-When using vials, never share needles or syringes between patients metformin, Basaglar, Lantus, Trulicity, Victoza, Tresiba, Novolin 70 / 30, Levemir, Humulin 70 / 30, Novolog. Use: To improve glycemic control in adult patients with diabetes mellitus. • Hepatic impairment: Use with caution in patients with hepatic impairment. • Renal impairment: Use with caution in patients with renal impairment. Initiate insulin infusion 1 to 2 hours after starting fluid replacement therapy. Can regular and lispro insulin (Humalog) be mixed? -Insulin resistant patients that require daily insulin doses of more than 200 units may find U-500 insulin to be useful as large doses may be administered subcutaneously in a reasonable volume. -To prevent rebound hyperglycemia, initiate subcutaneous insulin 15 to 30 minutes (rapid-acting) or 1 to 2 hours (regular insulin) before stopping the insulin infusion; alternatively, basal insulin may be administered in the evening and the insulin infusion stopped the next morning. Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. In noncritically ill patients with adequate nutritional intake, a combination of basal insulin, nutritional, and correction components is preferred. Without insulin, cells are starved for energy and must seek an alternate source. Evaluate risk versus benefit of long-term postoperative use and consider alternative therapy due to potential for insulin-induced weight gain (Apovian 2015). If you run out of insulin or if your prescription happens to be expired, you’ll need to have a backup plan. The proper functioning of Insulin … Since combinations of agents are frequently used, dosage adjustment must address the individual component of the insulin regimen which most directly influences the blood glucose value in question, based on the known onset and duration of the insulin component. Dosage requirements may be reduced. Types: Technosphere insulin-inhalation system (Afrezza) Characteristics of insulin. Comments: Use: Treatment of diabetic ketoacidosis (DKA). In order to properly resuspend the insulin, vials should be carefully inverted or rolled at least 10 times, Humulin N KwikPen should be rolled between the palms ten times and inverted 180° ten times, and Novolin N FlexPen should be inverted 180° twenty times prior to the first injection and ten times thereafter. Use: To improve glycemic control in pediatric patients with diabetes mellitus. Patients with diabetes undergoing surgery: SubQ: On the evening before surgery or procedure, reduce the usual dose by 25%; on the morning of surgery or procedure, reduce the usual dose by 25% to 50% (ADA 2020; Pichardo-Lowden 2012). -An endocrinologist or critical care specialist with training and expertise in the management of DKA should direct care; frequent monitoring of clinical and laboratory parameters is necessary as well as identification and correction of precipitating event. -Insulin requirements in pre-pubertal children who are outside the partial remission phase are usually from 0.7 to 1 unit/kg/day -May be used in combination with oral antihyperglycemic agents or longer-acting basal insulin Insulin therapy is used to slowly correct high glucose levels; consult current treatment protocols for specific guidance on fluid and electrolyte management. Patients using twice daily insulin NPH: Consider intensification of therapy with additional agents that target postprandial glucose rather than continuing to increase the insulin NPH dose (AACE/ACE [Garber 2020]; ADA 2020). Symptoms differ in patients and may change over time in the same patient; awareness may be less pronounced in those with long-standing diabetes, diabetic nerve disease, patients taking beta-blockers, or in those who experience recurrent hypoglycemia. Management: If insulin is combined with pioglitazone, consider insulin dose reductions to avoid hypoglycemia. Glucose is … in Ihren Insulin­ pen dürfen nur U-100-Insuline eingesetzt werden. Comments: -Insulin requirements during the honeymoon phase (period of partial remission) are usually less than 0.5 units/kg/day and may be much lower Insulin secretion and sensitivity may be partially or completely restored after these procedures (Korner 2009; Peterli 2012). The hormone travels through the body and induces fat and muscle cells to absorb excess glucose from the blood for use as energy. Division of TDD (multiple daily injections): Basal insulin: Generally, 40% to 50% of the TDD is given as basal insulin (intermediate- or long-acting) (AACE [Handelsman 2015]; ADA 2019). -Dose: 0.1 unit/kg/hour IV until resolution of DKA (pH greater than 7.3, bicarbonate greater than 15 mmol/L and/or closure of the anion gap); resolution of DKA takes longer than normalization of blood glucose concentrations. Insulins are categorized based on the onset, peak, and duration of effect (eg, rapid-, short-, intermediate-, and long-acting insulin). -Starting insulin therapy before IV fluid replacement may precipitate shock, and increase the risk of hypokalemia and cerebral edema. The daily doses presented are expressed as the total units/kg/day of all insulin formulations combined. Continuous Subcutaneous Insulin Infusion (CSII) - Insulin Pump Therapy: Use of regular insulin is not recommended because of the risk of precipitation. Amnesty International: Frau im Koffer - Duration: 1:31. zeiteinheit 134,119 views. Insulin regular (human) injectable solution is a prescription medication used to treat type 1 and type 2 diabetes. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Intravenous Administration U-100 insulin only: Consult drug interactions database for more information. -For patients with marked sensitivity to insulin, decrease insulin to 0.05 units/kg/hour or less provided the metabolic acidosis continues to resolve. Vergewissern Sie sich deshalb beim Kauf im Ausland im­ mer, ob die Konzentration «stimmt». Initial TDD: ~0.4 to 0.5 units/kg/day; conservative initial doses of 0.2 to 0.4 units/kg/day may be considered to avoid the potential for hypoglycemia; higher initial doses may be required in patients who are obese, sedentary, or presenting with ketoacidosis (AACE [Handelsman 2015]; ADA 2020). Humulin N vials: Store unopened vials in refrigerator between 2°C and 8°C (36°F to 46°F; do not freeze; keep away from heat and sunlight. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. Endocrine & metabolic: Amyloidosis (cutaneous at injection site), hypoglycemia, hypokalemia, lipodystrophy, lipohypertrophy, weight gain, Hypersensitivity: Anaphylaxis, hypersensitivity reaction, Local: Atrophy at injection site, erythema at injection site, hypertrophy at injection site, injection site reaction, swelling at injection site, Neuromuscular & skeletal: Swelling of extremities. The Bottom Line! Regeln & Tipps Diabetes mellitus: Plasma glucose (typically before meals and snacks and at bedtime; occasionally additional monitoring may be required), electrolytes, HbA1c (at least twice yearly in patients who have stable glycemic control and are meeting treatment goals; quarterly in patients not meeting treatment goals or with therapy change [ADA 2020]); renal function, hepatic function, weight. -Insulin therapy should be initiated in children and adolescents for whom the distinction between type 1 diabetes mellitus and type 2 diabetes mellitus is unclear, specifically those with a random venous or plasma blood glucose concentration of 250 mg/dL or greater, or those who HbA1c is greater than 9%. --Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal Adjust dose to maintain premeal and bedtime glucose in target range. Initiate insulin infusion 1 to 2 hours after starting fluid replacement therapy Novolin N vials: Store unopened vials in refrigerator between 2°C and 8°C (36°F to 46°F) until product expiration date or at room temperature ≤25°C (≤77°F) for up to 42 days; do not freeze; keep away from heat and sunlight. 40-50 min. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty. Data sources include IBM Watson Micromedex (updated 2 Nov 2020), Cerner Multum™ (updated 2 Nov 2020), ASHP (updated 23 Oct 2020) and others. -Total daily insulin requirements are usually between 0.5 to 1 unit/kg/day -Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day Monitor therapy. Treatment and monitoring regimens must be individualized. Rates and timing of type 2 diabetes improvement and resolution vary widely by patient. -U-500 regular human insulin should not be administered IV. -Closely monitor blood glucose and serum potassium during IV administration Use of long-acting insulin preparations (eg, insulin degludec, insulin detemir, insulin glargine) may delay recovery from hypoglycemia. Documentation of allergenic cross-reactivity for drugs in this class is limited. All drugs may cause side effects. Multiple-Daily Insulin (MDI) injections: Utilizing a combination of prandial (i.e., bolus, rapid, or short-acting insulins) and basal (i.e., intermediate or long acting insulin) insulin, may administer 3 to 4 injections per day; regular human insulin is a short-acting prandial insulin Insulin production is regulated based on blood sugar levels and other hormones in the body. Once punctured (in use), store vials at room temperature ≤25°C (≤77°F) for up to 42 days; refrigeration of in-use vials is not recommended. Table 1 summarizes the most important relationships among various components of the insulin prescription, their injection times, and the most appropriate self-monitoring of blood glucose (SMBG) test to judge their effects. Insulin doses should be individualized based on patient needs; adjustments may be necessary with changes in physical activity, meal patterns, acute illness, or with changes in renal or hepatic function. Hypersensitivity to insulin NPH or any component of the formulation; during periods of hypoglycemia. -Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs; duration of action of insulin will vary according to dose, injection site, blood flow, temperature, and level of physical activity. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Children ≥10 years and Adolescents with ketosis/ketoacidosis/ketonuria: SubQ: Initial: 0.25 to 0.5 units/kg/dose once daily; use in in combination with lifestyle changes and metformin to achieve goals (ISPAD [Zeitler 2018]). We comply with the HONcode standard for trustworthy health information -. Alternatively, if you measure your body weight in kilograms: Total Daily Insulin Requirement (in units of insulin… Comments: Note: Insulin NPH is an intermediate-acting insulin formulation. Prandial insulin: The remaining portion (ie, 50% to 60%) of the TDD is then divided and administered before, at, or just after mealtimes depending on the formulation (eg, short-, rapid-, or ultra-rapid acting) (AACE [Handelsman 2015]; ADA 2020). Cold injections should be avoided. High blood glucose levels from lack of insulin can lead very quickly to diabetic ketoacidosis (DKA), a potentially deadly condition. -Novolin(R): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags; this insulin is stable in normal saline, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride -Do not share multi-dose insulin pens between patients, even if the needle is changed Insulin resistance is a very common condition that often accompanies obesity or a diagnosis of pre-diabetes, type 2 diabetes, polycystic ovary syndrome (PCOS), cardiovascular disease, and other metabolic conditions such as hypertension and non-alcoholic fatty liver disease. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. -Patients should be instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia. In patients who fail to achieve glycemic goals with metformin and basal insulin, may consider initiating prandial insulin (regular insulin or rapid acting insulin) and titrate to achieve goals. -Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal For hypoglycemia: If no clear reason for hypoglycemia, decrease dose by 10% to 20% (ADA 2020); for severe hypoglycemia (ie, requiring assistance from another person or blood glucose <40 mg/dL) reduce dose by 20% to 40% (AACE/ACE [Garber 2020]). Dosage adjustment when adding prandial insulin: Consider reducing the basal insulin dose by 4 units (or ~10%) if HbA1c is <8% when initiating prandial insulin (ADA 2020). Monitor therapy, Pioglitazone: May enhance the adverse/toxic effect of Insulins. If heart failure develops, consider PPAR-gamma agonist dosage reduction or therapy discontinuation. -Monitor urine ketones when blood glucose levels are unexpectedly high or inconsistent, and as clinically indicated. Insulin is a hormone produced by the pancreas that allows cells to absorb glucose, which is the body's preferred source of fuel. Insulin dose reduction of ≥75% has been suggested after gastric bypass for patients without severe β-cell failure (fasting c-peptide <0.3 nmol/L) (Cruijsen 2014). Hildegard Frieda Albertine Knef (28 December 1925 – 1 February 2002) was a German actress, voice actress, singer, and writer. Once punctured (in use), vials may be stored for up to 31 days in the refrigerator between 2°C and 8°C (36°F to 46°F) or at room temperature ≤30°C (≤86°F). Monitor patients for fluid retention and signs/symptoms of heart failure, and consider pioglitazone dose reduction or discontinuation if heart failure occurs Consider therapy modification, Pramlintide: May enhance the hypoglycemic effect of Insulins.

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