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Cautions

Warnings/Precautions

Warnings

Hypoglycemia

Care should be taken in patients who are most at risk for the development of hypoglycemia, including those who are fasting or those with defective counterregulatory responses (e.g., patients with autonomic neuropathy, adrenal or pituitary insufficiency, those receiving β-adrenergic blocking agents).

Reduce the potential for late postprandial hypoglycemia by altering the timing, frequency, and content of meals; altering exercise patterns; frequently monitoring blood glucose concentrations; adjusting insulin dosage; and/or switching to a more rapid-acting insulin (i.e., insulin lispro).

Use intensive insulin therapy with caution in patients with a history of hypoglycemic unawareness or recurrent, severe hypoglycemic episodes. Higher target blood glucose concentrations (e.g., fasting blood glucose concentrations of 140 mg/dL and 2-hour postprandial concentrations of 200–250 mg/dL) are advisable in these patients.

Sensitivity Reactions

Local reactions (e.g., pain at injection site, erythema, pruritus, swelling) reported. Warming refrigerated insulin to room temperature prior to use will limit local irritation at the injection site.

Generalized hypersensitivity reactions (e.g., rash, shortness of breath, wheezing, hypotension, tachycardia, diaphoresis) reported less frequently; may be life-threatening.

Insulin (regular) is more immunogenic than insulin human and insulin lispro.

General Precautions

Lipodystrophy

Atrophy or hypertrophy of subcutaneous fat tissue may occur at sites of frequent insulin injections. Rotate injection site to reduce or prevent these effects.

Hypokalemia

Care should be taken in patients who are most at risk for the development of hypokalemia, such as those who are receiving potassium-lowering drugs.

Since diabetic ketoacidosis often is associated with hypokalemia, the possibility of potassium imbalance should be evaluated and, if present, corrected before administration of insulin as long as adequate renal function is assured.

Concurrent Illness

Illness, particularly nausea and vomiting, and changes in eating patterns may alter insulin requirements.

Specific Populations

Pregnancy

Category B.

Most clinicians recommend initiation of intensive insulin therapy (3 or more insulin injections daily with dosage adjusted according to results of at least 4 daily blood glucose determinations, dietary intake, and anticipated exercise) prior to conception in diabetic patients who are well controlled on oral hypoglycemic agents and who are considering pregnancy.

Geriatric Use

The safety of an intensive insulin regimen (3 or more insulin injections daily with dosage adjusted according to results of at least 4 daily blood glucose determinations, dietary intake, and anticipated exercise) in geriatric patients has been questioned. Increased incidence of hypoglycemia associated with intensive insulin therapy may increase the probability of strokes and heart attacks in such patients.

Hypoglycemic reactions in geriatric diabetic patients may mimic a cerebrovascular accident. An increased incidence of macrovascular disease in geriatric patients with type 2 diabetes mellitus may make such patients more vulnerable to serious consequences of hypoglycemia, including fainting, seizures, falls, stroke, silent ischemia, myocardial infarction, or sudden death.

Common Adverse Effects

Hypoglycemia.

Drug Interactions

Specific Drugs