insulin regular (Humulin R®)

insulin regular (Humulin R®)

Note: Be certain that you have regular insulin since there are many forms of insulin

Indication

• Treatment of hyperglycemia
• Treatment of hyperkalemia to facilitate intracellular shift of potassium

Dosage Guidelines

• Hyperglycemia: 0.01-0.1 units/kg/hr IV continuous infusion
• Hyperkalemia: 0.1-0.2 units/kg/hr in combination with 0.5 g/kg/hr of dextrose given as a continuous IV infusion
• Neonates are very sensitive to the effects of insulin.  Start therapy at lower end of infusion rate.  Titrate infusion rate to blood glucose or potassium levels as per prescriber order.

Administration

• IV continuous infusion

  To make 10 mL of insulin 0.04 unit/mL [0.4 units/10 mL] (for patients 0.5 kg or less)

  1) Add 0.1 mL (10 units) of regular insulin [100 units/mL] to 9.9 mL of IV solution and mix.  This results in a diluted 1 unit/mL stock solution.

  2) Add 0.4 mL (0.4 units) of the diluted stock insulin [1 unit/mL] to 9.6 mL of IV solution.  Discard the diluted stock solution after use.  Do NOT store.

  To make 10 mL of insulin 0.1 unit/mL [1 units/10 mL] (for patients over 0.5 kg to 2 kg)

  1) Add 0.1 mL (10 units) of regular insulin [100 units/mL] to 9.9 mL of IV solution and mix.  This results in a diluted 1 unit/mL stock solution.

  2) Add 1 mL (1 unit) of the diluted stock insulin [1 unit/mL] to 9 mL of IV solution.  Discard the diluted stock solution after use. Do NOT store.

  To make 50 mL of insulin 0.5 unit/mL [25 units/50 mL] (for patients over 2 kg to 10 kg)

  1) Add 0.1 mL (10 units) of regular insulin [100 units/mL] to 9.9 mL of IV solution and mix.  This results in a diluted 1 unit/mL stock solution.

  2) Add 5 mL (5 units) of the diluted stock insulin [1 unit/mL] to 5 mL of IV solution.  Discard the diluted stock solution after use.  Do NOT store.

• Prime tubing with insulin solution and allow to sit for 30 minutes to allow for insulin adsorption. 
• Flush line prior to infusing.

Adverse Effects

• Hypokalemia, hypoglycemia

Comments

• Potential for decreased insulin delivery secondary to adsorption to plastic tubing
• Medications that may increase insulin requirements: caffeine, corticosteroids, furosemide, EPINEPHrine (decreased efficacy of insulin)
• Hypokalemic effect occurs within 30 minutes and lasts 30 minutes to 1 hour. Maintain adequate urine output

Supplied As

• 100 units/mL vial of Regular Insulin (10 mL)
• IV syringe prepared by Pharmacy in 0.04 units/mL, 0.1 units/mL or 0.5 units/mL standard concentrations
• At LHSC, standard concentration reference charts are available on the NICU Intranet site