General dosage of insulins: The starting dose should be 10-16 units of soluble insulin SC 15-30 minutes (depending on the type of insulin) before meal TID. The dose is adjusted gradually in 5 unit aliquots to achieve plasma glucose range of 8.3-13.4 mmol/L in hospital and target the range of 4-10mmol/L at home. Once the blood glucose stabilizes at 8-11.0 mmol/L the patient is switched to the intermediate insulin whose dose is 2/3 of the total dose of soluble insulin. Normally 2/3 of the intermediate insulin is administered in the morning and 1/3 before supper.
Recognition of early hypoglycaemic signs; reduce dose in renal failure; some patients have reported a loss of warning of hypoglycaemia after transfer from human insulin; beta-blockers; conversion from one type of insulin to another; tolerance to insulin [more common with bovine insulin than with porcine insulin]; close control of blood sugar in pregnancy.
Fat hypertrophy at the injection site; allergic reactions; hypoglycaemia; insulin resistance; weight gain
DRUG INTERACTIONS: Corticosteroids antagonize effects of insulin by stimulating release of catecholamines, causing hyperglycemia; thyroid hormone replacement therapy may increase insulin requirement; androgens may increase tissue sensitivity to insulin resulting in hypoglycemia; MAOIs may require possible adjustment in insulin dose; large quantities of alcohol enhance hypoglycaemic effect of insulin; NSAIDs increases basal insulin secretion; quinine decreases degradation of insulin, resulting in hypoglycaemic effects; potassium-depleting diuretics may inhibit secretion of insulin and decrease tissue sensitivity to it; hyperglycemia-causing agents include the following-calcium channel blocking agents, clonidine, danazol, dextrothyroxine, epinephrine, estrogen, estrogen-progestin-containing oral contraceptives, glucagons, growth hormone, heparin, H2-blockers, nicotine, phenytoin; hypoglycemia-causing agents include the following - angioten-sin-converting enzyme inhibitors, bromocriptine, clofibrate, ketoconazole, lithium, mebendazole, pyridoxine, sulfonamides, theophylline. USE OF INSULIN IN PREGNANCY ||| Insulin does not cross the placenta. Maternal glucose crosses the placenta and together with insulin antibodies can cause fetal hyperinsulinemia. This may results in problems like large-for-gestational-age infant and macrosomia [big baby syndrome]. ||| High glucose levels in the 5-8 wks of gestation are associated with congenital abnormalities and in later stages of gestation it can lead to increased perinatal morbidity and mortality. ||| Poor control of diabetes in pregnancy may cause increased insulin production in the fetus. This can lead to neonatal hypoglycemia that may require medical control. ||| Insulin requirements drop rapidly after child-birth.