Neonatal Drug Therapy Manual

Insulin, Human Regular

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Humulin-R, Novolin GE Toronto
Classification: 
Hormone
Original Date: 
June 1996
Revised Date: 
May 2022
Indications: 
  • To maintain normoglycemia
  • Adjuvant therapy for hyperkalemia
Administration: 
  • IV continuous infusion
  • SC
Dosage: 
  • Use only Regular insulin for IV administration
  • IV continuous infusion: 0.01 - 0.1 units/kg/hour. Titrate infusion based on blood glucose
  • SC: 0.1 - 0.25 units/kg/dose Q4-12h

 

Management of Non- Oliguric Hyperkalemia in the Newborn Infant:

  • Commence insulin continuous infusion (at 0.05-0.1 units/kg/hour) along with IV dextrose (to increase GIR to at least 8.3 mg/kg/min)
  • After stabilizing,  must gradually reduce insulin and glucose over hours to prevent rebound hypoglycemia and hyperkalemia. 
Side Effects: 
  • CVS: tachycardia
  • Endocrine and metabolic: hypoglycemia, hypokalemia
Parameters to Monitor: 
  • Blood glucose one hour after starting infusion and after any change; Q4h once blood glucose stable
  • Electrolytes, urine glucose
  • For treatment of hyperkalemia: monitor blood glucose q30- 60 min after commencing therapy, and 2 to 4 hrs after stabilizing blood glucose.
Reconstitution and Stability: 

** Prior to connecting IV line to the patient, fill the IV line with the insulin infusion and let it stand 15 to 30 minutes.  After 15 - 30 minutes, open the IV and rapidly flush through the line with the insulin infusion to prime it.

CHEO:

  • Insulin Reg. 100 units/mL (fridge)
    • Add 0.02 mL (2 units) to 20 mL D5W
    • Final concentration: 0.1 unit/mL
  • Insulin Reg. 100 units/mL (fridge)
    • Add 0.1 mL (10 units) to 19.9 mL D5W
    • Final concentration: 0.5 unit/mL

 

TOH:

  • Insulin Reg. 100 units/mL
    • Take 0.1 mL (10 units) add to 9.9 mL D5W
    • Take 1 mL of above solution and add to 19 mL of D5W
    • Final concentration: 0.05 unit/mL

 

  • Insulin Reg. 100 units/mL (fridge)
    • Take 0.1 mL (10 units) add to 9.9 mL D5W
    • Take 2 mL of above solution and add to 18 mL D5W
    • Final concentration: 0.1 unit/mL

 

  • Insulin Reg. 100 units/mL (fridge)
    • Take 0.1 mL (10 units) add to 9.9 mL D5W
    • Take 4 mL of above solution and add to 16 mL D5W
    • Final concentration: 0.2 unit/mL

 

  • Insulin Reg. 100 units/mL (fridge)
    • Take 0.1 mL (10 units) add to 9.9 mL D5W
    • Take 10 mL of above solution and add to 10 mL D5W
    • Final concentration: 0.5 unit/mL

 

 

Compatibility: 

- Solutions Compatible: D5W, D10W, TPN, heparin, KCl

References: 
  • Vemgal P, Ohlsson. Interventions for non-oliguric hyperkalaemia in preterm 
    neonates. Cochrane Database Syst Rev. 2012 May 16;5:CD005257.
  • Lexi-Comp Database 

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