Human Insulin (Actrapid / Mixtard) (Insulin Human / Insulin Analogues)
Also sold as: Actrapid, Mixtard, Lantus (glargine), NovoMix, Huminsulin, Tresiba (degludec)
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Vial 100 IU/mL +2
Indications
- Type 1 DM (lifelong)
- Type 2 DM (when oral fail/CKD/pregnancy)
- GDM
- DKA / HHS
- Hyperkalemia (with dextrose)
- Inpatient hyperglycemia
Adult Dosing
Type 1 DM (basal-bolus)
Total daily 0.4-1 U/kg/day. 50% basal (glargine HS), 50% bolus (split TID with meals)
Type 2 DM (basal start)
10 U glargine HS or 0.1-0.2 U/kg, titrate by 2 U every 3 days to FBG <130
DKA
0.1 U/kg IV bolus, then 0.1 U/kg/hr infusion
Pediatric Dosing
Specialist endocrinologist supervision
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| eGFR > 50 | No adjustment |
| eGFR 10-50 | Reduce dose by 25% |
| eGFR < 10 | Reduce dose by 50% |
Pregnancy & Lactation
Pregnancy: Category B
Drug of choice for diabetes in pregnancy. Insulin requirements increase in 2nd-3rd trimester.
Lactation: Safe
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Beta-blockers | Mask hypoglycemia symptoms | Moderate |
| Steroids, thiazides, atypical antipsychotics | Hyperglycemia — may need dose increase | Moderate |
| Alcohol | Hypoglycemia (delayed) | Major |
| ACEi, fibrates, MAOIs | Enhanced hypoglycemia | Moderate |
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Side Effects
Common
- Hypoglycemia
- Weight gain
- Lipohypertrophy/atrophy at injection sites
- Local allergic reaction
Serious / Discontinue If
- Severe hypoglycemia (loss of consciousness, seizure, death)
- DKA if doses missed
- Severe allergic reaction (rare)
Contraindications
- Hypoglycemia
- Hypersensitivity to specific insulin product
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Actrapid 100 IU/mL | Novo Nordisk | 10 mL ₹140 |
| Mixtard 30/70 100 IU/mL | Novo Nordisk | 10 mL ₹165 |
| Lantus (glargine) | Sanofi | 3 mL pen ₹600 |
| Huminsulin R/N | Eli Lilly | 10 mL ₹145 |
Monitoring Required
- Fingerstick glucose 4× daily on initiation
- HbA1c every 3 months
- Weight, injection sites
Patient Counseling Points
- Rotate injection sites
- Always carry glucose tablets/sweets for hypos
- Recognize hypo symptoms (sweating, tremor, hunger, confusion)
- Refrigerate unopened vials; in-use vial OK at room temp 28 days
- Do not skip meals
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References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- Specialty society guidelines (RSSDI/CSI/IAP)