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 :5808

%Protein binding :5

%Excreted unchanged in urine : 0

Volume of distribution (L/kg) :0.15

half-life – normal/ESRD (hrs) :2–5/13

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Variable

10 to 20 : Variable

<10 : Variable

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose according to clinical response

HD :Not dialysed. Dose according to clinical response

HDF/high flux :Not dialysed. Dose according to clinical response

CAV/VVHD :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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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