Insulin

• Rapid acting insulin includes NovaRapid, Apidra, and Halog (CLEAR)
• Rapid acting Insulin has an onset of 10-15 mins, peak 1-1.5 hours, and duration of 3-5 hours
• Short acting insulins include Humulin R, and Novolin ge Toronto (CLEAR)
• Short acting insulins have on onset of 30 mins, peak of 2-3 hours and duration of 6.5 hours
• Only short acting insulins can be given IV
• Intermediate insulins include Humulin-N and Novolin ge NPH (CLOUDY) NEVER GIVE IV
• Intermediate insulins have an onset of 1-3 hours, peak of 5-8 hours and duration of up to 8 hours
• Long-acting insulins include Levemir, Lantus and Toujeo (CLEAR)
• Long acting insulins have an onset of 90 mins, have no peak, and last up to 24 hours (Toujeo onset up to 6h, duration up to 30h)
• Mixing insulins - never mix Lantus with any other type of insulin.

  
• After drawing up mixed insulins, administer within 5-15 mins
• Always ensure dextrose 4% and saline 0.18% infusion is running whilst insulin infusion is in progress
• insulin administration chart

  
• If the patient has not eaten or drunk anything for more than 8 hrs, do not give insulin unless advised by doctor
• Insulin can be given via subcutaneous injection or intravenous infusion
• Subcutaneous route is preferred as it mimics physiological release from pancreas
• Subcutaneous route - most common method of giving insulin to patients with diabetes
• IV route allows rapid onset but requires careful monitoring to avoid hypoglycaemia
• Intravenous route - only used if other routes cannot be used e.g. emergency treatment of diabetic ketoacidosis
• Injection sites include abdomen, thigh, upper arm, buttock
• Abdominal site is recommended as it provides quick absorption and reduces risk of lipohypertrophy
• Insulin is usually administered using an insulin syringe (U-100) which contains 100 units per ml
• Insulin is available in different forms including short acting, intermediate acting, long acting, and mixed preparations.