Clinical medicine profile
Biphasic and Intermediate Acting Insulins
Insulin (antidiabetic hormone)
- Route
- SC / IV (soluble in critical care)
- Schedule
- POM
- ATC
- Not assigned
- PPB status
- registered
This profile needs source confirmation
A traceable source link is not attached to this profile. Confirm prescribing decisions against the current SmPC and Kenya STG/EML.
Safety essentials
The information most likely to change a prescribing or dispensing decision.
Contraindications
- Hypoglycaemia.
- Hypersensitivity to specific formulation.
Precautions
- Recognition of early hypoglycaemic signs
- reduce dose in renal failure
- some patients have reported a loss of warning of hypoglycaemia after transfer from human insulin
- beta-blockers
- conversion from one type of insulin to another
- tolerance to insulin [more common with bovine insulin than with porcine insulin]
- close control of blood sugar in pregnancy.
Dosing matrix
Population and organ-function guidance, shown together for faster comparison.
General dosage of insulins: The starting dose should be 10-16 units of soluble insulin SC 15-30 minutes (depending on the type of insulin) before meal TID. The dose is adjusted gradually in 5 unit aliquots to achieve plasma glucose range of 8.3-13.4 mmol/L in hospital and target the range of 4-10mmol/L at home. Once the blood glucose stabilizes at 8-11.0 mmol/L the patient is switched to the intermediate insulin whose dose is 2/3 of the total dose of soluble insulin. Normally 2/3 of the intermediate insulin is administered in the morning and 1/3 before supper.
See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.
Reduced insulin clearance — lower doses often needed in advanced CKD.
- CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Impaired gluconeogenesis increases hypo risk.
Use, effects & interactions
Indications
- Therapeutic use is agent- and indication-specific within the class (Insulin (antidiabetic hormone)).
- Use according to culture results, national guidelines (Kenya STG/EML where applicable) and the current product SmPC.
- Diabetes mellitus
Adverse effects
- Hypoglycaemia, weight gain, injection-site reactions, lipodystrophy.
- Rare: severe allergy, hypokalaemia (shift).
Drug interactions
Open multi-drug checker ↗- USE OF INSULIN IN PREGNANCY ||| Insulin does not cross the placenta.
- Maternal glucose crosses the placenta and together with insulin antibodies can cause fetal hyperinsulinemia.
- This may results in problems like large-for-gestational-age infant and macrosomia [big baby syndrome]. ||| High glucose levels in the 5-8 wks of gestation are associated with congenital abnormalities and in later stages of gestation it can lead to increased perinatal morbidity and mortality. ||| Poor control of diabetes in pregnancy may cause increased insulin production in the fetus.
- This can lead to neonatal hypoglycemia that may require medical control. ||| Insulin requirements drop rapidly after child-birth.
Mechanism & disposition
Insulin Glargine Indications Diabetes mellitus Dose General dosage of insulins: The starting dose should be 10-16 units of soluble insulin SC 15-30 minutes (depending on the type of insulin) before meal TID.
Read complete mechanism
Insulin Glargine Indications Diabetes mellitus Dose General dosage of insulins: The starting dose should be 10-16 units of soluble insulin SC 15-30 minutes (depending on the type of insulin) before meal TID. The dose is adjusted gradually in 5 unit aliquots to achieve plasma glucose range of 8.3-13.4 mmol/L in hospital and target the range of 4-10mmol/L at home. Once the blood glucose stabilizes at 8-11.0 mmol/L the patient is switched to the intermediate insulin whose dose is 2/3 of the total dose of soluble insulin. Normally 2/3 of the intermediate insulin is administered in the morning and 1/3 before supper. For more information, click the links below Mode Of Action Precautions Contraindications Side Effects Pregnancy Risk Category Special Information Brands Show entries Search: Name Formulation Strength Pack size Cost Manufacturer Distributor No data available in table Showing 0 to 0 of 0 entries PreviousNext Sponsored Ads Quick Links Contacts Keep in touch Terms and conditions Privacy 2018 Drug Index Mode Of Action Insulin: ||| controls the storage and metabolism of carbohydrates, proteins, and fats. This occurs primarily in the liver, in muscle, and in adipose tissues after it binding to receptor sites on cellular plasma membranes. ||| is known to affect cell membrane transport characteristics, cellular growth, enzyme activation and inhibition, and changes in protein and fat metabolism. ||| promotes uptake of carbohydrates, proteins, and fats in most tissues. stimulates protein and free fatty acid synthesis. It inhibits release of free fatty acid from adipose cells. ||| increases active glucose transport through muscle and adipose cellular membranes ||| promotes conversion of intracellular glucose to glycogen and free fatty acid to triglyceride [storage forms] ||| increases hepatic glucose conversion to glycogen and suppresses hepatic glucose output. ||| stimulates growth hormonferre secretion by producing hypoglycemia, which is used to evaluate pituitary growth hormone reserve. ||| increases the intracellular shift of potassium and magnesium and decreases renal excretion of sodium. ||| decreases the synthesis of high-density lipoprotein [HDL] cholesterol and increases the synthesis of very low-density lipoprotein [VLDL] cholesterol in the liver. ||| increases lipoprotein uptake and utilization in the lactating mammary gland. ||| stimulates activity of and tissue response to the sympathetic nervous system.
Minutes–hours (formulation-dependent)
Hours–>40 h (basal analogues)
SC / IV (soluble in critical care)
varies by site, temperature, lipohypertrophy. Analogues engineered for prandial vs basal profiles. IV soluble insulin used in DKA/HHS protocols.
Pregnancy, lactation & diet
Insulin is preferred pharmacological therapy for diabetes in pregnancy when needed.
Compatible; may need dose adjustment postpartum.
Brands & loaded prices
| Brand | Manufacturer | Pack | Observed price |
|---|---|---|---|
| No reviewed brand listings are linked yet. | |||
Sources & review state
Decision support only. Confirm patient-specific decisions against the current product SmPC, Kenya STG/EML, and professional judgement.