Regular insulin

Regular insulin, also known as neutral insulin and soluble insulin is a type of short acting insulin.[2] It is used to treat diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but may also be used by injection into a vein or muscle.[2] Onset of effect is typically in 30 minutes and they last for 8 hours.[3]

Regular insulin
A vial of regular human insulin
Clinical data
Trade namesHumulin R, Novolin R, Actrapid, others[1][2]
Other namesinsulin injection (soluble),[2] neutral insulin,[2] regular human insulin, human insulin (regular)
AHFS/Drugs.comMonograph
MedlinePlusa682611
Pregnancy
category
  • US: B (No risk in non-human studies)
    Routes of
    administration    		subcutaneous, intramuscular, intravenous[2]
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Onset of action30 minutes
    Duration of action8 hours
    Identifiers
    CAS Number
    ChemSpider
    • none

    The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Regular insulin can be made from the pancreas of pigs or cows.[2] Human versions can be made either by modifying pig versions or recombinant technology.[2]

    Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[5] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] The wholesale cost in the developing world is about US$2.39–10.61 per 1,000 iu of regular insulin.[7] In the United Kingdom 1,000 iu costs the NHS £7.48, while in the United States this amount is about $134.00.[2][8] In 2016 it was the 84th most prescribed medication in the United States with more than 8 million prescriptions.[9] Versions are also available mixed with longer-acting versions of insulin, such as NPH insulin.[2]

    Medical uses

    Regular insulin is used for the long-term management of diabetes.[3] It is the treatment of choice for the two diabetic emergencies diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It may also be used in combination with glucose to lower potassium levels in those with hyperkalemia.[4]

    Side effects

    Side effects may include: low blood sugar levels, skin reactions at the site of injection and low potassium levels among others.[3]

    Manufacture

    Humulin, one brand name for a group of biosynthetic human insulin products, is synthesized in a laboratory strain of Escherichia coli bacteria which has been genetically altered with recombinant DNA to produce biosynthetic human insulin. Humulin R consists of zinc-insulin crystals dissolved in a clear fluid.

    Formulations

    It is currently sold by many manufacturers in a number of different forms.

    By Eli Lilly these include:

    • Humulin R (REGULAR human insulin injection [rDNA origin]) is a short-acting insulin that has a relatively short duration of activity as compared with other insulins.
    • Humulin R Regular U-500 (Concentrated) insulin human injection, USP (rDNA Origin) is a stronger concentration (500 units/mL) of Humulin R.
    • Humulin 70/30 (70% human insulin isophane suspension, 30% human insulin injection [rDNA origin]) is a mixture insulin. It is an intermediate-acting insulin combined with the onset of action of Humulin
    • Humulin 50/50 (50% human insulin isophane suspension, 50% human insulin injection [rDNA origin]) is a mixture insulin. It is an intermediate-acting insulin combined with the onset of action of Humulin R.

    In UK these include:[10]

    • Actrapid
    • Humulin S
    • Insuman Rapid

    References
    1. "insulin regular human (OTC) – Humulin R, Novolin R". Archived from the original on 16 December 2014. Retrieved 1 December 2014.
    2. British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 464472. ISBN 9780857111562.
    3. American Society of Health-System Pharmacists. "Insulin Human". www.drugs.com. Archived from the original on 22 October 2016. Retrieved 1 January 2017.
    4. Mahoney, BA; Smith, WA; Lo, DS; Tsoi, K; Tonelli, M; Clase, CM (18 April 2005). "Emergency interventions for hyperkalaemia". The Cochrane Database of Systematic Reviews (2): CD003235. doi:10.1002/14651858.CD003235.pub2. PMC 6457842. PMID 15846652.
    5. Fleishman JL, Kohler JS, Schindler S (2009). Casebook for The Foundation a Great American Secret. New York: PublicAffairs. p. 22. ISBN 978-0-7867-3425-2. Archived from the original on 18 January 2017.
    6. "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
    7. "Insulin, Neutral Soluble". International Drug Price Indicator Guide. Retrieved 8 December 2016.
    8. "NADAC as of 2016-12-07 | Data.Medicaid.gov". Centers for Medicare and Medicaid Services. Archived from the original on 21 December 2016. Retrieved 17 January 2017.
    9. "The Top 300 of 2019". clincalc.com. Retrieved 22 December 2018.
    10. "Human Insulin - Types, Production, Action, History". Retrieved 17 November 2017.

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