Regular insulin

Regular insulin, also known as neutral insulin and soluble insulin, is a type of short-acting medical insulin.[2] It is used to treat type 1 diabetes, type 2 diabetes, 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 it typically lasts 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), Toronto insulin
AHFS/Drugs.comMonograph
MedlinePlusa682611
License data
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
UNII

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.[6] In 2017, it was the 73rd most commonly prescribed medication in the United States, with more than ten million prescriptions.[7][8] Versions are also available mixed with longer-acting versions of insulin, such as NPH insulin.[2] In 2019, the combination of human insulin with insulin isophane was the 209th most commonly prescribed medication in the United States, with more than 2 million prescriptions.[9][10]

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 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:[11]

  • 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". 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. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  7. "The Top 300 of 2020". ClinCalc. Retrieved 11 April 2020.
  8. "Insulin Human - Drug Usage Statistics". ClinCalc. Retrieved 11 April 2020.
  9. "The Top 300 of 2019". ClinCalc. Retrieved 16 October 2021.
  10. "Insulin Human; Insulin Isophane Human - Drug Usage Statistics". ClinCalc. Retrieved 16 October 2021.
  11. "Human Insulin - Types, Production, Action, History". Retrieved 17 November 2017.
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