Parenteral Manual

Insulin, regular

Disclaimer: Official controlled document is the CHEO 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 R®, NOVOLIN GE TORONTO®
Classification: 
Hypoglycemic agent
Original Date: 
August 2005
Revised Date: 
August 2024
Indications: 
  • Diabetes control, treatment of diabetic ketoacidosis
  • Treatment of hyperkalemia
  • Treatment of beta blocker and calcium channel blocker overdose
Reconstitution and Stability: 
  • For long-term storage, keep refrigerated but do not freeze                          
  • Insulin vials that are in use may be stored at room temperature for 30 days
  • DO NOT USE regular insulin if not clear and colourless
  • Infusion solutions of regular insulin stable 24 hrs at room temperature
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: other insulins: withdraw the regular insulin into the syringe first

- Y-site Compatible: KCl (up to 40 mmol/L), morphine, SMOF Lipid 20%, TPN (must not contain ranitidine)

- SC: regular insulin can be mixed with NPH insulin. Draw up shorter acting insulin first. Do NOT mix regular insulin with Lantus or Levemir

- Incompatible: aminophylline, cytarabine, dopamine, norepinephrine, phenobarbital, phenytoin, ranitidine, thiopental

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES, for diabetic control (rotate sites)
IM YES, regular insulin only
IV Direct

YES, regular insulin only
Usual dilution for treatment of Hyperkalemia: 1 unit/mL 

Usual dilution for treatment of beta blocker/calcium channel blocker overdose: 4 unit/mL           
IV Intermittent Infusion NO
IV Continuous Infusion

YES, regular insulin only
Dilution for DKA:  1 unit/mL

Dilution for beta blocker & calcium channel blocker overdose: 4 unit/mL

Click here to access SDC Drug Infusion Sheet for DKA

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Individualized based upon degree of control indicated by blood glucose determination     

Pediatric:

  • Diabetic control: 
    • 0.5 - 1 units/kg/day SC in divided doses for all insulin products except Lantus®
  • Diabetic ketoacidosis: 
    • 0.1 units/kg/hr IV (Range: 0.05-0.2  units/kg/hr) continuous infusion
  • Hyperkalemia:  
    • 0.1 unit/kg/dose.  Maximum 10 units IV over 5 minutes 
    • PLUS D10W   5 mL/kg/dose IV over 2 - 5 minutes at the same time as insulin. (Note:  D10W   5 mL/kg = 0.5 g/kg/dose of dextrose)
  • Treatment of beta blocker and calcium channel blocker overdose:  
    • 1 unit/kg/dose IV bolus followed by continuous infusion of 1 - 10 unit/kg/hr.
    • If initial blood glucose less than 11 mmol/L consider D10W 5 - 10 mL/kg/dose IV over 2 -  3 minutes at the same time as the insulin. Follow with dextrose containing  maintenance infusion  (eg  D10W-0.45 NaCL) at age appropriate rate.
  • Hyperkalemia during a code transfusion (massive hemorrhage)

    • Insulin regular 0.15 unit/kg, max 10 units IV over 3 - 5 min 

    • For small insulin doses, may need to prepare a 1 unit/mL insulin: 

      • Add 0.2 mL (20 units) of insulin 100 unit/mL to 19.8 mL of NaCL 0.9% for a final volume of 20 ml of 1 unit/mL. Withdraw required dose 

    • D10W 3 ml/kg/dose IV over 2-3 minutes given at the same time as the insulin  

Adult:
- Diabetic control: 0.5-1 units/kg/day SC in divided doses for all insulin products except Lantus®

- Diabetic ketoacidosis: 0.15 units/kg or 10 units initially IV push, followed by 0.1 units/kg/hr continuous infusion  -If plasma glucose unchanged after 2 hours, double the infusion rate.

- Hyperkalemia:  25 - 50 g dextrose (250 - 500 mL D10W) with 10 units of regular insulin administered over 30 - 60 minutes, or alternatively, if urgent, 25 g dextrose (50 mL D50W) combined with 5 - 10 units of regular insulin infused over 5 minutes

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl 10-50 mL/minute: Administer 75% of recommended dose
  • CrCl <10 mL/minute: Administer 25-50% of recommended dose
Potential hazards of parenteral administration: 
  • Hypoglycemia (antidote: oral carbohydrate or 25-50% dextrose IV or glucagon IV/IM/SC).  Follow blood glucose carefully.
  • Hypokalemia                                                                                 
  • Lipodystrophy (atrophy, hypertrophy) may occur at injection sites in up to 3% of users.  Injection sites should be routinely rotated to avoid this complication
  • Allergic reactions
Notes: 
  • Onsets, peak times (hours) and durations vary and are shown below:         

Insulin

Onset (hours)

Peak (hours)

Duration (hours)

Rapid-acting
(Novorapid)

0.15-0.3

1-3

3-5

Regular (Humulin)

0.5-1

2-3

5-7

NPH

1-4

4-14

10-24

Lente

1-4

4-14

12-24+

Ultralente

4-10

10-30

18-36
  • Insulin binds to glass bottles and plastic IV bags/tubing
  • The availability of the insulin is enhanced if the tubing connections are "flushed" with the insulin infusion solution prior to infusion into the patient (binding sites are saturated preventing further adsorption)

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