Alternate Name(s):
Humulin-R, Novolin GE Toronto
Classification:
Hormone
Original Date:
June 1996
Revised Date:
Dec 2023
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 a minimum of 5 mL of the insulin infusion to prime it. This helps reduce absorption of running insulin by the plastic tubing. If there is no time to let insulin stand in the line, flush line with 20 mL of the insulin infusion over a 1 minute period immediately prior to connecting the tubing to the patient.
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, SMOF
References:
- Vemgal P, Ohlsson. Interventions for non-oliguric hyperkalaemia in preterm
neonates. Cochrane Database Syst Rev. 2012 May 16;5:CD005257. - Lexi-Comp Database
- Hewson M, Nawadra V, Oliver J, Odgers C, Plummer J, Simmer K. Insulin infusions in the neonatal unit: delivery variation due to adsorption. J Paediatr Child Health. 2000 Jun;36(3):216-20.
- Knopp JL, Chase JG. Clinical Recommendations for Managing the Impact of Insulin Adsorptive Loss in Hospital and Diabetes Care. J Diabetes Sci Technol. 2021 Jul;15(4):874-884.
- -Senarathna SMDKG, Strunk T, Petrovski M, Woodland S, Martinez J, Chuang VTG, Batty KT. Physical compatibility of lipid emulsions and intravenous medications used in neonatal intensive care settings. Eur J Hosp Pharm. 2023 Oct 23:ejhpharm-2023-003870.