Short-acting insulins
6.1.1.1 Short-acting insulins
Soluble insulin is a short-acting form of insulin. For maintenance regimens it is usual to inject it 15 to 30 minutes before meals.
Soluble insulin is the most appropriate form of insulin for use in diabetic emergencies e.g. diabetic ketoacid- osis (section 6.1.3) and at the time of surgery. It can be given intravenously and intramuscularly, as well as sub- cutaneously.
When injected subcutaneously, soluble insulin has a rapid onset of action (30 to 60 minutes), a peak action between 2 and 4 hours, and a duration of action of up to
8 hours. When injected intravenously, soluble insulin has a very
short half-life of only about 5 minutes and its effect disappears within 30 minutes.
The human insulin analogues, insulin aspart, insulin glulisine, and insulin lispro have a faster onset and
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6.1.1 Insulins BNF 57
End
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BNF 57
6.1.1 Insulins 371
shorter duration of action than soluble insulin; as a disposable injection devices (range 2–40 units, allow- result, compared to soluble insulin, fasting and prepran-
ing 2-unit dosage adjustment) = £27.90 dial blood-glucose concentration is a little higher, post-
Note Not recommended for use in subcutaneous insulin infusion prandial blood-glucose concentration is a little lower,
pumps
and hypoglycaemia occurs slightly less frequently. Sub- cutaneous injection of insulin analogues may be con-
Mixed preparations venient for those who wish to inject shortly before or,
See Biphasic Isophane Insulin (section 6.1.1.2) when necessary, shortly after a meal. They can also help
those susceptible to hypoglycaemia before lunch and those who eat late in the evening and are prone to
INSULIN ASPART
nocturnal hypoglycaemia. They can also be adminis- (Recombinant human insulin analogue) tered by subcutaneous infusion (see Insulin Administra-
Indications diabetes mellitus tion, above). Insulin aspart and insulin lispro can be
Cautions see under Insulin; children (use only if ben- administered intravenously and can be used as alter-
efit likely compared to soluble insulin) natives to soluble insulin for diabetic emergencies and
Side-effects see under Insulin at the time of surgery.
Dose . By subcutaneous injection , immediately before
INSULIN meals or when necessary shortly after meals,
according to requirements (Insulin Injection; Neutral Insulin; Soluble
. By subcutaneous infusion , intravenous injection or Insulin)
intravenous infusion , according to requirements
A sterile solution of insulin (i.e. bovine or porcine) or of human insulin; pH 6.6–8.0 c NovoRapid (Novo Nordisk) A , insulin aspart (recombinant human insulin
Injection
Indications
diabetes mellitus; diabetic ketoacidosis analogue) 100 units/mL, net price 10-mL vial = (section 6.1.3)
£17.27; Penfill c cartridge (for NovoPen c Cautions see notes above; pregnancy (Appendix 4);
c prefilled reduce dose in renal impairment (Appendix 3);
disposable injection devices (range 1–60 units, allow- interactions: Appendix 1 (antidiabetics)
ing 1-unit dosage adjustment) = £32.00 Side-effects see notes above; transient oedema; local
Counselling Show container to patient and confirm that reactions and fat hypertrophy at injection site; rarely
patient is expecting the version dispensed hypersensitivity reactions including urticaria, rash;
overdose causes hypoglycaemia Dose
INSULIN GLULISINE
(Recombinant human insulin analogue)
. By subcutaneous , intramuscular or intravenous injection Indications or intravenous infusion , according to diabetes mellitus
Endocrine
requirements Cautions see under Insulin Side-effects see under Insulin
Highly purified animal
Dose
Counselling Show container to patient and confirm that . By subcutaneous injection , ADULT and CHILD over 6
syst
patient is expecting the version dispensed years, immediately before meals or when necessary Hypurin c Bovine Neutral (Wockhardt)
shortly after meals, according to requirements
em
Injection , soluble insulin (bovine, highly purified) . By subcutaneous infusion , ADULT and CHILD over 6 100 units/mL. Net price 10-mL vial = £18.48; car-
years, according to requirements tridges (for Autopen c Classic
Apidra c (Sanofi-Aventis) TA Hypurin c Porcine Neutral (Wockhardt)
Injection A , insulin glulisine (recombinant human insu- Injection , soluble insulin (porcine, highly purified)
lin analogue) 100 units/mL, net price 10-mL vial = c
100 units/mL. Net price 10-mL vial = £16.80; car-
c Pro 1 and tridges (for Autopen c Autopen 24 Classic c (for OptiClik c Pen cartridge c
Optiset c Human sequence prefilled disposable injection devices (range Counselling
2–40 units, allowing 2-unit dosage adjustment) = Show container to patient and confirm that
c SoloStar patient is expecting the version dispensed c prefilled dis- posable injection devices (range 1–80 units, allowing
Actrapid c (Novo Nordisk) A 1-unit dosage adjustment) = £25.00 Injection , soluble insulin (human, pyr) 100 units/mL.
Counselling Show container to patient and confirm that Net price 10-mL vial = £7.48
patient is expecting the version dispensed Note Not recommended for use in subcutaneous insulin infusion
Note The Scottish Medicines Consortium (p. 3) has advised pumps—may precipitate in catheter or needle
(October 2008) that Apidra is accepted for restricted use within NHS Scotland for the treatment of adults and children Humulin S c (Lilly) A over 6 years with diabetes mellitus in whom the use of a short-
Injection , soluble insulin (human, prb) 100 units/mL. acting insulin analogue is appropriate
most Autopen c Classic or HumaPen c ) = £28.12
INSULIN LISPRO
Insuman c Rapid (Aventis Pharma) A (Recombinant human insulin analogue) Injection , soluble insulin (human, crb) 100 units/mL,
Indications diabetes mellitus
Cautions see under Insulin; children (use only if ben- Rapid OptiSet prefilled
c c Pro 1 )=
efit likely compared to soluble insulin)
Side-effects see under Insulin Dose . By subcutaneous injection shortly before meals or
when necessary shortly after meals, according to requirements
. By subcutaneous infusion , or intravenous injection , or intravenous infusion , according to requirements
Humalog c (Lilly) A Injection , insulin lispro (recombinant human insulin analogue) 100 units/mL. Net price 10-mL vial = c
Classic or HumaPen c c -Pen
prefilled disposable injection devices (range 1–
60 units, allowing 1-unit dosage adjustment) = £29.46; c KwikPen prefilled disposable injection devices (range 1–60 units, allowing 1-unit dosage adjustment) = £29.46 Counselling Show container to patient and confirm that patient is expecting the version dispensed