduce the prepared mixture directly after mixing. For the introduction of the exact amount of insulin of each type, you can use a separate syringe for Humulin Regular and Humulin NPH.
You should always use an insulin syringe corresponding to the concentration of insulin injected.
Adverse reactions
Side effect associated with the main action of the drug: hypoglycemia.
Severe hypoglycemia can lead to loss of consciousness and (in exceptional cases) death.
Allergic reactions: local allergic reactions are possible - hyperemia, swelling or itching at the injection site (usually stopped for a period ranging from several days to several weeks); systemic allergic reactions (occur less frequently, but are more serious) - generalized itching, difficulty breathing, shortness of breath, decreased blood pressure, increased heart rate, increased sweating. Severe cases of systemic allergic reactions can be life threatening.
Other: the likelihood of developing lipodystrophy is minimal.
Contraindications
- Hypoglycemia.
- Hypersensitivity to insulin or to one of the components of the drug.
Drug interactions
Hypoglycemic effect of Humulin Regular reduce oral contraceptives, corticosteroids, preparations of thyroid hormones, thiazide diuretics, diazoxide, tricyclic antidepressants.
Hypoglycemic effect of Humulin Regular enhance oral hypoglycemic drugs, salicylates (eg, acetylsalicylic acid), sulfonamides, MAO inhibitors, beta-adrenoblockers, ethanol and ethanol-containing drugs.
Beta-blockers, clonidine, reserpine may mask the manifestation of symptoms of hypoglycemia.
Pharmaceutical Interaction
The effects of mixing human insulin with animal insulin or human insulin produced by other manufacturers have not been studied.
Pregnancy and Lactation
In pregnancy, it is especially important to maintain good glycemic control in patients with diabetes. During pregnancy, the need for insulin usually decreases in the first trimester and increases in the second and third trimesters.
Patients with diabetes are advised to inform the doctor about the onset or planning of pregnancy.
In patients with diabetes mellitus during lactation (breastfeeding), dosage adjustment of insulin, diet, or both may be necessary.
In studies of genetic toxicity in the in vitro and in vivo series, human insulin was not mutagenic.
Special instructions
The transfer of the patient to another type of insulin or to an insulin preparation with a different trade name should be under strict medical supervision. Changes in insulin activity, its type (for example, M3, NPH), species (pork, human insulin, human insulin analogue), or production method (DNA-recombinant insulin or insulin of animal origin) may lead to the need for dose adjustment.
The need for dose adjustment may be required already at the first injection of human insulin after insulin of animal origin, or gradually over several weeks or months after transfer.
The need for insulin can be reduced with insufficient adrenal, pituitary or thyroid function, or with renal or hepatic failure.
In some diseases or emotional stress, the need for insulin may increase.
Dose adjustment may also be required with increasing physical exertion or with a change in the normal diet.
Symptoms, precursors of hypoglycemia in the background of the introduction of human insulin in some patients may be less pronounced or different from those that were observed in them against the background of the introduction of insulin of animal origin. With the normalization of blood glucose levels, for example, as a result of intensive insulin therapy, all or some of the symptoms, precursors of hypoglycemia, may disappear, about which patients should be informed.
Symptoms, precursors of hypoglycemia may change or be less pronounced with long-term diabetes mellitus, diabetic neuropathy, or with simultaneous use of beta-blockers.
In some cases, local allergic reactions can be caused by causes not related to the action of the drug, such as skin irritation with a cleansing agent or improper injection.
In rare cases, the development of systemic allergic reactions require immediate treatment. Sometimes it may be necessary to change insulin or desensitization.
Influence on ability to drive motor transport and control mechanisms
During hypoglycemia, the patient may deteriorate the ability to concentrate and decrease the speed of psychomotor reactions. This can be dangerous in situations in which these abilities are especially needed (driving a car or controlling machinery). Patients should be advised to take precautions to avoid hypoglycemia while driving. This is especially important for patients with mild or absent symptoms, precursors of hypoglycemia or with the frequent development of hypoglycemia. In such cases, the doctor must assess the feasibility of driving a car by the patient.
Overdosage
Symptoms: hypoglycemia, accompanied by lethargy, increased sweating, tachycardia, pallor of the skin, headache, tremor, vomiting, confusion.
Under certain conditions, for example, with long duration or with intensive control of diabetes mellitus, symptoms of precursors of hypoglycemia may change.
Treatment: Light states of hypoglycemia can usually be stopped by ingestion of glucose (dextrose) or sugar. You may need a dose adjustment of insulin, diet, or physical activity.
Correction of moderate hypoglycemia can be performed using intramuscular or subcutaneous administration of glucagon, followed by ingestion of carbohydrates.
Severe conditions of hypoglycemia, accompanied by coma, convulsions or neurological disorders, are stopped by intramuscular or subcutaneous administration of glucagon or by intravenous administration of concentrated glucose solution (dextrose). After the restoration of consciousness, the patient must be given food rich in carbohydrates in order to avoid the recurrence of hypoglycemia.
Studies and clinical trials of Regular insulin (Click to expand)
- A new C-peptide correction model used to assess bioavailability of regular human insulin
- Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectiveness
- Multivariate calibration of covalent aggregate fraction to the raman spectrum of regular human insulin
- Selective stability-indicating high-performance liquid chromatographic assay for recombinant human regular insulin
- Simultaneous determination of regular insulin and insulin aspart by capillary zone electrophoresis and application in drug formulations
- Mealtime Pramlintide Administration Reduces Early Postprandial Glucose Excursions When Added to Regular Insulin or Insulin Lispro in Patients With Diabetes: A Dose-Timing Study
- Insulin lispro versus regular insulin in children with type 1 diabetes on twice daily insulin
- The snack is critical for the blood glucose profile during treatment with regular insulin preprandially
- Physiological responses during hypoglycaemia induced by regular human insulin or a novel human analogue, insulin glargine
- Post-prandial insulin lispro vs. human regular insulin in prepubertal children with Type 1 diabetes mellitus
- New insulin pen to suit stiff joints : No. 63 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes-related cases and conditions
- Infusion site infection in a patient using U-500 insulin delivered via insulin pump : No. 64 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes-related cases and conditions
- An unexpected hazard of insulin injection. No.12 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes related cases and conditions
- Selective temporal lobe damage demonstrated by MRI imaging in insulin-induced hypoglycaemia : No 20 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes related cases and conditions
- Eruptive xanthomata in insulin-treated type 2 diabetes : No. 28 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes-related cases and conditions
- Unexpected finding of amyloidosis at the site of insulin injection : No. 44 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes-related cases and conditions
- Dangers of injecting insulin through clothing in diabetic people : No. 49 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes-related cases and conditions
- Insulin oedema in a newly diagnosed type 1 diabetic patient : No. 52 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes-related cases and conditions
- Studies on the mechanism of improved glucose control during regular exercise in Type 2 (non-insulin-dependent) diabetes
- Loss of regular oscillatory insulin secretion in islet cell antibody positive non-diabetic subjects
- Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal-bolus therapy for patients with Type 1 diabetes
- Variations in the four and a half LIM domains 1 gene (FHL1) are associated with fasting insulin and insulin sensitivity responses to regular exercise
- A case of insulin neuritis that developed in a patient under regular insulin treatment on increasing the insulin dose
- Study of Subchronic Toxicity of Relatox on Sexually Immature Animals
- Catalytic Asymmetric anti-Selective Nitroaldol Reaction En Route to Zanamivir
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