insulin soluble (Actrapid or humulin s)

CLINICAL USE


Hyperglycaemia, control of diabetes mellitusEmergency management of hyperkalaemia

DOSE IN NORMAL RENAL FUNCTION

Variable

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :5808
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :5
  • %Excreted unchanged in urine &nbsp &nbsp : 0
  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.15
  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2–5/13

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Variable
  • 10 to 20 &nbsp &nbsp : Variable
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Variable

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose according to clinical response

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose according to clinical response
  • HDF/high flux &nbsp :Not dialysed. Dose according to clinical response
  • CAV/VVHD &nbsp &nbsp &nbsp:Not dialysed. Dose according to clinical response

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsFibrates: may improve glucose tolerance; additive effect with insulin

    ADMINISTRATION

    Reconstition

    Route

    IV via CRIP

    Rate of Administration

    Over 30 minutes or as required

    Comments

    Add 15–25 IU insulin to 50 mL 50% glucoseFor maintenance infusion or sliding scale infusion, add 50 IU insulin to 500 mL 10% glucose and adjust rate according to blood glucose levelsContinue infusing insulin/glucose solution at rate of 10 mL/hour according to serum potassium

    OTHER INFORMATION

    Monitor blood glucose Prior to insulin/glucose infusion for hyperkalaemia, give IV 20 mL 10% calcium gluconate to protect myocardium and 50–100 mL 8.4% sodium bicarbonate to correct acidosisCommence calcium resonium 15 g 4 times per day orallyInsulin is metabolised renally; therefore, requirements may be reduced in ERF