Usual Adult Dose for Diabetes Type 1

Individualize dose based on glucose treatment goals, metabolic needs, eating habits, and other lifestyle variables.

Usual dose: Administer prescribed units subcutaneously approximately 30 to 45 minutes before a meal

Comments:

• Total daily insulin requirements are estimated to be between 0.5 and 1 unit/kg/day.
• Duration of action may vary according to the dose, injection site, blood flow, temperature, and level of physical activity.

Use: To improve glycemic control in patients with diabetes mellitus.

Usual Adult Dose for Diabetes Type 2

Individualize dose based on glucose treatment goals, metabolic needs, eating habits, and other lifestyle variables.

Usual dose: Administer prescribed units subcutaneously approximately 30 to 45 minutes before a meal

Comments:

• Duration of action may vary according to the dose, injection site, blood flow, temperature, and level of physical activity.

Use: To improve glycemic control in patients with diabetes mellitus.

Renal Dose Adjustments

Use with caution; insulin requirements may be reduced in patients with renal impairment.

Liver Dose Adjustments

Use with caution; insulin requirements may be reduced in patients with hepatic impairment.

Dose Adjustments

Geriatric Use: Dose selection should be cautious, usually starting at the low end of the dosing range reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease, or other drug therapies.

• Daily insulin requirements may be higher during illness, stress, pregnancy, in obese patients, trauma, during concurrent use with medications having hyperglycemic effects, or after surgery
• Daily insulin requirements may be lower with exercise, weight loss, calorie restricted diets, or during concurrent use of medications having hypoglycemic effects.

Supplemental doses may be prescribed during illness
Patients with type 2 diabetes receiving oral medications may be switched to insulin therapy temporarily.

Dosage adjustments may be required when the brand, type, or species of insulin is changed; oral antidiabetic treatment may need to be adjusted as well.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• For subcutaneous administration; do not administer IV or via insulin pump
• This insulin is a suspension and must be visually inspected and resuspended immediately before use; see preparation instructions below.
• Administer subcutaneously into the abdomen, buttocks, thigh, or upper arm approximately 30 to 45 minutes before a meal
• Rotate injection sites within same region to reduce the risk of lipodystrophy.
• Ensure patients have been educated as to proper injection technique.
• Never share an insulin pen between patients (even if the needle is changed) and do not reuse or share needles or syringes between patients when using vials as both present a risk for transmission of blood-borne pathogens.

Preparation techniques:

• Resuspension is easier when the insulin has reached room temperature
• Gently mix insulins by alternating rolling horizontally 10 times between palms and vertically up and down 10 times; continue with mixing steps until the liquid appears white and cloudy; administer immediately, if there is a delay, the insulin will need to be remixed.
• For specific information on insulin pens, the manufacturer product information should be consulted.

Storage requirements:

• Store unused pens and vials in the refrigerator at 36F to 46F (2C to 8C); discard if frozen
• Protect from light

Vials:

• In use insulin vials may be stored at room temperature or in the refrigerator.
• Unrefrigerated Humulin(R) vials (opened or unopened) should be stored below 86F (30C) and discarded after 31 days even if there is insulin remaining.
• Unrefrigerated Novolin(R) vials (opened or unopened) should be stored below 77F (25C) and discarded after 42 days even if there is insulin remaining.

Pens:

• In use pens should not be stored in the refrigerator; keep away from excessive heat or sunlight.
• In use Humulin(R) pens should be stored at room temperature below 86F (30C); discard unrefrigerated pens (opened or unopened) after 10 days even if there is insulin remaining.

General:

• Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs; duration of action will vary according to dose, injection site, blood flow, temperature, and level of physical activity.
• Hypoglycemia is the most common adverse reaction of insulin therapy; the timing generally reflects the time-action profile of the administered insulin; in this case, take into account both insulins.

Monitoring:

• Blood glucose monitoring is essential for patients receiving insulin therapy.
• Glycosylated hemoglobin measurements are recommended every 3 months.

Patient advice:

• Patients should be advised to never share an insulin pen with another person, even if the needle is changed; patients should understand that sharing needles or syringes with another person carries a risk for transmission of blood-borne pathogens.
• Patients should be instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia.
• Patients should be instructed on how to handle situations which may affect their insulin requirements.
• Remind patients to check insulin labels before injection to avoid medication errors.
• Patients should check blood sugar prior to driving a car or operating machinery.
• Advise patient to speak to physician or health care professional if pregnant or if they intend to become pregnant.

Frequently asked questions

• How and where should I inject insulin?
• How long does Humulin last?