Regular insulin
HUMULIN R
What it isShort-acting insulin-receptor agonist; mealtime diabetes treatment, DKA infusion, and hyperkalemia.
Why this oneIt is the standard insulin for intravenous treatment of diabetic ketoacidosis and hyperkalemia.
What limits itIts slower subcutaneous onset requires meal planning that rapid analogues avoid. Hypoglycemia is the limiting toxicity.
FDA-approved for
- diabetes (~1982)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Diabetes mellitus — glycemic control | adult | Individualized; SC inj ~30 min before meals | Individualized to metabolic needs, glucose monitoring, and glycemic goal | Individualized |
| Diabetes mellitus — glycemic control | pediatric | Individualized; SC inj ~30 min before meals | Individualized with frequent glucose monitoring | Individualized |
Renal Not studied; increased hypoglycemia risk — may require more frequent dose adjustment and glucose monitoring
Hepatic Not studied; increased hypoglycemia risk — may require more frequent dose adjustment and glucose monitoring
Increase glucose-monitoring frequency during any insulin regimen change
Instructions
- Inject SC ~30 min before meals into thigh, upper arm, abdomen, or buttocks; rotate sites (lipodystrophy/cutaneous amyloidosis risk); do not inject into affected areas
- SC regimens generally combined with an intermediate- or long-acting insulin
- IV only under medical supervision: 0.1-1 unit/mL in 0.9% NaCl; monitor glucose and potassium
- Do not mix with insulin preparations other than Humulin N
- Inspect before use: must be clear and colorless
- Dose adjustments may be needed with changes in activity, meal pattern, renal/hepatic function, or acute illness
Available strengths
- inj 1, 100, 500 [iu]/ml
- powder 4, 8, 12 [arb'u]/1
Contraindications
- During episodes of hypoglycemia
Cautions
- Never share needles or syringes (blood-borne pathogen risk)
- Regimen changes (strength, manufacturer, type, injection site/method) can cause hypo- or hyperglycemia — change under close supervision with increased glucose monitoring
- Hypoglycemia — most common adverse reaction; may be life-threatening; impairs driving/machine use
- Medication errors — accidental mix-ups between insulin products; check label before injection
- Hypersensitivity — severe generalized allergy incl. anaphylaxis can occur
- Hypokalemia — may be life-threatening; monitor potassium in at-risk patients (esp. IV use)
- Fluid retention and heart failure with concomitant thiazolidinediones — observe; consider TZD dose reduction/discontinuation
Adverse reactions
- Hypoglycemia
- Allergic reactions
- Injection site reactions
- Lipodystrophy
- Localized cutaneous amyloidosis
- Weight gain
- Peripheral edema
- Pruritus
- Rash
Pregnancy Decades of data show no association with major birth defects/miscarriage; poorly controlled diabetes itself carries maternal/fetal risk
Lactation Transferred into human milk; no adverse reactions reported in breastfed infants; weigh benefits
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 1 [iu]/ml | inj | per unit | — | not offered | |
| 100 [iu]/ml | inj | per unit | — | $4.63/mL | not offered |
| 500 [iu]/ml | inj | per unit | — | $91.61/mL | not offered |
Generic entryLong generic
NO BOXED WARNINGS
Principal riskHypoglycemia
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityHypoglycemia can rapidly cause seizures, coma or death; dosing and meal mismatches are the principal hazard.