• Basic Info
• Top Questions
• Clinical Info
• Interactions

Actions

• Supplements deficient levels of endogenous insulin and temporarily restores the ability of the body to properly utilize carbohydrates, fats, and proteins. Facilitates cellular uptake of glucose in muscle and fat cells.
• Inhibits output of glucose from the liver. In the liver, insulin facilitates phosphorylation of glucose to glucose-6-phosphate, which is converted to glycogen or further metabolized.
• Stimulates lipogenesis and inhibits lipolysis and release of free fatty acids from adipose cells. Also stimulates protein synthesis.
• Promotes an intracellular shift of potassium and magnesium and thereby appears to temporarily decrease elevated blood concentrations of these ions.
• When used in patients following an AMI, insulin in combination with dextrose (D-glucose) and potassium (referred to as glucose-insulin-potassium [GIK] therapy) decreases both circulating concentrations of free fatty acids (FFAs) and myocardial uptake of FFAs. Stimulates myocardial potassium uptake by insulin via Na⁺-K⁺-ATPase and provision of glucose (substrate) for glycolic ATP production. Aids in critical membrane functions such as calcium and sodium homeostasis.

Advice to Patients

• Importance of strict adherence to manufacturer’s instructions regarding assembly, administration, and care of specialized delivery systems, such as insulin pumps.
• Provide instructions regarding insulin storage and injection technique.
• Provide instructions regarding the use of intensive insulin therapy with multiple injections. Advise patients of the risks of such therapy (e.g., hypoglycemia).
• Provide instructions regarding self-monitoring of blood glucose concentrations. Particular importance of frequent self-monitoring of blood glucose concentrations in patients with a history of hypoglycemic unawareness or recurrent, severe hypoglycemic episodes.
• Provide instructions regarding adherence to meal planning, regular physical exercise, periodic hemoglobin A_1c (HbA_1c) monitoring, and management of hypoglycemia or hyperglycemia.
• Importance of changing insulin dosage with caution and only under medical supervision. Discuss potential for alterations in insulin requirements in special situations (e.g., illness, concomitant agents that alter glycemic control, travel, emotional disturbances or other stresses). Discuss potential for alterations in insulin requirements as a result of changes in physical activity, missed doses, or inadvertent administration of incorrect doses.
• Importance of not changing the order of mixing insulins or the model or brand of syringe or needle without medical supervision. When mixing with other insulin preparations, importance of drawing insulin (regular) into the syringe first.
• Importance of informing clinicians of the development of skin reactions (erythema, pruritus, edema, lipodystrophy) at injection site.
• Importance of informing clinicians of the development of generalized hypersensitivity reactions (shortness of breath, hypotension, wheezing, whole body rash, tachycardia, diaphoresis).
• Importance of wearing a medical identification bracelet or pendant, carrying ample insulin supply and syringes on trips, and having carbohydrates (sugar or candy) on hand for emergencies, and of noting time-zone changes for dose schedule when traveling.
• Inform patient that use of marijuana may increase insulin requirements.
• Importance of patient not smoking within 30 minutes after insulin injection due to potential for decreased absorption of insulin.
• Instruct patient on the appropriate measures for safe disposal of needles.
• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.
• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
• Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

AHFS Drug Information. © Copyright, 1959-2008, Selected Revisions August 2005. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.