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

370

6.1.1 Insulins BNF 57

End

ocrine

sys

tem

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