#建議持續輸注 (IV pump) 之高警訊藥品

糖尿病 (其他胰島素) Diabetes mellitus, Diabetic ketoacidosis

Insulin, Short-Acting
Regular human insulin is a polypeptide hormone structurally identical to endogenous human insulin. The primary activity of insulin is regulation of glucose metabolism. Insulin binds to insulin receptors on muscle and adipocytes, and lowers blood glucose by facilitating the cellular uptake of glucose. Insulin simultaneously inhibits output of glucose from the liver.

Absorption:
1. Tmax, subQ: 3 hours (50 or 100 units)
2. Bioavailability: (Intraperitoneal) good; (SubQ) well absorbed
Distribution:
1. Protein binding: none
2. Vd: 0.15 L/kg
Metabolism:
1. Adipose tissue/muscle: about 20%
2. Hepatic: more than 50%
3. Renal: about 30%
Elimination Half Life:
1. Intraperitoneal: 1.6 to 5.2 hours
2. IV: 5 to 15 minutes
3. SubQ: 198 minutes

During episode of hypoglycemia and hypersensitivity to human regular insulin or any of its excipients.

B (FDA)

Compatible with breastfeeding and infant risk is minimal.

1. Cardiovascular: Peripheral edema
2. Dermatologic: Erythema or pruritus at injection site
3. Metabolic: Hypoglycemia, hypokalemia, weight gain
4. Hypersensitivity: Anaphylaxis, hypersensitivity, hypersensitivity reaction
5. Local: Hypertrophy at injection site, lipoatrophy at injection site

Diabetes mellitus:
Note: Individualize dosage and timing based on patient needs
1. Administration: give subQ 3 or more times daily approximately 30 minutes prior to meals
2. Dosage: typical total daily dose is 0.5 to 1 units/kg/day
Diabetic ketoacidosis:
1. Dosage: 0.14 unit/kg/hr continuous IV infusion or 0.1 unit/kg IV bolus followed by 0.1 unit/kg/hr continuous IV infusion
2. Adjustment:
(1) If in first hour, blood glucose does not decrease by 10%, give IV bolus of 0.14 unit/kg while continuing infusion at prior rate
(2) When BG reaches 200 mg/dL, decrease IV infusion to 0.02 to 0.05 unit/kg/hr and add dextrose to replacement fluids
(3) Adjust rate of insulin administration and dextrose concentration to maintain BG between 150 and 200 mg/dL until resolution of diabetic ketoacidosis

Note: Individualize dosage and timing based on patient needs
1. Administration: give subQ 3 or more times daily approximately 30 minutes prior to meals
2. Typical total daily dose is 0.5 to 1 units/kg/day but varies in prepubertal children from 0.7 to 1 unit/kg/day; may be lower during period of partial remission and higher in situations of insulin resistance (eg, puberty, obesity)

1. CrCl >50 mL/min: No dosage adjustment necessary
2. CrCl 10-50 mL/min: Administer at 75% of normal dose and monitor glucose closely
3. CrCl <10 mL/min: Administer at 50% of normal dose and monitor glucose closely
4. Hemodialysis, Peritoneal dialysis: Because of a large molecular weight (6000 daltons), insulin is not significantly removed; supplemental dose is not necessary
5. Continuous renal replacement therapy: Administer 75% of normal dose and monitor glucose closely; supplemental dose is not necessary

There are no dosage adjustments provided in the manufacturer's labeling; dosage requirements may be reduced and patients may require more frequent dose adjustment and glucose monitoring.