DRUG | SUPPLIED | DOSE | COMMENTS |
---|---|---|---|
INSULIN (Paeds) Mechanism of action: Analogue of Human Insulin, a peptide hormone produced by beta cells of the pancreatic islet cells, that promotes absorption of glucose from the blood into cells, lowering blood sugar. It stimulates sodium-potassium ATPase, shifting potassium into cells and lowering serum potassium. Ref: 44, 353, 354 Last update: 2022-07-03 |
BOLUS INSULINS (very rapid to rapid acting) Insulin aspart (NOVORAPID); onset: 0.25-0.5 hours; administered: Pre-meals. Insulin lispro (HUMALOG, ADMELOG (non-formulary)); onset: 0.25-0.5 hours; administered: Pre-meals. Insulin glulisine (APIDRA); onset: 0.25-0.5 hours; administered: Pre-meals, Insulin regular (HUMULIN-R, NOVOLIN-ge, TORONTO); onset: 0.5-1 hours; administered: Pre-meals. BASAL INSULINS (intermediate to long acting) Insulin NPH (isophane) (HUMULIN-N, NOVOLIN-ge, NPH); onset: 1-2 hours; administered: HS or BID. Insulin glargine (BASAGLAR, LANTUS (non-formulary), TOUJEO (non-formulary)); onset: 3-4 hours; administered: Once daily. Insulin detemir (LEVEMIR); onset: 3-4 hours; administered: Once daily or BID. Insulin degludec (TRESIBA (non-formulary)); onset: 1-4 hours; administered: Once daily **different types/ brands of insulin are not interchangeable |
Type 1 Diabetes: Given subcutaneous in divided doses, as a combination of basal and bolus insulins. Dosage is individualized based on degree of blood glucose control. Usual initial dose: 0.2 - 0.6 unit/kg/day. Usual maintenance dose: 0.5 - 1 unit/kg/day. Diabetic Ketoacidosis: Regular insulin 0.05-0.1 unit/kg/hr. Hyperkalemia: Regular insulin 0.1 unit/kg/dose (maximum 10 Units/dose) IV over 30 minutes (given with dextrose 0.5 grams/kg/dose (5 mL/kg of dextrose 10%); maximum 25 grams/dose of dextrose) ** see Forms Supplied for Insulin types ** |
Only insulin regular is to be given intravenously. Refer to BCCH Diabetic Ketoacidosis Protocol Toolkit. Lipohypertrophy or -dystrophy may occur at subcutaneous injection sites. Injection sites should be routinely rotated. monitor glucose levels closely. When treating hyperkalemia, consider checking blood glucose Q30-60 minutes. Standard Prescription: Type 1 Diabetes: Insulin {type}__ units (___ units / kg) __ frequency SC Diabetic Ketoacidosis: Regular Insulin __ units/kg/hr IV Hyperkalemia: Regular Insulin __ units/kg/ with dextrose __% __ml IV over __ mins |