Humulin Regular (Insulin)

Company: Lilly (France)

Usage: injectable

Description Humulin Regular (Insulin)

Humulin regular is a polypeptide hormone which consists of two polypeptide chains connected by disulfide bonds. It is absolutely identical to human pancreatic insulin.

Since biosynthetic human insulin (BHI) is a product of recombinant technology it represents absolute copy of natural human insulin. Unlike insulin of animal origin, recombinant insulin is less likely to induce immune response. Besides it doesn’t contain protein contaminants, which is common for all insulins derived from pancreatic glands.

Due to highly technological purification procedures the recombinant insulin contains insufficient amount of E. coli polypeptides to raise antigenic response in deliberately sensitized animals. Radioimmunoassay methods showed that there are no antibodies to E. coli polypeptides in patients’ serum samples.

Injections of insulin temporarily recover ability in diabetics to metabolize carbohydrates, to transform glucose to fats and to store glycogen in the liver. At proper doses and intervals insulin keeps the blood sugar at normal level, thus preventing acidosis and diabetic coma.

There are many types of insulin which differ in their action. For instance, the supplement of protamine and zinc can prolong the action of insulin due to formation of stable complex, and correspondingly, slow dissolution.

Types of Insulin

• Humulin-R, Regular, Insulin Injection, Human Biosynthetic, is a fast acting insulin with duration from 6 to 8 hours.
• Humulin-N, NPH, Insulin Isophane, Human Biosynthetic, has delayed beginning of action and more prolonged activity (up to 24 hours)
• Humulin-L, Lente, Insulin Zinc Suspension Medium, Human Biosynthetic, has delayed beginning of action and more prolonged activity (up to 24 hours)
• Humulin-U, Ultralente, Insulin Zinc Suspension Prolonged, Human Biosynthetic, is a long-acting insulin with a slower onset of action than Regular insulin and a longer duration of activity (24 hours or more).
• Humulin Mixtures (10/90, 20/80, 30/70, 40/60 and 50/50 Insulin Injection, Human Biosynthetic and Insulin Isophane, Human Biosynthetic) are intermediate-acting insulins with a more rapid onset of action than NPH alone and a duration of activity of up to 24 hours.

Besides, you can mix Humulin-N, Humulin-L or Humulin-U with Humulin regular to meet your metabolic requirements.

Indications And Clinical Uses:

For treatment of diabetic symptoms in patients with insulin deficiency.
Humulin regular is only for emergency cases (coma, pre-coma, in diabetic patients during surgery) but not Humulin-N, Humulin-L, Humulin-U or Humulin Mixtures.
If you switch from insulin of animal origin to Humulin you may need adjustment of dosage (from the first dose or during several weeks). In any case you have to do it under supervision of your doctor. After all, any change of insulin quality (purity, strength, brand, type of production (recombinant or animal origin) requires adjustment of dosage.

Contra-Indications:

Hypoglycemia.

Manufacturers` Warnings In Clinical States:

Do not use Humulin-N, Humulin Mixtures, Humulin-L and Humulin-U intravenously or for treatment of diabetic coma.

Some patients who had hypoglycemic reactions after switching to Humulin, reported that these symptoms were weaker than from insulin of animal origin. Do not use Humulin-N, Humulin-L, Humulin-U or Humulin Mixtures if there are clots that float or stick to the sides of the vial.

Precautions:

In uncontrolled diabetes there can be visual disturbances due to refractive alteration. Usually they disappear in case of early management. However, after beginning of therapy the changes of osmotic balance between the lens and ocular fluids may take few weeks to stabilize. So, it’s better to delay prescribing new lenses for 3 to 6 weeks.

Some cases require increase of insulin dosage (illness, emotional disturbance or usage of substances with hyperglycemic activity – oral contraceptives, corticosteroids etc.) The reduction of dosage is necessary in case of kidney or liver impairment, or during intake of substances with hypoglycemic function – inhibitors of monoamine oxidase or adrenoreceptors.

The dosage, schedule, diet and exercises require continuous medical supervision. The best time for injection is before breakfast.For safe treatment of diabetes there should be also control of allergic reactions on insulin.

If you switch from insulin of animal origin into recombinant insulin, it may require reduction of the dosage (from first dose or during several weeks). You have to be aware that there may be a risk of hypoglycemia in case of decreased insulin requirement. However, the risk is minimal if your daily dose doesn’t exceed 40 units.

Pregnancy

There should be precise control of insulin consumption during pregnancy. Usually it decreases in the first trimester and increases during 2nd and 3rd trimester. Lactation may also require adjustment of insulin dosage or diet.

Drug Interactions

There are hormones that oppose hypoglycemic activity of insulin. Among them growth hormone, corticotropin, glucocorticoids, thyroid hormone and glucagon. Epinephrine also inhibits insulin production and causes glycogen breakdown to glucose.

Therefore it is hard to control diabetes in case of acromegaly, Cushing`s syndrome, hyperthyroidism, and pheochromocytoma. Phenytoin may also counteract hypoglycemic activity of insulin.

Anabolic steroids, MAO inhibitors, guanethidine, alcohol, propranolol, inhibitors of beta-adrenoreceptors can increase hypoglycemic action of insulin.Adjustment of insulin dosage may be needed if you take diuretics or oral contraceptives.

Adverse Reactions:

There were reports about allergic reactions from patients taking Humulin. They may happen due to improper cleaning of skin, contamination of injection spot with alcohol or other antiseptic, or due to intracutaneous injection (instead of subcutaneous). Local allergic reactions causing skin sensitivity phenomenon usually disappear spontaneously. There are also few cases of lipohypertrophy, lipoatrophy and serum sickness.

Symptoms and Treatment of Overdose

Hypoglycemia (low blood glucose) may happen when you exceed the dosage, miss your meal, work too hard before your meal, have infection or other illness (especially with diarrhea or vomiting).

The manifestations of hypoglycemia include: hunger, nervousness, warmth, sweating, palpitations, headache, confusion, drowsiness, fatigue, anxiety, blurred vision, diplopia, numbness of the lips, nose or fingers. Propranolol or inhibitors of beta-adrenoreceptors can mask clinical signs of hypoglycemia.

The symptoms usually appear when blood sugar level drops below 2.2 mmol/L (40 mg/100 mL). But they may also occur during sudden drop of blood sugar even if the level remains higher above mentioned values.

Treatment: You can take solution of carbohydrates or fruit juice orally. But if a patient is unable to do that, 10 to 20 g of dextrose intravenously or glucagon subcutaneously (or intramuscularly) can treat hypoglycemia.

Dosage And Administration:

Only doctor can prescribe the dosage according to your requirements.

If you take insulin for the first time you can start with Humulin in the same manner as with insulin of animal origin. Medical personnel should watch over your health during adjustment period.

Besides, when you switch from insulin of animal origin to Humulin, use the same dosage and schedule, or ask your doctor to make adjustment. If you were on high doses of animal insulin and transferred to Humulin it may be necessary to reduce the starting dose and monitor your health carefully.

If you had allergic reaction to animal insulin you may also have allergy to human insulin. In this case you have to make intradermal testing (and desensitization if necessary) before taking therapeutic doses.

Humulin has a quicker onset and shorter duration than insulin of animal origin.

Humulin regular is a clear, colorless solution for subcutaneous, intramuscular, or intravenous injections.

Humulin-N, Humulin Mixtures, Humulin-L and Humulin-U are suspensions for subcutaneous injections only.

Rotate the spot of subcutaneous injection, do not use it more than once a month. The proper place for injection is abdomen, upper arms, thighs or buttocks. Make sure you do not enter the blood vessel. Do not massage the injection site.

Mixing Instructions:

The fast onset of Humulin regular activity remains unchanged when you mix it with Humulin-N independent of proportion and period of time between mixing and injection.

Humulin-L + Humulin regular mixture results in delay of Humulin-R action, lowering of peak activity magnitude, and extension of total activity.

Humulin regular + Humulin-U results in reduction of the quick-acting effect of regular insulin.

We do not recommend mixing Humulin with insulin of animal origin.

Stability and Storage:

Store insulin in a cold place with temperature from 2 to 10°C. Don’t let it freeze and keep away from direct sunlight. Don’t use if expired. When you use insulin, you can keep vials at room temperature during 28 days.

Composition of Humulin

Humulin-Regular: Each mL is equal to 100 units of Regular insulin. Additional ingredients: glycerol, m-cresol. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Cartridges of 1.5 and 3 mL, boxes of 5. Vials of 10 mL.

Humulin-N: Each mL is equal to 100 units of NPH insulin. Additional ingredients: dibasic sodium phosphate, glycerol, m-cresol, phenol, protamine sulfate and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Cartridges of 1.5 and 3 mL, boxes of 5. Vials of 10 mL.

Humulin-L: Each mL is equal to 100 units of Lente insulin. Additional ingredients: methyl paraben, sodium acetate, sodium chloride and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Vials of 10 mL.

Humulin-U: Each mL is equal to 100 units of Ultralente insulin. Additional ingredients: methyl paraben, sodium acetate, sodium chloride and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Vials of 10 mL.

Humulin Mixtures

Humulin 10/90: Each mL is equal to 10 units of Regular insulin and 90 units of NPH insulin. Additional ingredients: dibasic sodium phosphate, glycerol, m-cresol, phenol, protamine sulfate and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Cartridges of 1.5 and 3 mL, boxes of 5. Vials of 10 mL.

Humulin 20/80: Each mL is equal to 20 units of Regular insulin and 80 units of NPH insulin. Additional ingredients: dibasic sodium phosphate, glycerol, m-cresol, phenol, protamine sulfate and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Cartridges of 1.5 and 3 mL, boxes of 5. Vials of 10 mL.

Humulin 30/70: Each mL is equal to 30 units Regular insulin and 70 units of NPH insulin. Additional ingredients: dibasic sodium phosphate, glycerol, m-cresol, phenol, protamine sulfate and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Cartridges of 1.5 and 3 mL, boxes of 5. Vials of 10 mL.

Humulin 40/60: Each mL is equal to 40 units of Regular insulin and 60 units of NPH insulin. Additional ingredients: dibasic sodium phosphate, glycerol, m-cresol, phenol, protamine sulfate and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Cartridges of 1.5 and 3 mL, boxes of 5. Vials of 10 mL.

Humulin 50/50: Each mL is equal to 50 units of Regular insulin and 50 units of NPH insulin. Additional ingredients: dibasic sodium phosphate, glycerol, m-cresol, phenol, protamine sulfate and zinc. May contain: dimethicone, hydrochloric acid and sodium hydroxide. Cartridges of 1.5 and 3 mL, boxes of 5. Vials of 10 mL.

You can use Humulin cartridges with B-D Pen, B-D Pen Ultra Cartridge System, or future Lilly injector systems.