A Drug Study on

REGULAR INSULIN

In Partial Fulfillment of the

Requirements in NCM 209 – RLE 

OB-GYNE NURSING ROTATION

Submitted to:

Maria Catherine M. Belarma, RN, MN

Clinical Instructor

Submitted by:

Sophia Elyssa D. Ibuyan, St.N

BSN-2K

April 26, 2021

Generic Name

Insulin Regular Human

Brand Name Humulin R, Novolin R, Humulin R U-500, Myxredlin,

Velosulin BR

Drug Classification Antidiabetics, Short-Acting Insulin, Exogenous Insulin,

Pregnancy Category: B

Suggested Dose Availability

 OTC: 100units/mL (3mL vial), 100units/mL (10mL
vial)
 Rx: 500units/mL (20mL vial); prescribe with U-500
syringes to avoid conversion for U-100 tuberculin
syringes, 500units/mL (3mL pen), 100units/100mL
0.9% NaCl (Myxredlin)

Diabetes Type 1:
 Initial: 0.2-0.4 units/kg/day SC divided q8hr or more
frequently 
 Maintenance: 0.5-1 unit/kg/day SC divided q8hr or
more frequently; in insulin-resistant patients (eg, due
to obesity), substantially higher daily insulin may be
 required
Diabetes Type 2:
 Suggested beginning dose of 10 units/day SC (or 0.1-
0.2 unit/kg/day) in evening or divided q12hr
 Morning – Give two thirds of daily insulin requirement;
Ratio of regular insulin to NPH insulin 1:2
 Evening – Give one third of daily insulin requirement;
Ratio of regular insulin to NPH insulin 1:1

Severe Hyperglycemia/Diabetic Ketoacidosis .

 Dose: 0.14 unit/kg/hour IV; alternatively, a bolus of
0.1 unit/kg followed by an infusion of 0.1 unit/kg/hr
has been used.
 Blood glucose should drop 50 to 75 mg/dL per hour, if
this drop does not occur in the first hour; administer
bolus of 0.14 unit/kg while continuing the insulin
infusion.
 Subcutaneous regular human insulin: 0.1 unit/kg
subcutaneously every 1 to 2 hours; when blood
glucose is less than 250 mg/dL (14 mmol/L), give
glucose-containing fluids orally and reduce insulin to
0.05 unit/kg subcutaneously as needed to keep blood
glucose around 200 mg/dL (11 mmol/L) until
resolution of DKA.
Insulin Resistance
 Patients with insulin-resistant type 1 or type 2
diabetes who require daily insulin doses of more than
200 units may find U-500 insulin to be useful
Hyperkalemia
 SC, IV: dextrose 0.5– 1 g/kg combined with insulin 1
unit for every 4– 5 g dextrose given.
 

Gestational Diabetes
 A safe starting dose is 4 or 6 units once or twice a
day. Increase the dose by 2 – 4 units once a week
until the pre-breakfast and post-meal glucose levels
are below 5.0mmol/L and 7.4mmol/L respectively.

Mode of Action  Short-acting, clear, colorless solution of exogenous

unmodified insulin extracted from beta cells in pork
pancreas or synthesized by recombinant DNA
technology passage of glucose across cell
membranes in muscle and adipose tissue. Promotes
conversion of glucose to glycogen in the liver. It
lowers blood glucose levels by increasing peripheral
glucose uptake and by inhibiting the liver from
changing glycogen to glucose. It starts to work within
30 minutes after injection, peaks in 2 to 3 hours, and
keeps working for up to 8 hours.

Indications  Treatment of Type 1 Diabetes (Insulin Dependent)

 Treatment of Type 2 Diabetes (Non-Insulin
Dependent) that cannot be controlled by diet,
exercise, or oral medications
 Gestational Diabetes
 Mild to moderate Hyperosmolar Hyperglycemic state
 Emergency treatment of Diabetic Ketoacidosis or
coma
 Highly purified and human insulins promoted for short
courses of therapy (surgery, intercurrent disease),
 newly diagnosed patients, patients with poor
metabolic control, and patients with gestational
diabetes
 Treatment of hyperkalemia with infusion of glucose to
produce a shift of potassium into the cells

Contraindications  Insulin use is contraindicated in patients during

episodes of hypoglycemia. Hypoglycemia is the most
common adverse effect of insulin therapy and a major
barrier to achieving optimal glycemic control long
term.
 It also contraindicated to patients with hypersensitivity
to insulin
 Use cautiously with pregnancy. Lactation (monitor
mother carefully; insulin requirements may decrease
during lactation
 Avoid use in patients with severe kidney, liver,
thyroid, and other endocrine dysfunction.

Side Effects Occasional: Localized redness, swelling, itching (due to

improper insulin injection technique), allergy to insulin
cleansing solution. Dizziness, confusion, blurred vision,
mood changes, irritability, slurred speech, hunger,
tachycardia, tremors
Infrequent: Somogyi effect (rebound hyperglycemia) with
chronically excessive insulin dosages. Systemic allergic
reaction (rash, angioedema, anaphylaxis), lipodystrophy
(depression at injection site due to breakdown of adipose
tissue), lipohypertrophy (accumulation of subcutaneous
 tissue at injection site due to inadequate site rotation).
Rare: Insulin resistance.

Adverse Effects  Severe hypoglycemia (due to hyperinsulinism) may

occur with insulin overdose, decrease/delay of food
intake, excessive exercise, patients with brittle
diabetes.
 Diabetic ketoacidosis may result from stress, illness,
omission of insulin dose, long-term poor insulin
control.
 Low blood potassium (tiredness, weakness, muscle
cramps, constipation, breathing problems, heart
rhythm problems)
 Serious allergic reaction (rashes all over the body,
trouble breathing, tachycardia, sweating, fainting)
 Heart Failure (shortness of breath, swelling of ankles
or feet, sudden weight gain)

Drug Interaction Drug-Alcohol: may increase risk of hypoglycemia

Drug-Drug:

 Beta blockers (Carvedilol, Metoprolol) may alter

effects; may mask signs, prolong periods of
hypoglycemia.
 Glucocorticoids, Thiazide diuretics may increase
serum glucose.
 Drugs for heart rate disorders (Disopyramide), for
pain (Salicylates, Aspirin), for depression (Fluoxetine)
may cause very low blood sugar level.
 Drugs to treat cholesterol (Niacin), hormones used in
 birth control (Progesterone, Estrogen), to treat HIV
(Ritonavir), to treat Psychiatric disorders
(Olanzapine), for Tuberculosis (Isoniazid) may cause
high blood sugar levels.
 Antidiabetic agents: Sulfonylureas (Glipizide,
Glimepiride, Glyburide) have been widely implicated
as causes of hypoglycemia. These medications
directly stimulate insulin release from pancreatic beta
cells.

Drug-Herbal: Garlic, ginger, ginseng may increase risk of

hypoglycemia.

Nursing 1. Check and verify with the doctor's order and Kardex.
Responsibilities
2. Observe rights in medication administration such as
giving the right drug to the right patient using the right
route and at the right time.
3. Note the frequency of blood glucose monitoring is
determined by the insulin regimen and health status
of the patient.
4. Obtain serum glucose level, Hgb A1c as this can
help the doctor make more informed decisions
regarding the type and dosage of medication
needed.
5. Discuss lifestyle to determine extent of learning,
emotional needs.
6. Assess for hypoglycemia: cool, wet skin, tremors,
dizziness, headache, anxiety, tachycardia, numbness
in mouth, hunger, diplopia.
7. Assess sleeping pt for restlessness, diaphoresis.
8. Check for hyperglycemia: polyuria (excessive urine
output), polyphagia (excessive food intake),
polydipsia (excessive thirst), nausea/vomiting, dim
vision, fatigue, deep and rapid breathing (Kussmaul
respirations).
9. Be alert to conditions altering glucose requirements:
fever, trauma, increased activity/stress, surgical
procedure.
10. Instruct the patient/ family on proper technique for
drug administration, testing of glucose,
signs/symptoms of hypoglycemia and hyperglycemia
11. Notify prescriber promptly for markedly elevated
blood sugar or presence of acetone with sugar in the
urine; may indicate onset of ketoacidosis.
12. Inform the patient/ family diet and exercise are
essential parts of treatment; do not skip/delay meals.
13. Check with physician when insulin demands are
altered (e.g., fever, infection, trauma, stress, heavy
physical activity).
14. Do not take other medication without consulting
physician.
15. Weight control, exercise, hygiene (including foot
care), not smoking are integral parts of therapy.
16. Carry candy, sugar packets, other sugar
supplements for immediate response to
hypoglycemia.
17. Check your blood glucose often as directed by the
prescriber. Hypoglycemia can result from excess
insulin, insufficient food intake, vomiting, diarrhea,
unaccustomed exercise, infection, illness, nervous or
 emotional tension, or overindulgence in alcohol.
18. Caution patient not to share pen device with another
person, even if needle is changed; may risk
transmission of blood-borne pathogens.
19. Explain to patient that this medication controls
hyperglycemia but does not cure diabetes. Therapy
is long term.
20. Advise patient to notify health care professional if
pregnancy is planned or suspected or if breast
feeding or planning to breast feed.
21. Instruct patient to notify health care professional of all
Rx or OTC medications, vitamins, or herbal products
being taken and to consult health care professional
before taking other Rx, OTC, herbal products, or
alcohol.

Bibliography
Kizior, R., & Hodgson, K. (2019). Saunders Nursing Drug Handbook 2019. St. Louis,
Missouri: Elsevier.
Vallerand, A., & Sanoski, C. (2019). Davis's Drug Guide for Nurses Sixteenth Edition.
Philadelphia: F.A Davis Company
Wilson, Shannon, & Shields. (2015). Pearson Nurse's Drug Guide. Hoboken, New
Jersey: Pearson Education, Inc.