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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

INSULIN REGULAR
(Humulin-R(R), Novolin-Toronto(R), Toronto Insulin)

Note:"REGULAR" INSULIN IS THE GENERIC NAME. BE CERTAIN THAT YOU HAVE REGULAR INSULIN SINCE THERE ARE SEVERAL OTHER FORMS OF INSULIN.

Indication

  • used in the treatment of hyperglycemia and hyperkalemia

Pharmacology

  • insulin is a hormone that is derived from the beta cells of the pancreas; it is the principal hormone needed for glucose utilization
  • facilitates transport of glucose into skeletal and cardiac muscle and adipose tissue
  • promotes intracellular shift of potassium and magnesium

Side Effects

  • hypoglycemia, hyperglycemic rebound

Monitoring

  • carefully monitor serum glucose, potassium and sodium

Dose

HYPERGLYCEMIA

  1. Loading Dose

    0.1 unit/kg IV push or slow IV infusion as ordered

  2. Maintenance Dose

    0.02 to 0.1 unit/kg/h by continuous IV infusion (titrate with hourly determinations of serum glucose and 4 hourly determinations of serum potassium until these levels are stable) See standard concentrations below for infusions

HYPERKALEMIA

0.05 to 0.1 unit/kg/h by continuous IV infusion (titrate with hourly determinations of serum glucose and 4 hourly determinations of serum potassium until these levels are stable)

Standard Concentrations for continuous infusions implemented October 2014:

     Weight 2kg or less: 0.1units/mL or 5 units/50mL of IV fluid

     Weight over 2kg: 0.5 units/mL or 25 units/50mL of  IVfluid

Dose=0.05 unit/kg/h Weight = 0.7 kg
 =0.035 unit/h
 =0.035 unit/mL (solution to be run at 1mL/h)
 =1.75 units/50mL

ALWAYS PREPARE AN INITIAL INSULIN DILUTION OF 1 UNIT/ML FOR SMALLER DOSES

EMERGENCY PREPARATION

Add 0.1 mL of Regular Insulin (100 units/mL) to a 10 mL vial of 0.9% NaCl. Mix.
CONCENTRATION = 1 unit/mL of Regular Insulin

NON-EMERGENCY PREPARATION

Add 0.1 mL of Regular Insulin (100 units/mL) to 9.9 mL of IV solution. Mix.
CONCENTRATION = 1 unit/mL of Regular Insulin

To make 50 mL of Insulin [0.1 unit/mL]

[5 units/50 mL]:

 

1. Add 0.1 mL (10 units) of regular insulin

(100 unit/mL) to 9.9 mL of IV solution and

mix. This results in a diluted 1 unit/mL

stock solu􀆟on.

2. Add 5 mL (5 units ) of the diluted stock

insulin [1 unit/mL] to 45 mL of IV solution, resulting in a 0.1unit/mL solution

Discard the diluted 1mg/mL stock solution after use,

do not store.

 

To make 50 mL of Insulin [0.5 units/mL]

[25 units/ 50 mL]:

Add 0.25mL (25 units) of regular insulin [100 units/mL] to 49.75 mL of IV Solution

Supplied

  • 100 unit/mL vial of "Regular" Human Insulin ( Novolin Toronto (R)) (10 mL size)
  • Patient specific standard concentration syringes for infusions of 5units/50mL and 25units/50mL of IV fluid
  • date and initials should be written on yellow sticker (which is on the vial) when the vial is punctured for the first time. Insulin may be kept for 2 months after the vial is punctured for the first time.

References

  1. Pagliaro LA and Pagliaro AM (ed): Problems in Pediatric Drug Therapy, 1987, Drug Intelligence Publ Inc, Hamilton, Illinois.
  2. Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
  3. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
 



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