Precautions and warnings

During pregnancy, insulin needs usually decrease in the first trimester and then increase during the second and third trimesters. Insulin requirements may also change while breastfeeding. It’s important to regularly check HbA1c and blood sugar levels during this time.

Drug Interactions

Some medications, like beta-blockers, may make it harder to notice the warning signs of low blood sugar. The blood sugar-lowering effect of insulin can be reduced if taken with medicines such as corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, phenothiazines, growth hormone (somatropin), certain stimulants (sympathomimetics), thyroid hormones, female hormones (oestrogens and progestins, like those in birth control pills), protease inhibitors, and some antipsychotics (like olanzapine and clozapine).

On the other hand, taking insulin with other diabetes medications (oral antidiabetic medicines), ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, pentoxifylline, propoxyphene, salicylates or sulfonamide antibiotics can make the blood sugar-lowering effect stronger.

Drugs like octreotide and lanreotide can decrease insulin resistance. Pioglitazone and rosiglitazone, when taken with insulin, may cause more weight gain and swelling in the limbs. Lastly, insulin can reduce the effect of sermorelin.

Contraindications

Hypoglycaemia.Hypersensitivity to any of the components.

Mode of actions

Insulin lowers blood sugar levels. It helps control how the body uses carbohydrates, proteins, and fats by stopping the liver from making more glucose and breaking down fat, while helping the muscles and other tissues use up glucose. Different types of insulin are grouped by how long they work after being injected under the skin (subcutaneously). They can be short-, intermediate-, or long-acting. "Soluble" or "regular" insulin is a short-acting type.

To make insulin last longer, two methods are used to prepare it as a suspension. The first method combines insulin with a protein, which makes it release slowly. Examples include protamine zinc insulin (extra protamine) and isophane or NPH insulin (equal protamine and insulin). The second method changes the size of insulin particles, like in insulin zinc suspensions. All forms of insulin can be given under the skin (SC), most can be injected into the muscle (IM), but only regular (soluble) insulin can be given directly into the vein (IV). Injections into the muscle generally work faster but don’t last as long as injections under the skin.

Dosage & Administration

Adult: SC DM Dosage should be individualised and adjusted based on patient's glycaemic response. Usual range: 0.5-1 u/kg/day.

IV Diabetic ketoacidosis As soluble insulin at a concentration of 1 u/mL via an infusion pump: Initial: Infuse at a rate of 6 u/hr, double or quadruple the rate if blood glucose concentration do not decrease by about 5 mmol/L/hr. If blood glucose concentrations have decreased to 10 mmol/L, reduce infusion rate to 3 u/hr and continue w/ 5% glucose until the patient can eat orally.

IM Diabetic ketoacidosis As soluble insulin: Loading dose: 20 u, then 6 u/hr until blood glucose drops to 10 mmol/L, when the dose is given 2 hrly. SC DM Dosage should be individualised and adjusted based on patient's glycaemic response.

Pregnancy & Lactation

Although animal reproduction studies have shown an adverse effect even sometimes unable to demonstrate the risk on the fetus and there are no adequate and well-controlled studies in pregnant women, but during pregnancy, this medicine can be used just when definitely required.

Discuss with your doctors and tell them feedback about this medicine.

There is no specific information about whether this medicine is passed on to the baby through breast milk. Discuss with your doctor before breastfeeding.

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